US Trends in Lacking a Personal Doctor, by Educational Attainment, 2016-2023.

Abstract

Having a personal doctor is a cornerstone of primary care and is associated with improved preventive service use, chronic disease management, and patient satisfaction. Educational attainment is a key social determinant of health and access to care. We analyzed national trends in the percentage of US adults lacking a personal doctor from 2016 to 2023 using the State Health Compare tool (SHADAC) based on the Behavioral Risk Factor Surveillance System (BRFSS). Adults were classified by educational attainment: less than high school, high school graduate, some college/associate's degree, and bachelor's degree or higher. The SHADAC "no personal doctor" measure is based on self-report: respondents answering "no" to the BRFSS question "Do you have one person you think of as your personal doctor or health care provider?" were considered to lack a personal doctor. Only descriptive statistics were used; no inferential testing was performed. Nationally, the share of adults without a personal doctor declined from 21.9% in 2016 to 17.1% in 2023 (absolute change -4.8 percentage points; relative change -21.8%). Reductions occurred across all education groups, but disparities persisted. In 2023, 30.8% of adults with less than a high school diploma reported lacking a personal doctor, compared with 9.7% among those with a bachelor's degree or higher-a gap of over 21 percentage points. Improvements were largest for college-educated adults (-36.0% relative change) and smallest for those without a high school diploma (-2.9%). Despite overall improvement, large and persistent education-related disparities remain. Interventions such as care-navigation support, insurance literacy programs, and payment models that fund outreach may help address these gaps. The persistent 21-point gap highlights the ongoing challenge for equity in primary care access in the United States.