Affordable care access tops physicians’ concerns

When access becomes a clinical risk

Clinicians often notice subtle shifts long before they show up clearly in the data. They learn to read the room — changes in expression and pauses in conversation. In recent years, one of those moments has become increasingly familiar: the pause before a patient agrees to a prescription when cost enters the conversation, and the quiet recalculation that follows.

Clinicians are trained to look for patterns over time. A single abnormal lab value may prompt attention, but it is the trend line that tells us whether a patient is truly at risk. That same pattern recognition applies beyond lab values.

Over the past several years, those moments of hesitation have become more frequent. Taken together, they point to a diagnosis we can no longer overlook: access to care is eroding — not suddenly, but steadily.

Through ongoing research at the athenaInstitute, including our 2026 Physician Sentiment Survey, 52% of physicians and practice leaders identify access to affordable healthcare as the single most urgent issue facing the system, up sharply from 44% in 2025 and 38% in 2024.¹ What matters most is not just the percentage change, but what sits behind it. Clinicians are seeing longer wait times, more missed appointments driven by cost, and harder conversations about whether patients can realistically follow through on recommended care. Those pressures now shape the clinical judgment clinicians bring to each encounter.

A story from the screen that mirrors reality

The season premiere of The Pitt captures this tension in a way that will feel familiar to many clinicians. An emergency department patient with a visibly injured arm pushes back on recommended imaging, calling the charges “unnecessary” and insisting he will heal on his own — even as clinicians worry he may also have sustained a head injury.²

It is a fictional moment, but clinicians recognize the conversation immediately — patients trying to protect themselves from financial risk, even when that choice introduces real clinical risk.

Similar exchanges unfold every day in exam rooms and emergency departments across the country. They reflect patients doing their best to navigate uncertainty, and clinicians carrying the weight of knowing what care should happen, even when circumstances make it harder to deliver.

Affordability is not episodic — it is cumulative

A recent longitudinal study published in JAMA Internal Medicine reinforces what clinicians have sensed for years. When affordability is measured over time rather than as a single-year snapshot, the scale of the problem becomes far more apparent.

Over a four-year period, nearly one in four patients experienced difficulty affording medical care or skipped care altogether. Almost 10% faced what researchers defined as catastrophic medical cost burdens, and more than a quarter delayed or avoided care because of cost, often after having already experienced financial strain from prior encounters with the healthcare system.³

These burdens accumulate. Patients who have struggled to afford care in the past are more likely to hesitate later — even when symptoms worsen or new concerns emerge. This pattern is more common among people with lower incomes, unstable insurance coverage, prior hospitalizations, and chronic disease — precisely the patients clinicians work hardest to keep engaged in care. For clinicians, that history matters. It affects how much reassurance is needed, how often follow-up is required, and how fragile adherence can become.

Clinician shortages and the shrinking independent practice

Affordability pressures are colliding with a care delivery system under strain. Clinician shortages persist, and the steady decline of independent practices continues to reshape access, particularly in primary care and rural communities.

Since 2012, the share of physicians working in independent practices has fallen by roughly 18%, with further decline between 2022 and 2024.⁴ According to our 2026 Physician Sentiment Survey, 89% of respondents overall — including 88% of practices with five or fewer physicians — said staying independent has become harder. Many clinicians cite unsustainable administrative burden, reimbursement pressure, and staffing challenges as reasons for selling, consolidating, or leaving practice altogether.⁵

For patients, consolidation often translates to fewer entry points into care and longer wait times for appointments. For clinicians, those access challenges often mean meeting patients later in the course of a disease, when intervention is harder, conversations are heavier, and outcomes are less predictable.

Coverage instability is widening gaps clinicians already see

The sharp rise in physicians naming access as the top concern reflects real changes in coverage stability and affordability that intensified entering 2026.

While the national uninsured rate remained near historic lows through 2024, that stability was supported by temporary policies that are no longer in place. From the frontlines, the impact looks less like a single coverage loss and more like ongoing uncertainty — patients delaying visits, declining diagnostics, or disengaging altogether because the financial risk feels unpredictable or unmanageable. That lived reality helps explain why more than half of physicians now rank access above every other system-level concern.

One of the most sobering findings from the JAMA study is that more than half of individuals who died during the study period had experienced healthcare cost burdens in the years preceding their death. For clinicians, this reinforces a difficult truth. Access is not an abstract policy issue — it functions as a clinical risk factor.

When patients delay care, the consequences rarely remain contained to a single visit or condition. Preventive screenings are missed. Chronic conditions progress without consistent management. Acute issues become emergencies. Over time, those delays translate into more complex care, higher costs, and greater strain across the healthcare system. Clinicians often recognize this pattern first, because they are navigating that uncertainty with patients in real time.

Access demands shared accountability at the point of care

No single stakeholder created this problem, and no single lever will resolve it. Access is shaped by affordability, capacity, workflow design, and trust — and those forces converge in the exam room, where clinicians and patients must act with imperfect information.

Clinicians are operating at the limits of their time and emotional bandwidth. Patients are navigating a system that often asks them to choose between financial stability and medical care. Payers, providers, and technology partners all influence whether access feels navigable or fragmented when patients need care most.

Continuing to study access — and its clinical consequences

Healthcare IT systems offer a powerful lens into how access to care is changing. Through ongoing research at the athenaInstitute, we are examining deidentified network data, qualitative interviews, and computational analysis to better understand where access challenges are emerging — and what that means for patient outcomes and clinical practice.

The health of patients, clinicians, practices, and payers is deeply interconnected, and when access breaks down in one place — a missed visit, a delayed test, an unaffordable prescription — the effects compound elsewhere.

While our Physician Sentiment Survey highlights growing concern among physicians about access to care, and longitudinal research confirms that affordability barriers diminish health over time, continued study can help clarify how access challenges are evolving. For clinicians, the signal is already clear. The hesitation they see today is not incidental — it is an early warning that access to affordable healthcare itself has become part of the clinical risk profile they now manage.