The access gap won’t wait

The U.S. Census Bureau projects that by 2030, roughly 73 million Americans — more than 1 in 5 — will be 65 or older, as the last of the baby boomers cross into Medicare eligibility. At the same time, the Association of American Medical Colleges projects a shortage of up to 86,000 physicians by 2036, including as many as 40,000 in primary care.

The math is not complicated. But the questions it forces are.

Scaling care teams has been the response. Nurse practitioners, physician assistants, and allied health professionals are already delivering care that was once the exclusive domain of physicians — working at the top of their license, and serving as a critical means of closing the access gap. The settings and geographies where this happens are shifting just as fast. Practice authority for nurse practitioners has expanded significantly since 2010. Today, AANP lists 27 states, Washington, D.C., and two U.S. territories as full practice authority jurisdictions — roughly double the footprint at the start of the last decade.

New models like the CMS ACCESS Model — Advancing Chronic Care with Effective, Scalable Solutions — are expanding reimbursement for remote patient monitoring and technology-enabled care that falls outside traditional fee-for-service encounters, adding new layers to an already growing care team alongside clinical AI agents and direct-to-consumer diagnostics. Patients entering this era face new questions: Who — or what — will see them? What does this mean for the humans who remain in the loop? And when they need care, what does the front door of American medicine actually look like?

The stage is set

The shift away from inpatient settings has been underway for years. Medicare Payment Advisory Commission data show a sustained decline in inpatient hospital stays by FFS Medicare beneficiaries, and that trend isn't reversing. What's less appreciated is that patient preference is now pulling in the same direction with equal force.

AARP's 2024 Home and Community Preferences Survey found that 75% of adults 50 and older want to stay in their current homes as they age, and 73% want to remain in their communities. Sixty-one percent say they would prefer to receive care at home if they needed help with daily activities. That preference is stronger among adults 65 and older — exactly the population whose healthcare demand is peaking.

Care will need to flex across in-office, home-based, and virtual settings — and do so at scale.

A different kind of workforce — and a harder coordination problem

U.S. medical schools produced 21,590 MD graduates in 2025, according to the Association of American Medical Colleges — a number that has grown slowly over the past decade. Nurse practitioner programs, by contrast, graduated approximately 39,000 NPs in the 2021-2022 academic year, according to the American Association of Colleges of Nursing. The NP workforce has grown rapidly over the past decade and a half, rising from under 100,000 in 2010 to more than 461,000 today.

A peer-reviewed study in the Annals of Internal Medicine tracking Medicare claims from 2000 to 2019 found that a primary care physician's patient panel saw a median of 52 other physicians in a given year at the start of that period. By 2019, that figure had grown to 95. The average primary care physician is now theoretically coordinating care across nearly double the clinical network they were managing two decades ago.

Scale is the mechanism. Interoperability is the condition.

In a system defined by scarcity — where there are not enough clinicians to meet demand and new layers of the care team continue to stack up — collaboration becomes more practical than competition, and care delivery becomes inherently interdependent across teams, settings, and organizations.

That changes what interoperability has to do.

A physician does not need a data standard. They need to know, at the moment they are seeing a patient, what changed since the last visit — a new medication, a specialist note, an updated care plan.

Systems focused on closed networks will end up blind to the full picture of a patient — resulting not just in poor clinical outcomes, but in a less effective healthcare system overall, one that limits care delivery options precisely when they are expanding.

The issue for the provider is data overload — we already see this today. That brings us back to the need for interoperability to deliver relevance: deduplicating, synthesizing, and preparing information from across the system to reduce the cognitive burden on the clinician. AI will help interoperability significantly in this era. Frankly, we need it to.

What this means for independent medicine

Independent practices that connect into broader clinical networks — sharing infrastructure and coordinating across care teams — have a path to sustained autonomy. That local, relationship-based model remains difficult to replicate at scale; merging it with network-wide visibility is a viable path forward.

Practitioners without those tools risk being overburdened, or frustrated by being locked into a single-system view when patients are seeking care outside of it. Without that connective layer, independence becomes isolation.

Further, the physician may no longer be the first point of contact in the care journey. Companies like Amazon, Google, Anthropic, and OpenAI are actively building consumer-facing health tools that start the care journey well ahead of the provider. When the physician becomes the second stop rather than the first, it changes how organizations design access, where they invest in clinical relationships, and what it means to preserve the connection between patient and doctor when the entry point shifts upstream.

Openness to create access

The demographic wave is no longer a forecast. It has arrived at the edges of the system and is moving inward. Closing the gap in patient access requires openness to the new care teams being created.

Choosing systems that channel broader, more open care teams will enable that change. Reconsidering the design and roles of the care team will be a key decision point. Providers that answer these questions early — about the front door, about who's behind it, and about whether the rooms beyond it are actually connected — will be positioned to thrive and meet the needs of patients in this era.