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Microtrends Healthcare
Patient Behavior · · accelerating

Gen Z is building healthcare habits that don't include a primary care physician

Only 37% of adults aged 18-27 consulted a primary care physician in the past year, and 51% relied on urgent care or the emergency department for most of their health needs. This generation is forming its initial healthcare habits around async telehealth, social media self-diagnosis, and on-demand platforms, with no traditional primary care physician (PCP) at the center.

Evidence

McKinsey's 2024 Consumer Health Insights survey found only 66% of Gen Z has a PCP, the lowest of any generation. Aflac's 2025 Wellness Matters survey (n=2,000) found 51% of Gen Z relied on urgent care or the ED for most health needs. PYMNTS Intelligence (April 2025, n=2,021) found 30% of Gen Z had their latest visit remotely. LifeStance Health (Feb 2025, n=1,110) found 50% of Gen Z self-diagnosed a mental health condition based on social media content.

Counter-signal

Regulatory scrutiny around async prescribing practices is tightening, particularly for controlled substances and mental health medications. Insurers may reintroduce PCP gatekeeping for specialist referrals, which would push younger patients back toward traditional care relationships. Chronic and complex conditions still require continuity that async models are not equipped to deliver.

If this continues

If this pattern holds, primary care practices that depend on younger, healthier patients to cross-subsidize older panels face a financial viability crisis. The family medicine residency fill rate has already dropped to 85% (NRMP 2025), and fewer than 1 in 4 new physicians choose primary care (Milbank 2025). Downstream chronic disease management could suffer as an entire generation ages without longitudinal care relationships.

Time horizon: 6-12 months to inflection

Why this matters

For previous generations, getting a primary care physician (PCP) was a default. Your parents set it up, your insurer nudged you toward one, and your employer health plan assumed you had one. Gen Z is the first generation where that default doesn’t hold.

Only 66% of Gen Z reports having a PCP at all, according to McKinsey’s 2024 Consumer Health Insights survey. Among Gen Z men, the Cleveland Clinic found that 37% have no established primary care provider. That figure is 27% for Millennials, 17% for Gen X, and 7% for Boomers.

This isn’t about access barriers. It’s about preference. Gen Z is choosing async telehealth, urgent care walk-ins, and social media self-diagnosis over scheduled PCP visits. They’re building healthcare habits from scratch, and those habits don’t include a traditional doctor-patient relationship.

37%Consulted PCP last year
51%Used urgent care or ED instead
50%Self-diagnosed via social media
$40-90Async visit vs $176 PCP

The data

Where Gen Z goes instead

Aflac’s 2025 Wellness Matters survey (n=2,000 employed adults) found that 51% of Gen Z and 54% of Millennials relied on urgent care or the emergency department for most of their health needs. Only 37% of Gen Z consulted a PCP about a health concern in the past year, compared to 61% of Boomers.

PYMNTS Intelligence (April 2025, n=2,021) found that 30% of Gen Z had their most recent healthcare visit remotely. Gen Z uses telehealth for urgent care at 27%, nearly double any older generation. For mental health, Gen Z leads at 22%.

The generational gap is stark. The pattern isn’t “Gen Z uses telehealth more.” The pattern is that Gen Z is replacing the PCP entirely with a mix of on-demand channels: async text consults for quick questions, urgent care for acute needs, and the emergency department as a safety net.

The economics are driving the behavior

The cost structure makes the choice rational. An async telehealth visit runs $40 to $90 out of pocket. A PCP office visit averages $176 without insurance. An emergency department visit starts at $1,734.

For the 14.3% of 19-25 year-olds who are uninsured (the highest uninsured rate of any age group, per the Census Bureau), the price transparency of flat-fee async platforms is a major draw. Even for insured Gen Z, the friction of scheduling, traveling, and waiting for a PCP appointment makes async platforms more appealing than a system built around 15-minute office visits booked weeks in advance.

Platform pricing reinforces this. K Health offers a primary care subscription for $49 per month. Amazon One Medical charges $29 for messaging or $49 for video. GoodRx starts at $19 per visit. These prices are listed upfront on the platform websites, with no surprise bills and no insurance coding confusion.

The social media self-diagnosis loop

LifeStance Health’s 2025 survey (n=1,110) found that 50% of Gen Z has self-diagnosed a mental health condition based on social media content, compared to 38% of Millennials and 29% overall. More than half of Gen Z (55%) has sought mental health advice on social media platforms.

One in three Gen Z adults uses TikTok as their main source of health and wellness advice, according to Healthline. And 33% have let a content creator with no medical training influence a personal health decision.

The concerning number: 24% of those who self-diagnosed on social media rarely or never follow up with a clinician. They diagnose on TikTok, treat with over-the-counter solutions or lifestyle changes, and never enter the clinical system at all.

The supply side is collapsing too

This isn’t only a demand-side shift. The supply of primary care physicians is shrinking at the same time.

The National Resident Matching Program (NRMP) reported that the family medicine residency fill rate dropped to 85% in 2025, down from 92.7% in 2018. The Milbank Memorial Fund’s 2025 Primary Care Scorecard found that fewer than 1 in 4 new physicians (24.4%) enter primary care, the lowest rate in a decade. Primary care reimbursement averages $259 per visit, compared to $1,092 for gastroenterology.

The projected PCP shortage reaches 68,020 by 2036. At the same time, a generation of potential patients is opting out of primary care entirely. The demand is shrinking and the supply is shrinking. Both curves point in the same direction.

What to watch next

  • Whether CMS or commercial payers create async-specific primary care attribution models that count digital interactions toward quality measures and risk adjustment
  • How the ACA enhanced subsidy expiration affects Gen Z insurance coverage. The Urban Institute projects 4.8 million more uninsured in 2026, disproportionately young adults aged 19-34.
  • Whether any async platform begins offering longitudinal care bundles that approximate PCP relationships without the traditional model. Amazon One Medical’s membership model is the closest current example.
  • State telehealth payment parity laws. Only 23 states require parity as of November 2025. States without parity create barriers to sustainable async care business models.
  • The mental health pipeline specifically. Gen Z uses telehealth for mental health at nearly 4x the rate of Boomers. If platforms like Cerebral and BetterHelp face regulatory tightening, that channel could contract sharply.

Sources

All signals