The Future of Primary Care

Primary care leaders and practitioners are concerned about the future of their specialty. In this issue of Annals, they explain their concerns and offer suggestions based on discussions at a conference on the Future of Primary Care held in October 2001. In this editorial, I underscore some of the reasons for concern, point out key elements of the mission of primary care, and identify points of leverage for renewal of the field.

What is primary care? In 1978, the Institute of Medicine offered a memorable description: primary care is first contact, comprehensive, and continuing (1). A subsequent Institute of Medicine description focused on integration, access, and sustained partnerships with patients (2). Patients like this type of care and wish they got more of it. Surveys over the past 20 years consistently show that most adult Americans rely on general internists, family physicians, and general practitioners as their usual source of care (3). Surveys summarized by Safran in this issue (3) document the public's perception about primary care. Unfortunately, the picture that emerges is unflattering. The American people want a regular physician who knows their medical history and knows them as a person, but they don't think that their physicians are fulfilling this role. A helping profession that is not meeting the deepest human needs of its constituency is in trouble.

Workforce trends also paint a gloomy picture for primary care. Fewer young physicians are choosing residency training that leads to careers in primary care (4). Anecdotes about primary care physicians leaving practice are plentiful, although we lack documentation that the rate of exodus is increasing. A field is in trouble when the number of practitioners is getting smaller while the demand for services remains strong.

Moore and Showstack's article in this issue (4) documents reasons …