Primary Care: Too Important to Fail

The U.S. primary care system is struggling. Increasing demands and expectations, coupled with diminishing economic margins, have created a challenging work environment. Analysts warn of increasing attrition in the current workforce and diminishing recruitment of new physicians to primary care (1).

As the new Obama administration arrives in Washington, policy prescriptions for health care reform are being dispensed from every side. Many of them emphasize the importance of revitalizing the nation's primary care system. As a foundational element of the health care system, primary care is needed to improve quality, increase access, and contain costs (2). These are the principal goals of health care reform.

A key to the sustainability of primary care will be payment reform coupled with innovative quality measures and value-based purchasing. Although challenging, payment reform seems possible within the larger context of national health care reform, particularly because Congress must act on Medicare physician reimbursement this year. Payment reform alone, however critical, won't revitalize primary care. Payment reform is a maintenance medication and primary care is in need of an immediate rescue. The U.S. primary care system needs a stimulus package that, such as plans for an economic stimulus package, focuses on infrastructure.

As the article by Pham and colleagues (3) in this issue suggests, a primary care infrastructure investment must address the substantial challenges of care coordination in primary care. By using a survey of more than 2000 primary care physicians who participated in the …