Designed to Fail? the Future of Primary Care

Primary care is widely viewed as being in crisis despite its purported central role in addressing population issues related to healthcare cost, quality, access, and equity. Despite this pivotal role, the nature of the clinical practice today has largely emerged by default. We review the evolution of clinical practice in primary care from its genesis in small practices with paper charts and telephonic patient communication to managed care, pay-for-performance, and today's era of the electronic medical record, value-based payment, and consumerism. We suggest a necessary reset of expectations that focuses on today's practice structure and the historic face-to-face patient care expectations. Only by doing so can we successfully meet the demands of patients, society, and practicing internists.

Automated summary

This article discusses the evolution of clinical practice in primary care, from traditional small practices to today's electronic medical records and value-based payment systems. It emphasizes the need to reset expectations regarding current practice structures and patient care expectations in order to meet the evolving demands of patients, society, and practicing internists.