Lewis G. Sandy, MD; Steven A. Schroeder, MD
Acknowledgments: The authors thank Kelly A. Hunt, researcher, and Jessica K. Siehl, research assistant at The Robert Wood Johnson Foundation, Princeton, New Jersey, for their research assistance.
Requests for Single Reprints: Lewis G. Sandy, MD, The Robert Wood Johnson Foundation, Route One and College Road East, PO Box 2316, Princeton, NJ 08543-2316; e-mail, email@example.com.
Current Author Addresses: Dr. Sandy: The Robert Wood Johnson Foundation, Route One and College Road East, PO Box 2316, Princeton, NJ 08543-2316.
Dr. Schroeder: Department of Medicine, University of California, San Francisco, 3333 California Avenue, Suite 430, San Francisco, CA 94118.
Sandy LG, Schroeder SA. Primary Care in a New Era: Disillusion and Dissolution?. Ann Intern Med. 2003;138:262-267. doi: 10.7326/0003-4819-138-3-200302040-00035
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Published: Ann Intern Med. 2003;138(3):262-267.
For decades, health policy experts have bemoaned the beleaguered status of primary care. Rather than building our health care system based on “provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing sustained partnerships with patients, and practicing in the context of family and community,” (1) our health care system continues to emphasize technologically oriented specialty care.
Although this contrast is unremarkable, given the long-standing pro-specialty biases in our medical payment and education systems (2, 3), what is perhaps more surprising is that primary care seems more precarious than ever, even as forces thought to promote it continue to strengthen. Managed care, with its emphasis on cost-effective care for populations, was envisioned by many as a major stimulus to promote primary care. Medical school curricula have evolved to place greater emphasis on early exposures to patients, longitudinal clinical experiences, and clinical clerkships with community-based physicians, all of which are thought to increase interest in primary care.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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