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Supplement: The Future of Primary Care |

Primary Care Medicine in Crisis: Toward Reconstruction and Renewal

Gordon Moore, MD, MPH; and Jonathan Showstack, PhD, MPH
[+] Article, Author, and Disclosure Information

From Harvard Medical School/Harvard Pilgrim Health Care, Boston, Massachusetts; and University of California, San Francisco, San Francisco, California.

Acknowledgment: The authors thank Ellen Weber, MD, for her advice and suggestions.

Grant Support: By grant 039940 from the Robert Wood Johnson Foundation.

Corresponding Author: Jonathan A. Showstack, PhD, MPH, University of California, 3333 California Street, Suite 265, San Francisco, San Francisco, CA 94118-1944.

Current Author Addresses: Dr. Moore: Harvard Medical School/Harvard Pilgrim Health Care, 133 Brookline Avenue, 6th floor, Boston, MA 02215.

Dr. Showstack: University of California, 3333 California Street, Suite 265, San Francisco, CA 94118-1944.

Ann Intern Med. 2003;138(3):244-247. doi:10.7326/0003-4819-138-3-200302040-00032
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Primary care is in crisis. The behavioral and economic evidence is ubiquitous (1). Patients are voting with their feet and pocketbooks by going directly to emergency departments and specialists (23). After promoting primary care as the manager of access to specialty care, health maintenance organizations have backed off their gatekeeping strategy for such referrals. Alternative providers are an attractive and heavily used substitute for traditional providers (45). Incomes of primary care physicians have decreased, and insurance companies are stripping payment for some types of primary care services out of benefit packages (6). Primary care residencies fail to attract enough applicants, while teaching hospitals continue to withdraw much-needed support for their primary care clinics. Despite primary care's proud history and theoretical advantages, the field has failed to hold its own among medical specialties.

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