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Supplement: The Future of Primary Care |

Primary Care in a New Era: Disillusion and Dissolution?

Lewis G. Sandy, MD; and Steven A. Schroeder, MD
[+] Article and Author Information

From The Robert Wood Johnson Foundation, Princeton, New Jersey; and the University of California, San Francisco, San Francisco, California.


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, lsandy@rwjf.org.

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.


Ann Intern Med. 2003;138(3):262-267. doi:10.7326/0003-4819-138-3-200302040-00035
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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.

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Figure 1.
Interest in generalist specialties among graduating medical students between 1984 and 2000.6

Specialty certification data are not available for 1990. Data obtained from reference .

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Figure 2.
Mean annual physician net income (in real dollars) after expenses but before taxes from 1981 to 1998.9

Data obtained from reference . Ob/Gyn = obstetrics/gynecology.

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Figure 3.
Number of nonphysician clinical graduates between 1992 and 2001.11

The solid line represents nurse practitioners; the dotted line represents physician assistants. The asterisks represent projections. Data obtained from reference .

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