Gordon Moore, MD, MPH; Jonathan Showstack, PhD, MPH
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.
Primary care is in crisis. Despite its proud history and theoretical advantages, the field has failed to hold its own among medical specialties. While the rest of medicine promises technology and sophistication, the basic model of primary care has changed little over the past half-century. Why has the transition from general practice to today's primary care been so difficult? Many of the causes of this struggle may lie within primary care itself, ranging from failure to articulate to the public (and insurers and policymakers) what value it, and it alone, can offer, to taking on an ever-broadening set of roles and responsibilities while all too often falling short of its promises. Perhaps most important, in the emerging health care system, the lack of a discrete definition of primary care has allowed managed care organizations and payers, among others, to define the role of primary care to suit their own interests.
In response to a changing marketplace, political uncertainty, and shifting consumer expectations, primary care will need to reconstruct itself. The reconstruction will not be easy. Nevertheless, a process should begin that moves the field in the right direction. Building on its unique abilities, primary care can emerge as a redefined product that is attractive to patients, payers, and primary care practitioners alike.
Moore G, Showstack J. Primary Care Medicine in Crisis: Toward Reconstruction and Renewal. Ann Intern Med. ;138:244–247. doi: 10.7326/0003-4819-138-3-200302040-00032
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Published: Ann Intern Med. 2003;138(3):244-247.
Healthcare Delivery and Policy, Hospital Medicine.
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