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            Published On January 27, 2020

            CLINICAL CARE

            The Changing Landscape of Primary Care

            Peter L. Slavin and Timothy G. Ferris discuss a shortage of primary care physicians and how to address the problem.

            The Writer John Steinbeck said that his ideal doctor was “a friend with special knowledge.” The primary care physician who could form that kind of sustaining, lifelong bond was once a mainstay of American life. Increasingly, however, that is changing. Now only about half of people between 18 and 30 have a personal physician at all, and that number is bound to get smaller.

            The changing landscape of primary care is the result of several factors, some of which are laid out in our article “The Primary Problem.” More and more people today, whether motivated by convenience or economic concerns, choose to receive their care à la carte at retail health clinics. And for some individuals, sadly, it’s not even a choice, as many areas—both rural and urban—face a shortage of primary care physicians.

            Adding to the problem, fewer physicians are going into primary care. Those who do take on a growing list of critical tasks—not only addressing patients’ physical ailments but also screening for mental health problems and discreetly asking about conditions at home while racing to document all of these factors in electronic health records. For many doctors, patient rosters are growing while time spent with each patient is shrinking.

            It is widely recognized that regular primary care can improve health, save lives and make care more cost-effective. Indeed, primary care represents the foundation of trusting and effective relationships in medicine that not only support and foster good health, but also prevent disease and diagnose problems at the earliest possible time. And primary care is not only important to individual patients, but also to the larger community. Academic medical centers like Massachusetts General Hospital bear a certain responsibility to work collaboratively with communities to improve health care and health access, with primary care as a major focus. Mass General Community Health Associates, for instance, delivers comprehensive primary and preventive community health services to underserved populations around Boston. And our Crimson Care Collaborative enables medical students, in conjunction with faculty, to provide care to local patients who don’t have a primary care doctor.

            As the story notes, models for primary care are being reinvented around the country. We are proud to be part of that process, through the efforts of the John D. Stoeckle Center for Primary Care Innovation and other initiatives throughout this institution. The bonds that primary care physicians create—and the high-quality care that they bring to their patients—are too precious and too critical to let erode.

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