BMJ  2005;331:1400-1402 (10 December), doi:10.1136/bmj.331.7529.1400

Education and debate

Primary care in the United States: problems and possibilities

¹ Robert Graham Center, 1350 Connecticut Ave NW, Washington DC, 20036 USA bphillips@aafp.org

The UK government is hoping to improve primary care through competition. But US experience shows the difficulties created by a system reliant on market forces

The first 150 words of the full text of this article appear below.

Introduction

The United States has never had a more robust primary care workforce, but dysfunctional financing schemes and inability to compete for the hearts and minds of the next generation of young doctors threaten its future. Many of the problems are a direct result of the market approach to health care. Innovation is needed in how primary care functions are financed, protected, organised, and taught in order to identify options for a stable and robust health system built on primary care.

The US undervalues family doctors

 

US primary care

Primary medical care in the US is delivered by three specialties: family medicine, general internal medicine, and general paediatrics. The specialties have a combined workforce of 222 000 doctors, whose primary function is to direct patient care. There is at least one doctor for every 1321 people in the US (table).¹ In addition, more than 100 000 nurse practitioners and physician assistants work . . . [Full text of this article]

Problems facing primary care

Costs of neglecting primary care

Possible solutions

Pay for care differently
Separate fund pools
Rallying primary care doctors and providers

Hearts and minds

Time for experimentation

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