A century of primary care transformation, conclusion: What the future holds

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Click here to read Chapter 5: The vanishing independent physician

Primary care, like health care generally, has undergone enormous change in the hundred years since Medical Economics published its first issue. But what of the future? Although difficult to predict, it’s highly likely that primary care doctors — especially those in independent practice — will continue to face strong headwinds in the coming years. As noted earlier, primary care doctors earn considerably less than specialists. They also experience higher rates of burnout, a problem exacerbated by the COVID-19 pandemic, while facing growing competition from retail clinics. Little wonder, then that the U.S. faces an estimated shortage of between 21,000 and 55,000 primary care doctors by 2033.

To medical historian Frey, these problems are the result of underlying policy choices. “The U.S. has never invested adequately in promoting or supporting family physicians and generalists,” he says. “Our belief in the ‘free market’ as the solution to every problem has failed where health care is concerned.”

Others see brighter days ahead for primary care. They point to the growing popularity of arrangements such as accountable care organizations and clinically integrated networks that allow small practices to band together to share resources and expertise and take advantage of the financial incentives available through value-based payment models.As a 2016 article in Annals of Family Medicine put it, these entities enable practices to “profit from economies of scale without sacrificing the benefits of being small.”

Lucarelli sees cause for hope in technological developments. Remote patient monitoring devices enable doctors to collect and monitor real-time data on patients’ health to address problems at an early stage.

And genomic medicine, she says, has been used in oncology for years, but now primary care doctors are using it to develop remedies tailored to individual patients. “We are starting to refer to genomic data when choosing treatments for conditions like depression and heart disease, and vaccines and biologic therapeutics can be made to order for specific diseases and individual patients,” she says.

Such developments give Lucarelli hope that doctors can continue doing what they love: getting to know their patients, understanding their health needs and addressing those needs as best they can.

“I attended medical school with the specific goal of becoming a family doctor,” she says. “After 25 satisfying years of practice in Randolph, I still feel that the best care for patients is primary care delivered in the community where they live.”

Click here to read an interview with Melissa Lucarelli, M.D., about holding onto the primary care dream

A century of primary care transformation: Table of contents

• Introduction
• Chapter 1: 1923 vs. 2023: A doctor's daily life
• Chapter 2: Rise of the specialists
• Chapter 3: How insurance changed everything
• Chapter 4: The malpractice threat
• Chapter 5: The vanishing independent physician
• Conclusion: What the future holds
• 'Holding onto the primary care dream:' An interview with Melissa Lucarelli, M.D.