Primary care in the United States is the topic of this 2-part essay. Part 1 argues that the low percentage of national health expenditures (primary care spending) and excessively large patient panels that clinicians without a team are unable to manage are the root causes of the problems in primary care, leading to widespread burnout and poor patient access. This essay makes use of clinical and policy experience, as well as evidence summaries. Conversations with hundreds of clinicians, practice leaders, and staff members, as well as visits to dozens of practices, provide the backbone of the analysis. Compared to the average of the 22 Organization for Economic Co-operation and Development (OECD) nations, the United States spent only 7.8% of its health budget on primary care in 2016. A clinician working alone would need 17 hours per day to offer good treatment to the average US primary care panel size of roughly 2,000 patients. In addition, most medical students avoid jobs in underfunded practices with unstable work-life balance, which is connected to low primary care spending and high panel numbers. Part 2 of this essay discusses the many efforts made over the past 20 years to resolve these issues. Part 2 argues that to reinvigorate primary care, 2 fundamental shifts are required: higher funding for primary care and the formation of powerful teams that boost the capacity to care for big panels.

Source: annfammed.org/content/20/5/464