Bohler and Blumenthal begin by lauding the noble idea that everyone deserves a trusted primary care physician to navigate the complexities of our healthcare system. They then explain the various threats to primary care, including physician shortages in rural and underserved areas, as well as the fee-for-service system's preference for procedures over cognitive work and treatment over prevention. The authors clearly illustrate how the odds are stacked against primary care and how promised reforms have failed to improve the situation.
Ironically, they note that the measures physicians take to cope with these challenges have only worsened our predicament. Increasing patient volume to enhance practice finances results in physical and mental fatigue. Aligning our care with quality metrics imposes significant administrative burdens. Seeking practice support by selling to hospitals or venture capital firms leads to a loss of autonomy and the commodification of the personal and intangible relationships we maintain with our patients.
Is it any wonder, they conclude, that practicing primary care physicians are burned out? Is it surprising that medical students and residents, burdened with debt, are turning away from primary care? They have seen the writing on the wall. A career in primary care offers only “pain, burnout, financial strain, and disrespect.”
This lament perfectly summarizes the authors’ bleak assessment of the future of primary care:
“The general practitioner of revered memory knew his patients, did whatever he could to cure or ease their varied ailments, and provided continuing care… Now he is vanishing. Time has changed both him and his patients… The general practitioner leaves behind him a vacuum that organized medicine has not decided how to fill.”
Take note that this quote is not from Bohler and Blumenthal's eulogy. It’s an assessment from the 1966 Millis Report, a seminal document that laid the groundwork for the specialty of Family Medicine. That’s right, we have been talking about the demise of primary care for over sixty years.
Tasked with addressing our nation’s failure to develop a “substantial corps of well-trained primary physicians,” the Millis Report originated from the Citizens Commission on Graduate Medical Education. It identified three principal causes for this failure: loss of prestige from specialists, lack of student interest, and less attractive practice conditions. The commission acknowledged that these were daunting obstacles but concluded, “All three of these difficulties can be overcome, but heroic work will be required. It is time for a revolution, not a few patchwork adaptations.”
This historical context is crucial, as it dispels the myth of a bygone "golden age" when primary care was universally respected and effortlessly practiced. Our specialty was not born into an era of ease, but rather out of necessity and struggle. The specialty of Family Medicine was created precisely to fill the vacuum described by the Millis Report, and its very existence is testament to the heroic work of those who envisioned and built it.
Over the past sixty years, primary care has successfully addressed most of the deficiencies identified in the Millis Report. From establishing dedicated residency programs to developing team-based care models, such as the Patient-Centered Medical Home, every gain for primary care has been a hard-fought struggle. The creation of Family Medicine as a primary care specialty was revolutionary and has succeeded in bringing comprehensive, continuous, and coordinated care to millions, often in the face of systemic neglect and financial disincentives.
In 2021, the National Academies of Sciences, Engineering, and Medicine published Implementing High-Quality Primary Care, a report that reaffirmed the value of our specialty. Primary care is the only field of medicine in which a greater supply results in both lower costs and higher quality. According to the National Academies, primary care should be viewed as a common good, an essential service that sustains the American values of “life, liberty and the pursuit of happiness.”
The idea of a strong, physician-led primary care foundation is not a pipe dream. The existence of robust primary care systems in countries such as the United Kingdom, Canada, and many European nations confirms the proven effectiveness of this model. Their success shows that our struggles are not due to inherent flaws in the concept of primary care. Instead, they result from dysfunctional policy choices unique to the United States. If other nations can build workable, primary care-centered healthcare systems, why can’t we?
The challenges we face sometimes seem insurmountable. From a political regime openly hostile to public health and medical research, to a legislature working day and night to dismantle the framework of publicly funded health insurance, to a corporate business culture salivating to replace us all with artificial intelligence, the current threats to primary care are novel but hardly unprecedented. Despite their complexity, these challenges echo the historic struggles that have made us a resilient and adaptable specialty.
Therefore, now is not the time for frivolous eulogies mourning a golden age that never existed. Instead, it is time for a call to action—a time for bold and heroic efforts to realize the full potential of primary care. We must rise to the occasion, embracing innovation and advocacy to protect and advance the health of our communities. It is time, once again, for a revolution—one that reaffirms our commitment to accessible, high-quality healthcare for all.
- Forrest Bohler, David Blumenthal; A Eulogy for the Primary Care Physician. J Grad Med Educ 16 June 2025; 17 (3): 371–372.
- Millis, J. S., Wiggins, W. S., Wolfe, D., et al. (1966). The Graduate Education of Physicians: The Report of the Citizens Commission on Graduate Medical Education. American Medical Association.
- National Academies of Sciences, Engineering, and Medicine. (2021). Implementing high-quality primary care: Rebuilding the foundation of health care (L. McCauley, R. L. Phillips, Jr., M. Meisnere, & S. K. Robinson, Eds.). The National Academies Press.
This article was published in South Carolina Family Physician.