Primary Care in the United States — The Best of Times, the Worst of Times

Abstract

Until relatively recently, primary care was a neglected facet of the modern U.S. health care system, obscured by the shadows of the citadels of specialty medicine. These lofty icons of American culture were richly furnished with the latest technology that an affluent society could afford, that a public entranced by biomedicine could desire, and that imaginative, well-intentioned physicians could devise. Between 1950 and 1990, the number of specialists per capita tripled in the United States, while the supply of primary care physicians declined.¹ The humble general practitioner in fraying tweeds became a second-class citizen. Subspecialists such as invasive cardiologists, slipping . . .