Primary Care and “the Vision Thing”

Published January 17, 2026

Primary care is the ugly duckling of the American healthcare system. Medical school graduates figure why bother becoming a general practitioner and earning $242,000 a year when they could specialize in something like gastroenterology and make $426,000 a year?

Medicare in particular reinforces these incentives by reimbursing specialists at substantially higher rates than primary care physicians, in part, because it places little intrinsic value at keeping people healthy.

Even the American people are increasingly bypassing primary care. In some parts of the country, it is hard to connect with a front-line medical provider. Instead, emergency room clinicians are now having to pick up the slack.

Meanwhile, the life expectancy of the American people is lower now than what it was in 2019. A Native American male can only expect to live 66.7 years. 

In short, primary care needs a facelift. It needs a vision that all Americans can latch on to—plus, one that works within the realities of our country as it is.

In 2021, The National Academies, a non-profit organization established by Congress to advise the nation on science and technology, put out a consensus report recommending that we think of high-quality primary care healthcare in terms of relationships as opposed to a series of transactions. 

The National Academies envision collaborative teams caring for the majority of an individual’s health and wellness needs at diverse settings (i.e.—telehealth, schools, the workplace) while at the same time, maintaining good relations with patients and their families and communities. 

Primary care teamwork should be patient-centered, starting with the core team. This team includes doctors, nurses and medical assistants who work collaboratively with patients, their families, and informal caregivers (maybe a neighbor). 

More peripheral from the patient is the extended health team, which might include a dentist, a pharmacist, a behavioral health specialist, a community health worker, and a nutritionist, any of whom might be called upon by the core team for assistance when needed. And at the perimeter is the extended community care team. Members of this team could come from elementary schools, churches, and food banks that serve the local public. 

Looking under the hood, a nurse care manager could call a person living with Type 2 Diabetes and ask them how they are doing and whether they are taking their medication. Not only does a friendly reminder strengthen the patient/clinician relationship, but being proactive in this manner leads to lower emergency department visits and hospitalizations—and less need for a specialist. 

Community health workers, for their part, are oftentimes good souls with lived experiences from a similar social and economic background as the patient. They help establish trust in the system and can connect patients to food and housing assistance programs in addition to providing patients with nonjudgmental support.  

In order for primary care teams to build a trusting relationship with their communities, they need a stable workforce. Coming up with skilled personnel is more difficult in primary care shortage areas where more than 75 million Americans live, which includes rural areas and urban neighborhoods with high Black, Brown, and Indigenous populations. For this reason, the National Academies recommends that we train primary care teams where people live and work. 

The National Academies estimates that one primary care team would need 37 full-time team members to properly care for a population of 10,000 adults. That number would include six general practitioners. By comparison, we now have 8.6 primary care physicians for every 10,000 people. The National Academies implies that if all health care professionals “work at the top of their licence,” they can relieve the primary care physicians of some of their responsibilities.

Building primary care teams from the bottom-up that cultivate positive relations between a community and its care providers takes time. At the very least, primary care physicians will begin earning relatively more while specialists will begin earning relatively less.

Studies show that when we invest in primary care, people live longer. Those studies are reason enough to dust off The National Academies 2021 report.