The insight struck me on my first day at my residency clinic: I realized I knew very little about this facet of medicine. The waiting area was packed, and each patient came with a diagnosis and the weight of an overstretched system. We had been trained to assess, document, and act swiftly, but not to guide, establish continuity, or see the clinic as the core of medicine. Throughout our education, genuine work felt limited to hospitals. Outpatient care seemed quieter, smaller, and dismissed as less significant, yet hindsight reveals how misguided that perspective was.
As chair of internal medicine at a clinic in Northern Georgia, the current challenge is attracting new physicians. Prospective candidates are few, often holding stereotypes of primary care as elementary, slower-paced, a haven compared to hectic wards. However, they find a rigorous field demanding emotional strength, broad clinical skills, patience, and humility. Primary care isn’t merely a fallback; it’s a vocation, though increasingly left unaddressed. Only about a quarter of medical graduates enter primary care, with many departing soon after they begin. The harsh realities of modern outpatient medicine include dwindling reimbursements, rising overhead, and relentless inboxes. It requires the greatest humanity yet offers the least reward.
Our system hinders the practice of the medicine that many of us aspired to deliver. An increasing dependence on non-physician clinicians aims to bridge growing divides, yet this transition undermines continuity and physician involvement. The concern stems not only from costs but also from the evolution of the profession when the notion of a personal doctor diminishes.
Each week, I meet patients who travel for hours because they are unable to find another internist taking new patients. They frequently question my commitment. Such inquiries reveal a conditioned expectation that their trusted physician may disappear, a situation that has become a normalized uncertainty in healthcare.
Once, primary care was the foundation of American medicine; it now risks becoming an afterthought. The AAMC predicts a physician shortfall of up to 86,000 over the next ten years, nearly half in primary care. This is not a theoretical issue. Communities deprived of primary care physicians experience increased mortality, more hospital admissions, and higher costs. Just 10 additional primary care doctors per 100,000 can extend life expectancy by over a month. These figures highlight the importance of continuity, prevention, and trust—elements unquantifiable by billing codes yet vital to a system’s healing versus mere functioning.
The dwindling numbers concern me less than the narrative we impart to future generations regarding the priorities of medicine. Training programs subtly suggest that true proving grounds are hospitals, while clinics are seen as a slowdown. Without reframing this narrative and demonstrating to young physicians that leadership, intelligence, and impact flourish in outpatient environments, we will face an irreversible shortage. Reviving the workforce becomes impossible if the call to service is diminished.
In addition to attracting more physicians, we must reshape the narrative of primary care—not as secondary, but as the truest form of medicine, where skill and presence converge, and knowing the individual matters as much as understanding their illness.
Every mentee who chooses primary care does so with one goal: connection. The revelation occurs that no algorithm can replace the quiet truth of a conversation. A focused 15-minute visit can provide healing akin to any hospital admission.
There is no single policy solution: payment reforms, training enhancements, support systems, and debt relief are all significant, but meaning is crucial. We must remind ourselves and others that primary care is not an endpoint; it is a starting point.
Observing consistently committed physicians offers a reassuring truth. They are driven not by monetary rewards or prestige but by faith in the finest version of medicine—witnessing and being present until the trust confirms that patients are not alone.
If we protect and nurture this space of doctoring, primary care will endure—not because of legislative measures or political maneuvers, but because it encapsulates something medicine cannot relinquish: the relationship between two individuals seeking wholeness together.
This often-ignored truth, steadfast yet gradually fading from sight, is undeniably worthy of restoration.