Interest in improving health care outcomes requires increasing the effectiveness of primary care. Focus on effectiveness is leading many innovative health systems to shrink primary care patient panels to strengthen relationships, and to enhance primary care teams to increase comprehensiveness. Such strategies would make primary care shortages worse than predicted, and are compounded by substantial declines in clinicians of all types choosing primary care careers. Severe primary care shortages beg for efficiency, but emphasizing efficiency at the expense of effectiveness threatens achieving the Triple Aim for health care. We cannot avoid the hard work of repairing our clinician training pipeline for primary care.