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Effectiveness Over Efficiency: Underestimating the Primary Care Physician Shortage

Phillips, Robert L. Jr MD, MSPH*; Bazemore, Andrew M. MD, MPH; Peterson, Lars E. MD, PhD

doi: 10.1097/MLR.0000000000000047

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.

*American Board of Family Medicine

Robert Graham Center, Washington, DC

American Board of Family Medicine, Lexington, KY

R.L.P. and A.M.B. have previously been supported by the US Agency for Healthcare Research and Quality, the Health Resources and Services Administration, and are currently supported by the Josiah Macy Jr Foundation to do health workforce research.

The authors declare no conflict of interest.

Reprints: Robert L. Phillips, Jr, MD, MSPH, American Board of Family Medicine; 1133 Connecticut Ave NW, Suite 1100, Washington, DC 20036. E-mail:

© 2014 by Lippincott Williams & Wilkins.