In a recent five-part series in the New England Journal of Medicine on the future of primary care, the author asks:

"Has the long-term general doctor become obsolete? In other words, should the dying primary care system be saved?"

The question itself is unsettling. Could a health system function effectively without primary care? What happens to patients when no one is responsible for truly caring about them and guiding them safely through the health care system? Today many, perhaps most, Americans don't have a doctor like that. But is that okay?

Research by one of the hosts, based on thousands of recorded physician–patient encounters, suggests that physicians who consider the circumstances, needs, and priorities of each patient when planning their care are uncommon.

In this episode, we introduce you to a primary care physician with his own practice in a mid-size Western city who, like many others — but far too few — provides this indispensable service to his community. He is a skilled and deeply knowledgeable clinician, a caring advocate who knows his patients well and finds the work deeply rewarding, despite the daily frustrations of insurance denials, specialists who don't return calls, and a payment system that measures almost everything except how well physicians care for people when they are sick.

There is also a major medical education challenge. What is poorly understood is that producing an excellent primary care physician is often harder than producing an excellent specialist. The work depends less on mastering technical procedures and more on integrating complex information, building long-term relationships, and making collaborative decisions under conditions of uncertainty.

Far too few graduates of U.S. medical schools and residency programs are being prepared for — or supported in — this kind of work. In a profit-driven health system that can at times be predatory, where patients are exposed to unnecessary procedures while their mental health and well-being are overlooked, the absence of accessible, high-quality primary care leaves patients vulnerable and often very alone.