Can Primary Care Recover Patient-Centered Medicine?

Introduction

First, I would like to say a word of thanks to ­Marieke VanSchie for her kind invitation to speak at this meeting. I wish also to bring all of you greet­ings from your Balint colleagues in the Unit­ed States. These are interesting and difficult times for many of our nations and our world, as you are certainly aware. I’d like to bring you today a view of our situation in primary care in the US.

Primary care, or more specifically Family Medicine, known to the rest of the world as General Practice, is also in many ways under critical stress in the US. The US spends more per person ($ 6401 in 2007) on health care than any other country, yet has mortality and overall health statistics that trail most Organization for Economic Co-operation and Development (OECD) nations [1]. In this context primary care is especially stressed as dollars in our quasi free-market system flow toward the most highly technical and procedur­ally oriented specialties. As a result, primary care has extreme difficulty filling its ranks with new medical school graduates, showing the lowest fill rate with US graduates in 2007 (42.1 %) [2], and ­rates of visits to family doctors are on the steady decline, comprising 24 % of total outpatient visits from 2000–2003 [3].

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