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THE FUTURE OF PRIMARY CARE Previous Volume 359:2087-2090 November 13, 2008 Number 20 Next

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The editors asked several experts to share their perspectives on the crisis in U.S. primary care. Their articles, which address this crisis from six different angles, follow. We also brought the five U.S. contributors together for a roundtable discussion of the problems and potential solutions for training, practice, compensation, and systemic change. A video of the discussion and reader comments can be seen at www.nejm.org.

At the heart of the decline in primary care lie dysfunctional payment systems, from the "gatekeeper" schemes of the 1990s to the current volume-driven, fee-for-service approaches. These have proved antithetical to the goals of primary . . . [Full Text of this Article]

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Dr. Goroll is a professor of medicine at Harvard Medical School and Massachusetts General Hospital, both in Boston, and chair of the Massachusetts Coalition for Primary Care Reform.

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