COMMENTARY 21st-Century Primary Care New Physician Roles Need New Payment Models

PRIMARY CARE MEDICINE IS IN SEARCH OF REDEFINI-tion. Prevalent payment modes have underminedtraditional models and reduced workforce interestwhile some functions of primary care are emerging in new incarnations. Payers find physicians “too expen-sive ” for basic primary care services, and young physicians find their earnings expectations greater than primary care careers can offer. Understanding these market forces could lead to better understanding of required physician exper-tise within the larger framework of primary care. A more explicit definition of that expertise could lead to more ap-propriate market valuation of physician services. Fee-for-service reimbursement has undermined good pri-marycare.1Ata timewhenadvances inunderstandingsystems of care point to newmodels in which physicians ’ roles might beredefined tocontributemorevalue topatientsandto thede-livery system, financingmodels havenot yet caughtup.Many of themost important aspectsofprimarycare services, includ