Solving the primary care crisis without more doctors: Can we do it?

Estimates are that primary care will have a shortage of 40,000 physicians by 2020. But do all primary care functions require doctors? Most clinical preventive services can be handled by medical assistants working as panel managers. The most time-consuming chronic care involves assisting patients to gain the knowledge, skills, and confidence to self-manage their disease, a job well performed by non-professional health coaches or patients trained as peer health coaches. Patients themselves, aided by new technologies, are afforded an array of self-care opportunities that could replace the need for many primary care encounters. Finally, true prevention takes place in the community and public health spheres which have never successfully integrated themselves with primary care. While the barriers to this new way of thinking are formidable, it's time to get started.