The primary care physician and health care reform.

WHATEVER FORM IT TAKES, HEALTH CARE REform will increase the number of Americans covered by health insurance. But there is concern that the legislation will not bend the cost curve—that is, will not reduce the growth of health care costs so that it more closely resembles the growth of the US gross domestic product (GDP). Currently, health care consumes about 16% of the GDP; advocates of bending the cost curve hope that in 2020 it will still consume roughly the same proportion. Increased health care coverage raises issues in addition to cost containment. Increased coverage will mean increased demand for primary care physicians. Virtually everyone would like to have a primary care physician—a trusted physician who provides comprehensive, continuous care. Many studies, including many with international comparisons, have established the benefits of primary care. However, it is increasingly difficult to convince graduates of US medical schools to choose primary care as their professional career path. Why is there such a disconnect between the demand for and supply of primary care physicians? Two reasons appear to predominate: scope of practice and salary.