First things first: getting primary care right.

G IVEN THE BROAD AGENDA, HIGH EXPECtations , increasing patient complexity, growing evidence base, intensifying threats to provider work dissatisfaction , and the worsening workforce shortage of primary care physicians, there is an urgent need to fix the problems of primary care. Primary care has been marginalized, and our own professional societies have encountered numerous obstacles in advocating for the pre-eminence of primary care. First, we need to define primary care, as the specialty focused on the primary and comprehensive health care needs of the patient. Because it is patient focused and not disease focused, the permutations of complexities of problems , presentations, and scenarios are infinite. From a health policy perspective, primary care is defined as care that is accessible, comprehensive, coordinated, continuous , and longitudinal. This framework has been helpful in studying and evaluating how primary care is delivered. 1,2 We need to give highest priority in health care reform to making a system of primary care that serves as the prime interface of the most care for the most people. But the capacity of physicians to address this enormous care burden is not infinite, and therefore we need to prioritize the resourcing and agenda of primary care. Primary care is hard work that requires a complex set of skills to manage the emotional, physical, and social problems that constitute what patients describe as their biggest concerns. 3 It is also important to understand what primary care is not. It is not simply preventive care and monitoring of disease metrics. Primary care is a unique specialty that requires special competencies and special training to do well. We need to be more intentional about defining the core agenda of primary care and training accordingly. In the study by Kale et al, 4 they found that up to 40% of " primary care " services are being provided by subspe-cialists. Clearly this is not primary care but rather care services that would be more appropriate in a primary care setting. As Barbara Starfield 1 has said has said, doing a little bit of primary care is like being a little pregnant. Primary care physicians are also taking it on the chin. Many feel duped by the promise of being able to care for patients by spending most of their time taking care of patients. This is not the case because much of their time is spent on marginal administrative logistics …