The Crisis in Primary Care No One Wants to Own with NEJM’s Lisa Rosenbaum, MD

Key Podcast Moments

• Lisa Rosenbaum outlines how misaligned expectations have contributed to the chronic crisis in U.S. primary care.
• The discussion continues into why continuity, trust, and “ownership” of patient care have eroded in modern practice.
• Lisa and Graham define the culture gap between what patients and physicians expect from primary care and what the system incentivizes.
• The conversation closes by charting a path forward - what’s at stake for the profession, and what structural changes might restore value to primary care.

Primary care has long been described as the backbone of medicine: the first point of contact, the center of continuity, and the engine of prevention. Yet, as Not Otherwise Specified host Lisa Rosenbaum emphasizes, the ideals of primary care have collided with the harsh realities of modern health systems. What was once a domain of deep patient–doctor relationships has become fragmented, misunderstood, and undervalued. A crisis few leaders are willing to confront head-on!

At the heart of the problem is a cultural and structural misalignment. On one hand, patients and physicians expect primary care to encompass comprehensive, continuous, and personalized care. On the other, the current health system rewards volume over value, quick visits over meaningful dialogue, and episodic interactions over lasting therapeutic relationships. This misalignment creates systemic pressure that erodes the very foundations clinical leaders say are essential to quality care.

Lisa’s reporting reveals that this crisis is not simply about reimbursement levels or workforce shortages. Tt’s about what medicine as a system chooses to prioritize. Graham and Lisa dissect common assumptions: that more pay will necessarily fix access issues, that AI can magically solve the workload crisis, or that simply increasing the number of trainees choosing primary care will change its fortunes. Each of these, while part of the conversation, fails to address the deeper cultural incentives that shape daily practice norms.

From an educational perspective, trainees encounter conflicting signals: primary care is touted as essential, yet specialties are often more rewarded, both financially and structurally. This “values gap” plays out not just in trainees’ career choices, but in how patients experience care fragmented, hurried, and lacking the sense of ownership that once defined primary medical practice.

But amid the diagnosis of what’s broken, Lisa continues to push the conversation toward solutions: aligning incentives with meaningful outcomes, restoring respect and autonomy to the specialty, and acknowledging that fixing primary care will require system-level change, not quick fixes. This means rethinking how care continuity is rewarded, how interdisciplinary teams are supported, and how physicians are enabled to own the patient journey rather than abdicate responsibility to specialist silos or disconnected systems.

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Top 4 Takeaways

1. The Crisis Isn’t About Dollars Alone, It’s About Ownership

Physicians and patients often speak as if the problems in primary care are solved with higher payment, more clinicians, or technological solutions. But Lisa points to a deeper issue: the erosion of ownership. When systems fragment responsibility and reward episodic care, no one is accountable for the whole patient. This cultural shift fundamentally changes what primary care is and undermines its value at the core.