Ask for a definition of primary care, and you are likely to hear as many answers as there are health care professionals in your survey. Primary Care fills this gap with a detailed definition already adopted by professional organizations and praised at recent conferences. This volume makes recommendations for improving primary care, building its organization, financing, infrastructure, and knowledge base--as well as developing a way of thinking and acting for primary care clinicians. Are there enough primary care doctors? Are they merely gatekeepers? Is the traditional relationship between patient and doctor outmoded? The committee draws conclusions about these and other controversies in a comprehensive and up-to-date discussion that covers

• The scope of primary care.
• Its philosophical underpinnings.
• Its value to the patient and the community.
• Its impact on cost, access, and quality.

Contents

• COMMITTEE ON THE FUTURE OF PRIMARY CARE
• Preface
• Acknowledgments
• Summary
• 1. Introduction
  • The Institute Of Medicine Study
  • Underlying Assumptions
  • Historic Roots And The Contemporary Context For Primary Care
  • Organization Of The Report
  • References
• 2. Defining Primary Care
  • Early Definitions
  • The First IOM Definition
  • Distinguishing Public And Personal Health Services
  • The 1984 Report On Community-Oriented Primary Care
  • Changes In Health Care Delivery Today
  • The New Definition And An Explanation Of Terms
  • Achieving The Goals Of Primary Care As Defined
  • References
• 3. The Value of Primary Care
  • The Value of Primary Care for Individuals
  • Primary Care And Costs, Access, And Quality
  • The Limits Of Primary Care In Improving Population Health
  • Summary
  • References
• 4. The Nature of Primary Care
  • Content Of Primary Care
  • Characteristics Of Primary Care
  • Summary
  • Appendix: Data On The Majority Of Personal Health Care Needs
  • References
• 5. The Delivery of Primary Care
  • Current Pathways For Primary Care
  • Moving Toward Delivery Of Primary Care As Defined
  • Summary
  • References
• 6. The Primary Care Workforce
  • Workforce Trends And Supply Projections: Physicians
  • Workforce Trends And Supply Projections: Nurse Practitioners
  • Workforce Trends And Supply Projections: Physician Assistants
  • Other First-Contact Providers
  • Comment On Workforce Estimation
  • Conclusions And Recommendations About The Supply Of Primary Care Clinicians
  • Summary
  • References
• 7. Education and Training for Primary Care
  • Appropriate Training In Primary Care
  • The Education Of Physicians
  • Other Content Issues In Training For Primary Care
  • Financial Support For Graduate Training In Primary Care
  • Interdisciplinary Education Of Primary Care Clinicians
  • Integrated Delivery Systems And Primary Care Training
  • Continuing Medical Education
  • Physician Retraining
  • Summary
  • References
• 8. Research and Evaluation in Primary Care
  • Support For The Infrastructure For Primary Care Research
  • Priority Areas For Primary Care Research
  • Summary
  • References
• 9. Implementation Strategy
  • Guiding Perspectives
  • A Primary Care Consortium
  • Implementation Of Specific Recommendations
  • Final Comment On Implementation
• Appendixes
  • A Site Visits
  • B Public Hearing
  • C Workshops
  • D Mental Health Care in the Primary Care Setting
  • E Life in the Kaleidoscope: The Impact of Managed Care on the U.S. Health Care Workforce and a New Model for the Delivery of Primary Care
  • F Integrating Our Primary Care and Public Health Systems: A Formula for Improving Community and Population Health
  • G Committee Biographies

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for this report were chosen for their special competencies and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.