20 Years of Transformation in Primary Care

Before the explosion of managed care, electronic health records (EHRs), hospital mega-mergers, and just before the rise of hospitalists, primary care physicians had a very different role.

Leaders in the field who have practiced over several decades have different ideas about what has had the biggest effect in the last 20 years, but all agree they see their careers very differently than they did in 1995.

Mark E. Williams, MD, clinical professor of medicine, University of North Carolina School of Medicine, Wilmington, and emeritus professor of geriatric medicine, University of Virginia Health System, Charlottesville, is quick to state he still loves medicine after nearly 40 years.

He sees the promise of developments in recent years such as 3D printing, stem cell research, and sequencing of the human genome, but he worries about the monetization of healthcare and the way that tugs on physicians' moral compass.

"I am no longer a physician; I deliver healthcare for a large provider," he explained. "I don't care for a patient; I care for a covered life as part of an insurance plan."

Those cultural changes can lead to ethical compromises and conflicts of interest, Dr Williams said. Physicians cannot always foresee when they enter into an arrangement with a payer or drug company how the agreement might compromise the trustworthiness and independence of their treatment decision making.