A century of primary care transformation

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Primary care medicine has undergone enormous changes in the past century.

From insulin to remote blood pressure monitors, today’s family practitioner or general internist has medications and diagnostic tools at their disposal undreamed of a century ago. With a few clicks on a keyboard, today’s doctors can find information about a disease or condition that would have required hours of library research in 1923. And advances in remote monitoring devices enable today’s doctors to track patients’ vital signs virtually.

Equally important are the changes in how primary care medicine is practiced and the primary care doctor’s role in the health care system. These changes were summarized in a 2021 National Academies of Sciences, Engineering, and Medicine (NASEM) report on the transformation of health care since the early 1980s.

For most of the 20th century, the report states, “the lone general practitioner served as the face of primary care in the United States.” However, “by the start of the 21st century, most primary care practices would be almost unrecognizable to past generations of primary care clinicians. Practices today are larger and often part of health care systems, and generally not organized around values, professionalism and relationships. Instead, they exist within a new administrative and technological context, including National Committee for Quality Assurance recognition, accountable care organization requirements, the ubiquitous use of electronic health records, compensation based on relative value unit productivity and pay-for-performance metrics,” the report notes.

To celebrate the Medical Economics 100th anniversary, we took an in-depth look at how medicine has changed. Click the links below to check out the entire feature.

Click here to read chapter 1: 1923 vs. 2023: A doctor's daily life.

A century of primary care transformation: Table of contents

• Chapter 1: 1923 vs. 2023: A doctor's daily life
• Chapter 2: Rise of the specialists
• Chapter 3: How insurance changed everything
• Chapter 4: The malpractice threat
• Chapter 5: The vanishing independent physician
• Conclusion: What the future holds
• 'Holding onto the primary care dream:' An interview with Melissa Lucarelli, M.D.