Blockbuster was once a dominant force in the video entertainment industry, with thousands of stores and near-total market control. However, when digital streaming services emerged, Blockbuster was slow to respond, dismissing Netflix as a passing trend. By the time it recognized the shift in consumer preferences, it was too late – the company collapsed, unable to compete in the new era of on-demand entertainment.

Health care, particularly primary care, is at a similar crossroads. The traditional primary care model, largely physician-driven, is struggling to meet the evolving demands of modern patients who seek convenience, affordability, and a greater emphasis on preventive care. The current challenges in primary care are multifaceted and stem from systemic constraints rather than any shortcomings of providers themselves. However, new models of care – such as advanced practice provider (APP)-led clinics, AI-driven health care solutions, and direct-pay models like direct primary care (DPC) – are emerging as transformative alternatives that prioritize accessibility, personalization, and proactive wellness.

Primary care physicians, like Blockbuster executives before them, have a choice: Evolve with the industry or risk being overshadowed by more agile care models.

Lessons from Blockbuster’s decline

Blockbuster’s downfall was not due to a lack of resources but rather an inability to adapt. The company strategy failed in three key areas:

Ignoring consumer preferences. Customers desired digital convenience, yet Blockbuster remained focused on in-store rentals, failing to align with shifting market demands.

Dismissing disruptors. The company had an opportunity to acquire Netflix for $50 million but underestimated its long-term potential, missing a critical chance to innovate.

Clinging to an outdated business model. Blockbuster continued relying on late fees and physical locations even as streaming services offered a more efficient, consumer-friendly alternative.

Parallels in primary care’s challenges

Similarly, traditional primary care is at risk of stagnation due to an outdated operating model, despite clear signals from health care consumers indicating a need for change:

A shift toward preventive and convenient care. Patients increasingly seek preventive strategies, wellness services, and flexible health care access, yet much of the current system remains reactive and illness-focused.

The expansion of advanced practice providers. Research demonstrates that care led by Doctors of Nursing Practice (DNPs), nurse practitioners (NPs), and physician assistants (PAs) is highly effective in terms of both cost and clinical outcomes.

Growing demand for direct-pay models. Many patients now prefer to bypass traditional insurance structures in favor of direct-pay health care, which offers greater accessibility, cost transparency, and personalized attention.

Primary care, like Blockbuster, must recognize these evolving preferences or risk being outpaced by emerging care models.

Innovations reshaping primary care

The role of advanced practice providers. Advanced practice providers, including DNPs, NPs, and PAs, are playing an increasingly vital role in primary care delivery. These clinicians are independently licensed, highly skilled, and adept at managing a broad spectrum of health care needs. They should not be viewed as “physician extenders” but rather as key contributors to an efficient, patient-centered health care system.

Studies in Health Affairs and JAMA have demonstrated that primary care models led by advanced practice providers achieve similar or better patient outcomes than traditional physician-led models, particularly in chronic disease management and preventive care. As demand for accessible and affordable care grows, recognizing and integrating APP-led models will be crucial in the evolution of primary care.

The rise of direct primary care (DPC) and direct-pay models. Direct-pay models, such as direct primary care (DPC), allow physicians and advanced practice clinicians to operate outside the traditional insurance system, offering patients greater access and cost predictability. By charging a flat monthly fee, these models eliminate many of the financial and administrative barriers that often hinder traditional primary care. As a result, providers can dedicate more time to patient-centered care, emphasizing prevention rather than brief, transactional visits dictated by insurance reimbursement constraints.

Just as streaming services revolutionized entertainment by eliminating inefficiencies in content distribution, direct-pay models are transforming primary care by making health care delivery more streamlined and patient-focused.

The integration of AI and digital health. Artificial intelligence (AI) and digital health technologies are reshaping primary care by enhancing efficiency, personalization, and data-driven decision-making:

• AI-powered diagnostics can identify diseases at earlier stages, improving treatment outcomes.
• Wearable health devices enable real-time monitoring, shifting care from reactive to preventive.
• Telehealth and virtual assistants reduce unnecessary in-person visits, improving access and efficiency.

Much like Blockbuster’s failure to embrace digital transformation, primary care must integrate AI-driven tools and consumer-friendly technology to remain relevant and effective.

Redefining the role of physicians in primary care

Physicians are highly trained professionals whose expertise is often underutilized in routine primary care tasks such as physicals, low-acuity visits, and administrative duties. Rather than resisting primary care transformation, the physician’s role should be redefined to focus on specialized, high-impact areas:

Complex and specialized care. Physicians should concentrate on complex cases requiring advanced diagnostics and specialized treatment, rather than serving as the default provider for all primary care needs.

AI-enabled precision medicine. Physicians can lead the integration of AI and digital tools to streamline care delivery, improve diagnostic accuracy, and enhance patient outcomes.

Longevity and preventive medicine. As medicine shifts toward proactive health strategies, physicians can play a key role in advancing longevity science, regenerative medicine, and holistic wellness initiatives.

By evolving into these specialized roles, physicians can enhance their impact and contribute to a more efficient and forward-thinking health care system.

How primary care can adapt and thrive

To avoid the fate of Blockbuster, primary care must embrace innovation and modernization:

Expand the role of advanced practice providers.

• Remove barriers that limit full practice authority for APPs.
• Display support and allyship for the establishment of advanced practice provider-led clinics to improve access and efficiency.

Advocate for direct-pay and DPC models.

• Promote alternative payment structures that prioritize patient-centered care over insurance-driven constraints.
• Increase affordability and transparency through streamlined pricing models.

Fully integrate AI and digital health.

• Utilize AI for diagnostics, administrative automation, and clinical decision support.
• Expand remote monitoring and telehealth to enhance access and efficiency.
• Involve physicians in the development of AI-driven tools to ensure alignment with clinical needs.

Redefine physicians’ roles in primary care.

• Transition physicians into specialized, precision medicine, and leadership roles.
• Encourage physician-led innovation in health care technology and system design.

Conclusion

Blockbuster’s story serves as a cautionary tale about the risks of resisting innovation. The company had the resources to lead the digital revolution but failed to adapt and evolve – ultimately leading to its demise.

Primary care stands at a similar juncture. Advanced practice providers, direct-pay models, and AI-driven health care solutions are proving that a more accessible, efficient, and patient-centered model is possible. Traditional, physician-led primary care must recognize these shifts and adjust accordingly.

The future of primary care is being reshaped by emerging models that prioritize convenience, affordability, and proactive health. The choice for traditional health care providers is clear: Adapt to the changing landscape or risk being left behind.

Trisha Swift is a health care executive.