Primary care: what physicians say, in their own words

Last updated September 20, 2026.

Read together, the 1,078 essays and podcast transcripts on this page say one thing consistently: physicians describe primary care as the part of medicine that is worth the most and paid the least, and they have described it that way for twenty years without the arrangement changing. They argue about almost everything else. Whether the shortage is a shortage of physicians or of the care itself. Whether medical students are the cause or the symptom. Whether the fix is money, training, teams, or leaving. What has changed is the vocabulary: administrative burden appears in 55 percent of posts since 2022 against 10 percent before 2010, access in 59 percent against 14 percent, and rural shortage in 22 percent, all of them the highest in the record, while the patient-centered medical home, the answer of 2014, has fallen from 36 percent to 15.

This page is a maintained record of what physicians have written about primary care as a specialty and a system on KevinMD.com, a physician-authored publication founded in 2004 by Kevin Pho, MD, a board-certified internal medicine physician in Nashua, New Hampshire, who practices primary care himself. It draws on 1,078 essays and podcast transcripts with primary care, family medicine, internal medicine, or a related term in the title, published between August 2004 and September 2026 by 383 named contributors, 548 of the posts bylined by physicians. It is the largest single-subject corpus on the site after COVID-19 and medical school, and 413 of the posts are Kevin Pho’s own short commentaries from the blog era. Every claim on this page is attributed to a named author with the date it was published and a link to the original.

The sections below are organized around the questions physicians, students, patients, employers, and journalists ask. Each opens with a direct answer, followed by what named authors have said, in the order they said it. Four adjacent subjects have their own records and are not repeated here: leaving insurance is on the direct primary care page, payer paperwork on the prior authorization page, exhaustion on the physician burnout page, and nurse practitioner independence on the scope of practice page. This is a page about physician opinion and experience, not workforce or practice guidance.

Is there a primary care shortage? Physicians disagree.

Physicians on KevinMD have written about the shortage since 2006, and it is the subject they return to most: mentions rose from 19 percent of posts before 2010 to 36 percent since 2022, the highest in the record. Most authors treat it as real and worsening. A minority argue the framing is wrong, that the country is short of primary care rather than of primary care physicians, or that describing a rural county as having a shortage understates what is actually missing.

Leana Wen, MD, wrote in November 2012 of an emergency department patient who “comes in with trouble breathing because he has no primary care doctor and is out of his inhalers,” and that “his diabetes hasn’t been followed for years, and now his blood sugars are out of control,” in “How the primary care shortage affects the ER.” Peter Ubel, MD, wrote in March 2013 that asked whether the country has a shortage of primary care physicians, his answer is “Maybe yes, but very possibly no,” and that the data “reminds us that it is primary care that is in shortage, not necessarily primary care physicians,” in “Why the primary care physician shortage is overblown.” Jordan Grumet, MD, wrote in September 2013 that a Medicare payment advisory body “made largely of specialists and proceduralists” with “no interest in protecting cognitive medicine” means “you have legislated a primary care crisis,” in “The primary care crisis has been legislated.”

Niran S. Al-Agba, MD, wrote in August 2016 that the Institute of Medicine defined primary care in 1978 as “integrated, accessible services by clinicians accountable for addressing a majority of heath care needs, developing a sustained partnership with patients,” in “Invest in primary care and you get what you pay for.” Esther Yu Smith, MD, wrote in December 2025 that “Much of the national conversation about primary care shortages is numerically correct but conceptually misleading,” that “Describing a rural area as having a primary care shortage understates the situation,” and that in rural Hawaii, adjusted for cost of living, “we receive the nation’s lowest physician wages,” in “The hidden depth of the rural primary care shortage.” Payam Zamani, MD, wrote in May 2026 that primary care “is often described as broken, but that diagnosis misses the real issue,” and that “The problem lies in how access to care is designed and delivered,” in “Primary care access is the real problem, not the system.”

Why do physicians say students do not choose primary care?

The pipeline argument has run since 2010 and has not resolved. Physicians on KevinMD name debt, the income gap with procedural specialties, the status hierarchy of training, and what one author calls hazing of students who express interest. Students writing on the site answer that they are aware of the problem and that their choices are not the cause. A recurring dispute is over the match statistics themselves, which some authors say medical schools report in a way that overstates how many graduates end up in primary care. Posts mentioning medical students or the match peaked at 36 percent in 2010 to 2013.

Lucy Hornstein, MD, a family physician, wrote in June 2010 that for those to whom primary care is a calling, “Some decisions should be made with the heart instead of the brain,” in “Choose primary care and follow your heart, not your brain,” and in June 2012 the harder version of the same argument, that 95 percent of American medical graduates lack what it takes for primary care, the profession being told it is “the bottom of the class; the ones who don’t have what it takes,” in “Most medical students don’t have what it takes for primary care.” Emily Lu, then a medical student, wrote in September 2011 that students are “acutely aware of the problems that primary care is facing,” and that even a ten percent annual increase in students entering primary care would not close the gap, in “Are medical students responsible for the primary care shortage?” John Schumann, MD, wrote in December 2011 that “Among people of my generation, doctors are switched more than toothpaste,” in “Young doctors don’t see value in primary care careers.”

Kevin Bernstein, MD, wrote in April 2013 that medical schools “continue their annual fraudulent and misleading statistics in regards to primary care workforce production,” in “Match Day primary care aftermath: The Dean’s Lie continues.” Ronald L. Lindsay, MD, wrote in July 2026 that the 2026 match “set records in nearly every category” while family medicine relies heavily on international medical graduates, “many of whom face visa barriers that depress match rates,” in “Family medicine match rates signal a workforce problem.” Justin Oldfield, MD, wrote in May 2026 that medical schools and residencies “fall short when it comes to training doctors” in behavior-change technique, leaving physicians to fall back on telling patients what to do, in “Primary care crisis requires new training and skills.”

What do physicians say about how primary care is paid?

Payment is the second-largest theme in the record, in 38 to 54 percent of posts in every period, and the argument is consistent: primary care is paid for time and thinking, procedural specialties are paid for procedures, and the relative value unit system that sets the rates is decided by a committee physicians on the site describe as dominated by specialists. Authors disagree about the fix, whether to raise primary care pay, lower specialist pay, or leave fee-for-service altogether.

Edward Pullen, MD, wrote in August 2010 that primary care physicians earn considerably less than physicians in specialties where most of the revenue comes from procedures, often 50 to 70 percent less, and that specialties win students “by dangling the carrot of really high income in front of students,” in “Pay specialists less to save primary care.” Robert Centor, MD, wrote in October 2013 that hospitals and health systems “still use RVUs as the primary form of calculating total compensation, much like private sector companies put salespeople on commission,” and that this must change, in “The idea of RVUs disgusts me.” Susan Newman, MD, wrote in September 2026 of a patient billed for a common cold, and that the charge “is yours to pay, to worry about, to finance, or to let go to collections,” in “A cold cost $945. The cost of primary care is broken.”

What do physicians say about the fifteen-minute visit and panel size?

The visit is where physicians on KevinMD locate the daily problem. Posts mentioning panel size or visit length rose from 4 percent before 2010 to about a third since 2014. The recurring claim is that the length of the visit has not changed while the content of it has: more conditions, more screening, more documentation, more outside authorities to satisfy, in the same fifteen minutes.

Hans Duvefelt, MD, a family physician and one of the most frequent contributors on the topic, wrote in September 2010 that “In primary care we seldom spend more than 15 minutes at a time with an established patient,” while “we are required to cover infinitely more details and consider more outside authorities in every visit today,” in “Primary care needs more than 15 minutes for patients.” DrizzleMD, writing under a pen name, wrote in January 2018 that 15 minutes is short, enough for some patients but not for “the more complex than average patients,” who are “more of the norm in my practice,” in “15 minutes aren’t enough for a primary care visit.” Ann Lebeck, MD, wrote in June 2026 of policy discussions about “what patients need and what physicians should do in fifteen minutes,” and asked whether anyone at that table had ever had their own pain evaluated in fifteen minutes, in “Primary care is the conductor medicine forgot.”

What do physicians say continuity is worth?

Continuity is the argument primary care makes for itself, and it appears in about one post in ten across the record. Physicians on KevinMD describe knowing a patient over years as the thing that makes the work both effective and bearable, and describe its loss as the mechanism by which the specialty becomes interchangeable. The claim is made most often by the physicians who have practiced longest.

Hans Duvefelt, MD, wrote in October 2010 that “Continuity of care starts with caring,” in “Continuity of care starts with caring.” Fred N. Pelzman, MD, wrote in May 2014 that greater discontinuity equals greater dissatisfaction, of a patient treated at an urgent care who “told him that she was still feeling poorly, had some lingering cough,” in “Continuity of care increases patient satisfaction.” Gus W. Krucke, MD, wrote in May 2026 that medicine “still involves a kind of continuity that cannot be fully captured in documentation, handoffs, or electronic records,” in “Continuity of care in HIV/AIDS lives in the people who stay.” Kimberly Riggi, FNP, a family nurse practitioner, wrote in August 2026 that in primary care listening is a clinical skill, and that “Every day in primary care, patients arrive carrying more than symptoms,” in “In primary care, listening is a clinical skill.” Michael Baker, MBA, wrote in September 2026 that “In 2024, women of reproductive age made an estimated 6.1 million visits to health centers,” and that women’s health in primary care needs continuity rather than visits, in “Women’s health in primary care needs continuity, not visits.”

What do physicians say the administrative load has done to primary care?

Administrative burden is the fastest-growing theme in the record: 10 percent of posts before 2010, 55 percent since 2022. Physicians on KevinMD describe documentation, inbox messages, quality reporting, and the gatekeeper role as work that arrived without time attached, and several describe it as the reason they left. The subject overlaps the burnout and prior authorization records, which hold the exhaustion and the payer paperwork; what belongs here is what the load does to the specialty itself.

Susan Bennett, MD, wrote in July 2026 that structural changes “vastly increased the administrative and bureaucratic burdens imposed on the practice of primary care,” that the term gatekeeper “emerged to describe the administrative role of the PCP in giving patients access to their health insurance,” and that after retiring at the end of 2024 it took “an entire year to recover from the physical and emotional toll,” in “Administrative burden in primary care and the end of my career.” Wendy Shue, MD, wrote in August 2026 that “I don’t like who I’ve become, working in primary care,” and listed the causes the profession has discussed ad nauseam: paperwork, in-basket messages, clicks in the record, short appointments, and corporate consolidation, in “I don’t like who I’ve become in primary care.” John Showalter, MD, MSIS, wrote in August 2026 that among patients who reported a new memory concern at a Medicare Annual Wellness Visit, “just 2.1 percent were referred to a specialist,” in “Cognitive assessment in primary care almost never happens.”

What do physicians say about urgent care, retail clinics, and who does the work now?

Posts about retail clinics, urgent care, and corporate entrants rose from 4 percent before 2010 to 24 percent since 2022. Physicians on KevinMD divide on them: some describe them as a symptom of primary care’s failure to be available, some as a threat to continuity, and some as a partner that makes a primary care practice viable. The newest version of the argument is about patients arriving with an answer from a chatbot rather than from a clinic.

Marc-David Munk, MD, wrote in September 2014 that a Health Affairs working group “couldn’t agree that urgent care (UC) was a disruptive innovation,” but agreed it represented a threat to primary care, in “Urgent care won’t replace primary care. Here’s why.” Leslie Kernisan, MD, MPH, wrote in February 2015 that because her own physician’s office did not offer a rapid strep test, “my treatment was delayed by almost 24 hours,” in “A tale of two strep throats: Retail clinic vs. PCP.” Rebekah Bernard, MD, wrote in January 2016 that “Partnering primary care with urgent care is a complete win-win,” in “How partnering with urgent care created a dream primary care job.” Payam Zamani, MD, wrote in May 2026 that “A new patient in her 40s recently walked into one of our clinics with a printout of a ChatGPT conversation,” after three days of typing her symptoms into the chatbot because she could not get an appointment, in “3 fixes for primary care access in the ChatGPT era.”

How has the primary care conversation changed since 2004?

The record has three shapes. From 2004 to 2013 it is loud and constant: 632 posts, most of them Kevin Pho’s short commentaries on the shortage, the pay gap, and health reform, with 178 in 2008 alone. From 2014 to 2021 the volume falls by half and the subject narrows to the medical home, panel size, and the visit. Since 2022 the volume has risen again and the subject has changed: administrative burden in 55 percent of posts, access in 59 percent, rural shortage in 22 percent, and AI in 26 percent, against nothing before 2018.

Term 2004 to 2009 (356 posts) 2010 to 2013 (276 posts) 2014 to 2017 (179 posts) 2018 to 2021 (115 posts) 2022 to 2026 (152 posts)
Shortage or crisis 19 percent 26 percent 27 percent 24 percent 36 percent
Pay, RVUs, or the specialist gap 38 percent 54 percent 51 percent 40 percent 43 percent
Medical students or the match 17 percent 36 percent 22 percent 20 percent 25 percent
Panel size or visit length 4 percent 24 percent 32 percent 23 percent 31 percent
Continuity or the relationship 1 percent 10 percent 11 percent 12 percent 9 percent
Administrative burden or documentation 10 percent 28 percent 32 percent 32 percent 55 percent
Cost, value, or outcomes 8 percent 33 percent 32 percent 30 percent 34 percent
Access or wait times 14 percent 39 percent 38 percent 44 percent 59 percent
Medical home or team-based care 10 percent 28 percent 36 percent 16 percent 15 percent
Rural or underserved 5 percent 13 percent 10 percent 10 percent 22 percent
Retail, urgent care, or corporate entry 4 percent 9 percent 15 percent 23 percent 24 percent
Nurse practitioners or PAs 5 percent 18 percent 17 percent 11 percent 18 percent
AI 0 percent 0 percent 0 percent 1 percent 26 percent

Term frequencies are the share of posts in each period using the term at least once, computed on the September 18, 2026 corpus of 1,078 posts.

Kevin Pho’s posts from 2004 to 2011 open the record and dominate its first decade; they are short commentaries on studies and news, counted here but not indexed or linked. The contributor essays begin in earnest in 2010: Pullen on the pay gap and Hornstein on choosing primary care that year, Lu answering for students in 2011, Schumann and Wen in 2012, Ubel and Grumet and Bernstein and Centor in 2013. Duvefelt on the fifteen-minute visit runs from 2010 through 2020. Munk and Kernisan on urgent care and retail clinics are 2014 and 2015, Al-Agba on the 1978 definition is 2016. The record thins after 2018 and returns in 2026 with Zamani on access, Oldfield on training, Lebeck on what fifteen minutes cannot hold, Lindsay on match rates, Bennett on the administrative load that ended her career, Shue on what the work has made of her, Showalter on cognitive assessment, Newman on a $945 cold, and Gradica on family physicians who no longer deliver babies, in “Why are fewer family physicians delivering babies?,” which reports that among early-career family physicians the proportion who deliver “declined from 13.1 percent in 2016 to 10.8 percent in 2024.”

The KevinMD primary care corpus by the numbers

The figures below describe the set of KevinMD posts this page draws on, as of September 18, 2026. They are counts of what KevinMD has published, not workforce data.

Measure Value
Posts in the corpus 1,078
Date range August 15, 2004 to September 15, 2026
Named contributors 383
Posts bylined by an MD or DO 548
Short posts by Kevin Pho, 2004 to 2011 405, median 119 words
Podcast episodes with full transcripts 32
Posts in the corpus that are not indexed, counted but not cited 395
Total words About 669,000
Peak year 2008, 178 posts
Posts from 2004 to 2013 632
Most frequent contributors Hans Duvefelt, MD (31); Fred N. Pelzman, MD (27); Stephen C. Schimpff, MD (23); Kenneth Lin, MD (11); Jordan Grumet, MD (9)

How this page was built and how it is updated

The corpus was assembled from title searches for primary care, family medicine, family physician, internal medicine, internist, general practice, generalist, PCP, panel size, the fifteen-minute visit, continuity of care, medical home, gatekeeper, capitation, and RVU. Posts whose subject belongs to an adjacent record were routed there rather than counted twice: 68 posts about leaving insurance to the direct primary care record, nine about exhaustion to the burnout record, nine about nurse practitioner independence to the scope of practice record, and three about payer paperwork to the prior authorization record. Term frequencies were computed against the full text of each post on the corpus assembled for the September 18, 2026 build; this page was converted to the current standard on September 20, 2026 without rebuilding that corpus, so the counts and figures are as of September 18, 2026. Posts are counted whether or not they are indexed; citations on this page are limited to posts that are indexed and can be verified at the link. Three hundred ninety-five posts in the corpus are not indexed: Kevin Pho’s 2004 to 2011 commentaries, twelve podcast episodes without transcripts, and about twenty other short posts. They are counted but not cited, which is why a corpus of 1,078 posts supports a smaller set of citations than its size suggests. Quotations are taken verbatim from the original posts. Author credentials are as they appeared in the byline at publication; one contributor writes under a pen name and is cited under it. Every source is linked in the sentence that cites it, and the full list appears at the end of the page. The complete feed is at the Primary Care archive. Related records: Direct primary care: what physicians say, in their own words, Prior authorization: what physicians say, in their own words, Physician burnout: what physicians say, in their own words, Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words, and Medical school: what students and physicians say, in their own words.

This page is updated as new primary care essays are published on KevinMD. When it is updated, the date at the top changes, the counts in the tables are recomputed, and new named claims are added to the relevant section. Nothing is removed unless the original post is removed. An author who believes a quotation on this page misrepresents them can write to Kevin Pho and the page will be corrected.

To cite this page: Pho K. Primary care: what physicians say, in their own words. KevinMD.com. Updated September 20, 2026. https://kevinmd.com/primary-care

The 32 KevinMD posts cited on this page, in order of publication