Why Primary Care Is a Product Nobody Wants

There is an unquestioned belief in healthcare no one wants to challenge: Primary Care. Everyone believes it plays a fundamental role in our care system, and everyone laments that we don’t invest in the primary care system or pay primary care doctors enough.

Of course, there is truth to that:

• High-quality primary care has been shown to improve diabetes and high blood pressure outcomes as well as reduce costs over the long term.

• Primary care providers as a whole are on the bottom of physician pay.

• There is a primary care shortage in the U.S., which pushes people toward more expensive, specialized care or emergency departments.

The assumption is straightforward: more primary care doctors and higher pay should deliver healthier outcomes at lower costs. The drumbeat from primary care advocates is exactly that.

But let’s say tomorrow we add another 100,000 primary care doctors in the United States and pay them 30% more. Will we see a transformation in population health and meaningful reduction in our country’s healthcare spending?

No.

Why?

Well, have you been to your primary care doctor recently? If you have, did you love it? Were you excited to go? Likely all no’s. And you’re not alone. Except for seniors, there isn’t much appeal for the rest of us to go to primary care. The value is not apparent.

I’m a practicing primary care physician, so this critique is directed at my own tribe. At my clinic, I’m surrounded by smart, caring, and dedicated colleagues at Morehouse Pediatrics and Hughes Spalding Hospital. But what’s the experience for a child who is sick or needs a routine visit?

The mother has to take time off work, pick up the kid from school, and travel to our clinic in downtown Atlanta. They either drive through bad traffic and park far away, or take multiple buses and trains. Once they arrive, they wait in a waiting room, then wait again in an exam room. I see them for 15-20 minutes, offer advice, give vaccines, and provide a note for the child to return to school. Then the family makes the trek back home. It’s a half-day endeavor for the mother and child, and for me it’s a 15-minute interaction.

We all have experienced something similar in our own lives.

This is health system-centered care, not patient-centered care.

If it were patient-centered, we wouldn’t have these stats:

• Nearly half of Americans are frustrated with the effort required to connect to their primary care doctor.

• 8 out of 10 people hide information from their doctor for fear of being judged or lectured.

• 75% of patients don’t adhere to the treatment plans outlined by their doctor.

People generally don’t like going to primary care. It’s a poor consumer experience. Pouring more doctors and money into a product no one wants wouldn’t fly in any other industry. Yet in healthcare, it’s gospel.

The Appeal of Alternative Models

On the other side of the coin, consider the company Him & Hers, which has grown 77% year over year. People are voting with their wallets. Him & Hers provides a narrow set of services that are in high demand, and they make the experience easy. They focus on convenience and direct access to care, like telehealth visits for hair loss, sexual health, and mental health.

Yes, primary care is different. It’s about building long-term relationships, preventing chronic illnesses from taking root, and helping patients navigate the complexities of serious diagnoses.

But there is demand for that service too - we have just done a poor job of capturing that demand. The value must be apparent to the consumer, like it is with Him & Hers.

The Contrarian Prescription

Here’s what needs to change:

1. Give People What They Want: Move away from the traditional 15-20 minute inconvenient in-office visit. Transition to a longitudinal relationship that spans virtual visits, in-person care, and AI-driven support, all tailored to the needs of the patient. Some of these models already exist. That’s why I joined Included Health - the idea of builing personalized, all-in-one healthcare.

2. Broaden Beyond Current Insurance Payment Models: Innovation in primary care is stifled by the fee-for-service payment system or complicated value-based care. There’s a market of people willing to pay for a better and a more personalized experience. Models like Direct Primary Care and concierge medicine are growing.

3. Own Your Practice Data: Primary care providers should track and own multiyear patient data and attribution rather than relying on insurers or academic studies. This empowers practices to demonstrate their value to patients and payers directly.

The Challenge

What about Medicaid beneficiaries or low-income commercial patients? This is where it gets harder because of limited out of pocket flexibility and stricter regulations from the government. But if you can show that a better experience leads to better adherence, improved outcomes, and cost reduction, then Medicaid managed care organizations and employer sponsored insurers are willing to try something new.

Here’s the Truth: Primary care doesn’t need more investment. It needs to be deconstructed and then rebuilt. No amount of money or workforce expansion will transform primary care into what it needs to be: a service people value, trust, and actively choose to engage with.