interests of government health care programs with the trend toward managed care in the private sector. Primary care seems to be on the rise in the career choices of physicians and nurses, as those entering the health professions read market signals. Educational programs for the health professions are focusing more attention on the preparation of clinicians for primary care.

Although these forces for change can be allies in implementing the recommendations of this report, they tend still to be focused on achieving cost containment and, to a lesser extent, on improving access to basic services for hard-to-serve populations. Demonstrating the value of primary care to patients and to the broader society, over and above its cost savings alone, will require concerted efforts and time to implement the changes described in this report.

Involving Interested Parties in the Implementation Effort

The intended audiences for this report are very broad, and all must play some role in the implementation of the recommendations. They include:

  • the health professions whose principal activity is the provision of comprehensive primary care and the organizations that represent them. These include physicians in family practice, general internal medicine, general pediatrics, and some obstetrician-gynecologists; nurse practitioners; and physician assistants;
  • the many health professions that have a role in primary care as first-contact professionals for specific functions, such as dentists, optometrists, pharmacists, and others;
  • medical specialists who have some primary care responsibilities or whose referral specialty functions require a relationship to and understanding of the appropriate scope of primary care clinicians;
  • managed care plans, other health care insurers, integrated health care systems, community and rural health centers, and other organizations providing or arranging for the provision of primary care;
  • academic health centers (AHCs) and other educational institutions providing education and training for primary care;
  • federal, state, and local governments, which finance care, provide care, support training programs, license health professionals, regulate health care quality and cost, and carry out public health functions;
  • employers and employer groups with health care interests;
  • specialty boards and other professional organizations that set standards for training and that help define competencies and scope of practice for the professions;
  • health services researchers and organizers of health data systems;
  • foundations with interests in health care and education, including primary care;
  • consumer health advocates (e.g., the American Association of Retired


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