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Dr. Strange’s editorial offers his prescription to cure family medicine in particular and the US health system in general. Like so many others I have read in the nearly 46 years since I entered medical school, it will not work. He offers 2 specific “glimmers of possibility”: direct primary care (DPC) and accountable care organizations (ACOs). Neither is the answer. Per the Robert Graham Center (2019) there are 228,000 primary care physicians in the US. Per the US Census Bureau (2022) there are 333,287,557 persons in the US. If all primary care physicians moved to DPC with “panels of around 500 patients”, where would the roughly 220,000,000 persons not in one of those practices get care? ACOs like all businesses are designed to maximize revenues and profit not improve quality, reduce spending or redesign practices. See, for example, Am J Manage Care. 2021;569-572. https://doi.org/10.37765/ajmc.2021.88795.
I do not know the right prescription, but alas neither does Dr. Strange nor, seemingly, anyone else