Skip to main content
In the past two years, the literature - both medical and popular press - repeatedly describes the terrible state of primary care clinicians, staff and practices. Parsing that state of affairs into more and more details is not really going to be helpful. Bold steps must be taken to change the control, support and communication among clinicians and staff and support the autonomy necessary to make changes in their practices. Hospital and system owned practices need to feel that they have the ability to redesign their work based on their resources, staff and community, not be protocol driven from some office in a 10 story building. Clinicians are better at holding Themselves accountable to their own goals and processes than following checklist medicine, staff being moved without discussion and other examples of top down management. Primary care clinicians have to be able to individualize care not just for each patient but for an entire practice. Edwards and colleagues (Health Aff (Millwood). 2021 Jun;40(6):928-936.. Cultural And Structural Features Of Zero-Burnout Primary Care Practices) showed the way to reform through their analysis of zero burnout practices. Health policy researchers should stop focusing on the pathology of what is falling apart and engage in innovations that might work. Corporate health care will push back hard on that, but we don't' need more studies about why clinicians are in distress, we need hopeful, and radical, solutions. We already know what they are.