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As an FP with 45 years of work I heartily agree with the viewpoint of the author. The more in house care we can competently we can provide the more we can provide the patient centred home model. I was taught many procedural skills during my residency and have picked up more along the way. IV insertion, phlebotomy, suturing including deep and skin level, removal of warts, injecting many joints, injecting trigger fingers, epicondylitis and DeQuervains, removing ingrown toenails, biopsies of the skin by excision or punch, removal of skin lesions, sebaceous cysts and foreign bodies etc. Yes I enjoy these procedures as a welcome diversion from treating chronic illnesses but I can also provide these services at a lower cost than a surgeon or dermatologist. In addition, since we know that insurances pay more for doing than thinking there are fiduciary benefits given the RVU system.