Primary care in the United States stands at a crossroads. Despite decades of investment in healthcare infrastructure and technology, the nation continues to lag behind peer countries in life expectancy and health outcomes. The causes are layered: workforce pressures, eroding patient trust, payment systems that reward volume over value, and a chronic shortage of time for meaningful care.

To explore what a stronger system could look like, the Hopkins Business of Health Initiative (HBHI) and the Center for Health Systems and Policy Modeling (CHSPM) convened a panel of national experts for a policy event, Primary Care Reform: Aligning Policy, Innovation, and Investment.

The discussion brought together Atul Grover, Executive Director of the Association of American Medical Colleges’ Research and Action Institute; Yalda Jabbarpour, family physician and Director of the American Academy of Family Physicians’ Robert Graham Center for Policy Studies; and Eliana Perrin, pediatrician and Bloomberg Distinguished Professor of Primary Care at Johns Hopkins University.

Moderated by Melinda Buntin, Director of CHSPM, the conversation set out to define a vision for primary care’s future. “If you don't know where you're trying to get,” Buntin said, “it’s very difficult to get there.”

 

Prevention as Primary Care’s Purpose

1. Prevention and keeping people well should define primary care's greatest purpose.

“I think one of the beauties of primary care, and this is especially true in pediatrics, is that I’m the person in charge of keeping people well,” said Perrin. “If I can spend more time with you when you’re well—seeing the real you and understanding that family unit, that person in their community—then that builds trust. It also builds whatever the opposite of burnout is in me.”

For Perrin, prevention is both the joy and the purpose of the profession. “If we can prevent illness, injury, and any lack of flourishing and thriving, then we are really living the epitome of primary care,” she said.  “We’re helping our patients, ourselves, and the bond that joins us.”

 

Redesigning Care: Time, Technology, and Systemic Barriers

2. Clinicians need more time for increasingly complex patients.

“Our patients have become so much more complex—their medical complexity, their social complexity, their mental health needs,” said Jabbarpour. “Primary care is the place people go for their mental health care. Each visit is becoming longer and more complex, even though we don’t have the time to meet those needs.”

As routine cases shift to urgent care and telemedicine, primary care physicians now handle the most challenging cases with fewer resources and less time—fueling burnout and limiting access.

3. AI can ease administrative burden—but only if clinicians lead its design.

Jabbarpour shared early results using ambient AI that transcribes patients’ visits. “It has really reduced my mental burden so that I can take care of complex patients and not feel burned out at the end of the day,” she said. “The fact that I can sit with a patient and talk like this and not have a computer screen in front of me is what I trained to do.”

She warned, however, that clinicians must lead the implementation of AI. “Primary care clinicians need to be at the table when there is development of AI, implementation of AI, choosing the AI system, and dissemination.”

4. Health care can’t fix what social policy fails to address.

Many clinics now provide basic necessities like diapers, cribs, and coats—what Perrin called “workarounds to poverty.” While these interventions build trust and help families access care, they highlight deeper policy gaps. “We should have social structures that allow people to have those needs met outside of the doctor's office,” she said.

Grover agreed: “Other OECD countries don’t expect their healthcare systems to solve housing insecurity and food access. We have 20% of our people, including children, living in poverty. That doesn't get anywhere near 10% in those other countries.”

Reframing Primary Care: Trust and Public Perception

5. Rebuilding trust between patients, providers, and institutions is critical.

“We’re seeing an erosion of trust, and that has made everybody in primary care’s life harder,” said Perrin. She noted that patients increasingly “do their own research” instead of trusting physicians, even for well-established interventions like vaccines.

Administrative systems can worsen that distrust. “Prior authorization—that’s a system that doesn’t trust me,” she said. “I wrote the prescription, and now I, or someone that works with me, has to spend a fair amount of time validating it, which trusts neither me nor the patient.”

6. Meeting people where they are helps rebuild trust.

“One of the ways that we re-establish trust is by bringing people into contact with spaces that are trusted. Nurses are trusted, community health workers are trusted, social workers, for the most part, are trusted,” said Perrin. “The other thing we can do is go into the spaces that people occupy, like schools and resource centers. These are programs that say, instead of you coming to us, because sometimes the walls of primary care can be way too high, we can come to you, and that is another way to establish trust.”

7. Primary care needs a better story.

“We need to show the public what good primary care looks like,” said Jabbarpour. “There are people out there who have had really good primary care—a continuity clinician who has been with them, maybe since childhood. But that is less and less common now, and we need to be able to sell the benefits of primary care to the U.S. population.”

Her call was less about branding than about visibility. “My role as a primary care researcher and physician is to provide good primary care in my office, but also to produce research that shows the benefits of good primary care,” she said. “We all have a part to play, but we have to change the narrative.”

Measuring What Matters

8. We need smarter ways to measure and deploy the primary care workforce.

By headcount, the U.S. appears to have sufficient primary care providers. “Between 2015 and 2025, family medicine and general internal medicine trainees each increased by about 2,000,” said Grover. “When you include nurse practitioners and physician assistants—about 70% of whom practice primary care—the workforce appears even stronger.”

But those numbers don’t reflect reality. “Regardless of whether we do or don’t have a shortage,” said Jabbapour, “what we know is that patients are having a hard time getting in, they’re not getting all their needs met, and clinicians are burning out. The numbers tell one story, but what's really happening in practice tells another story.”

The panelists converged on a shared vision: a system where trusted teams meet people in their communities; where technology reduces burnout rather than adds to it; and where prevention and time with patients define the value of care.

This event is part of a series of HBHI policy convenings, which include previous panel discussions on cultivating trust in the healthcare system, and advancing sustainability in healthcare delivery, as well as a fireside chat with HHS Secretary Xavier Becerra.

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