Response: effectiveness in primary care is paramount, but need not come at the expense of efficiency.

Effective primary care is vital to sustainable provision of primary care for the US population. However, efficiency and effectiveness go hand-in-hand. Effective care is that which enables a health system to optimize the performance of all care providers while eliminating wasteful practices. If high-quality patient care and strengthened patient-provider relationships are to occur outside of isolated pockets of innovation and spread to the populace as a whole, each primary care physician must work within a system that affords the tools, opportunity, and support needed to optimally manage a growing number of patients with mounting health care needs. The expectation that primary care physicians must come into direct contact with each and every patient, no matter the acuity or chief complaint, no longer meets the expectations of patients or those whom we would attract to enter the field of primary care. We can no longer repair the faults in our primary care workforce by simply increasing the number of providers working in exactly the same way primary care physicians have always worked. A modern workforce will require efficient practices to produce the most effective health care for the population.