Primary care, quality improvement, and health systems change.

In this article, we have examined evidence that supports inferences regarding the critical role of primary care in determining the ultimate quality and success of our health care system as a whole. It seems clear that this nation has a critical need to correct the rapidly eroding structure and impact of our primary care system. We have suggested several strategies necessary to improve the United States primary care system. We need to correct the numeric imbalance of generalists to specialists by enhancing motivation to enter this career field. To enhance primary care as a career choice, we must increase the status, contribution, and rewards of primary practitioners. Finally, to facilitate future growth and success, we must enhance the scholarly base of knowledge in this field, particularly as related to quality improvement technology and managed health care.