Wanted: This Kind Of Primary Care

Over Here, We Need More Of This Primary Care:  Dr. Sullivan showed up twice during a 79-year-old’s hospitalization this week in central Connecticut. The woman, 81 pounds, osteoporosis, 2 months removed from another bone density test failure, strong signs of dementia, fell at home for her first hospital visit. The woman, Joyce, was boarded for a day for observation, then eventually admitted to a room. Boarding is a big problem for hospitals who lack staff, and it is likely to get worse with a spike in disenrolled Medicaid patients without primary care. Joyce’s doctor was notified by her son, and also by an alert from the hospital. His visits here and later to Joyce’s home are a signal of what the health system needs more – primary care not so much in a 10x14 square foot office without the lens of what’s happening at home, but instead at points of crisis and points of impact. There was a gentleness to the doctor’s interactions – his cadence, posture, pauses, and questions. “In some ways, the fall was what she needed, now we have to try to prevent the cycle – this got the family’s attention,” he said to me days later. If you’re investing in primary care, think of it not just in terms of a billable visit but critical care for aging. The value of these visits and then the potential to use them to get paid to help hospitals handle the rising staffing crisis, and help government insurers, Medicare and Medicaid reduce the frequency of falls. The good is there’s a shade more interest from young people in primary care jobs. A record-high 20,712 primary care residency positions were offered in the 2026 residency match, up 412 slots over 2025, with 92 filled, but this is still less than half the number of surgical slots (~44,000). I wonder if we doubled the reimbursement for primary care doctors to go do what Dr. Sullivan does – meeting the folks where they’re at, changing behavior one visit at a time?