Episode #152: The failing health of Primary Care in the U.S. – with Barbra Rabson MPH and Katherine Gergen Barnett MD


I began this interview in a fairly calm state of mind, but I was shaken by the end. Throughout our dialogue, I could not help repeating the word ‘startling’ as our two expert guests shared stats on the state of primary care in their home state of Massachusetts and across the country. For example, were you aware that only about 5% of the total healthcare spend in the U.S. is in primary care? That is startling given that the literature repeatedly demonstrates primary care to be the keystone in any effective healthcare system. It is troubling in that this is a far smaller percentage compared to other developed nations. And, it is of national concern given that the health outcomes in the U.S. continue to lag every other developed nation. In fact, a recent presentation at a NCQA forum #qualitytalks2023 (data derived from the KFF) showed a major dip in life expectancy in the U.S. whereas other developed nations continued to show improvement.  Early on in the interview, I asked Dr. Gergen Barnett how she would assess Primary Care, if it were a patient of hers. Her response, “It’s on life support”. 

They say you can’t fix what you can’t measure. To that end, we’ll also learn about a critical new step the Massachusetts Health Quality Partners (MHQP) and the Center for Health Information and Analysis (CHIA) have taken in beginning to measure the health of Primary Care through an annual dashboard of ‘vital signs’.  What gives me some hope are expert champions, like our guests this episode, who are dedicating their careers and their keen skills to solving the primary care crisis in our country. 

Barbra Rabson has led Massachusetts Health Quality Partners (MHQP) since 1998. Under her leadership, MHQP has become a national leader in the measurement and public reporting of healthcare information, with a particular focus on measuring and improving patients’ experiences of care. She serves on numerous state committees and boards including within the MA Dept of HHS, the Massachusetts Health Equity Data Standards Technical Advisory Committee, the Betsy Lehman Center Task Force on Measurement and Transparency. She also serves on the Board of the Massachusetts Health Data Consortium. Ms. Rabson received her Master’s degree in Public Health from Yale University and her undergraduate degree from Brandeis University.

Dr. Katherine Gergen Barnett is the Vice Chair of Primary Care Innovation and Transformation in the Department of Family Medicine at Boston Medical Center (BMC).She’s a Clinical Associate Professor at Boston University School of Medicine, an Associate at Harvard’s Center for Primary Care, and a Health Innovators Fellow at the Aspen Institute. Prior to joining BMC in 2009, Dr. Gergen Barnett attended Yale University School of Medicine and worked at the National Institutes of Health. She is a practicing physician, an active researcher, a medical educator and is involved in local and state health policy. She is also a regular contributor to The Boston Globe and Boston Public Radio.

In this interview, we’ll discover:

  1. Why primary care is critical to our public health and the viability of our healthcare system.

  2. The extreme lack of investment that has been crippling the field of Primary Care, and the challenges imposed by the predominant Fee-For-Service payment model.

  3. The novel ‘vital signs’ dashboard that the MHQP, in partnership with the Center for Health Information and Analysis (CHIA), has constructed to measure and monitor the health of primary care in Massachusetts.

  4. A number of startling stats in the domains of Primary Care Finances, Capacity, Performance and Equity.

  5. A few encouraging solutions that Dr. Gergen Barnett and her colleagues have been working on.


Some important points I took away from this interview.

It is well known that primary care is the keystone for a viable and sustainable healthcare system. Without it, the system crumbles under its own weight. There have been numerous studies and reports verifying this, including a seminal report last year from the National Academy of Science Engineering & Medicine which stated, “Primary care is the only health care component where an increased supply is associated with better population health and more equitable outcomes.”  Another conclusion from that report, “… primary care in the United States is fragile and weakening… [it is]… not configured to provide… comprehensive, preventive and chronic care needs…”

By all accounts, our primary care system is in bad shape and getting worse. It’s not a stable situation. You can get a sense of this by going onto the MHQP/CHIA website and reviewing the Primary Care Dashboard they’ve constructed.  There are also some additional links at the bottom of these show notes, provided by our two experts.

Despite the failing state of Primary Care, we are continuing to see gross underinvestment and a relative lack of research. I was shocked to discover that only 0.2% of all NIH funding goes toward Primary Care research. Research is always the first step to a better future. This stat demonstrates that we’re stepping backwards, not forward when it comes to the state of primary care in the U.S.

While MHQP, CHIA and others, such as the Milbank Fund, are measuring and monitoring the state of affairs, it does not appear that political leaders at the state and federal level are aware of the looming crisis and its ramifications. 

We all need to do more to raise that awareness, or face the consequences.  And time is of the essence. From my perspective, we are heading into a perfect storm – an increased need and demand, a decreased supply, and rising costs and inequities of care that will leave a majority of Americans without access to care. To that end, I’ve included a number of links to further inform you and catalyze action.

Final thought – there are two scenarios – two situations we might find ourselves in a few years from now.  

One scenario is a crisis – and I suspect that we’ll be looking at one another and wondering why we didn’t act, especially when the facts were so apparent. 

The other scenario is a crisis abated – and I suspect we’ll be looking at one another with gratitude that we did act.  

Which one of those two scenarios we find ourselves in is a direct function of what our leadership – our healthcare leaders and our political leaders – do today. It’s a function of what we do today. I left this interview dumbfounded, frustrated and inspired to speak out even more. I’m curious how it leaves you. And even more curious about what you’re going to do about it. 

For starters – please share this podcast with anyone and everyone you know, including your congressional representatives. It is nothing less than a matter of life and death. 

Until Next Time,

Zeev Neuwirth, MD