Wonderful and Broken: The Complex Reality of Primary Care in the United States

How can we save primary care from collapse and improve health care outcomes?

Primary care in the United States faces an existential crisis. Its value is unchallenged: policy experts argue that the primary care sector is critical to the quality and equity of the health care system. On the other hand, studies show that primary care is underfunded, providers are struggling with burnout, and patients increasingly lack access to primary care. In Wonderful and Broken, Troyen A. Brennan offers a timely exploration into the precarious state of primary care in the American health system today. Drawing on years of field research and firsthand accounts from clinicians, this book paints a picture of both the current struggles and emerging solutions that define the primary care landscape.

With health care costs rising and clinician burnout at an all-time high, Brennan examines whether value-based care can truly rescue primary care from the brink of collapse. At the heart of this book are the compelling stories of doctors, nurses, and care teams who are forging a new path, championing preventive care, and prioritizing patient relationships. From the efforts of government policies to the involvement of venture capitalists, the book unveils the multifaceted approaches being employed to shift health care from a fee-for-service model to one centered around value, quality outcomes, and equitable access.

But will these efforts be enough? Brennan does not shy away from the hard questions, offering both a critique of past failures and a roadmap for a hopeful future. Essential reading for policymakers, health care professionals, and anyone concerned about the future of American health care, Wonderful and Broken illuminates the pivotal role primary care must play in achieving sustainable and effective reform.