The primary care crisis and health care reform.

P care crisis is a phrase we have heard many times. Often, it reflects not just a societal circumstance but the reality for health care professionals working firsthand with the medically underserved or vulnerable populations. These professionals are considered safety net providers because they deliver health care to uninsured patients, underinsured patients, and Medicaid patients. Safety net providers work in community health centers, federally qualified health centers, public hospitals, school-based clinics, teaching and community hospitals, and local public health clinics.1 Without safety net providers and their supporting institutions, many communities would have little or no contact with the health care system. Health care reform must ensure that our workforce is able to meet the demands of delivering primary care to patients. Program funding, financing mechanisms and incentives, and implementing infrastructure changes are all needed to ensure that clinicians are attracted to primary care, faculty are in place to educate health care professionals, and health care delivery is efficient and effective. Ameliorating the problems presently impeding primary care delivery involves more than just training additional doctors to become primary care physicians. At the core of the debate are several issues: (1) how to address the financial reimbursement inequities seen in primary care and specialty care; (2) how health care will be delivered; (3) which professionals will provide primary care, oral health care, and behavioral health care; and (4) how emerging technologies will be used. If these issues are not addressed, health reform agreed upon by politicians may not be adequate for the patients, the health care workforce, or health care institutions.