1. Fitzhugh Mullan. “The Mona Lisa of Health Policy: Primary Care at Home and Abroad,” Health Affairs, 1998; 17(2):118–26.

2. Primary Care: America's Health in a New Era, ed. Molla S. Donaldson, Karl D. Yordy, Kathleen N. Lohr, and Neil A. Vanselow (Washington, D.C.: National Academy Press, 1996), p. 1.

3. Institute of Medicine, A Manpower Policy for Primary Health Care (Washington, D.C.: National Academy of Sciences, 1978), pp. 16–20.

4. There is a considerable body of literature on the cost, quality, and patient satisfaction related to primary care. Particularly useful in this regard is chapter 3 entitled “The Value of Primary Care” in Primary Care: America's Health in a New Era, ed. Donaldson et al.; Barbara Starfield, Primary Care: Balancing Health Needs, Services, and Technology (New York: Oxford University Press, 1998); and chapter 1 entitled “What Is Primary Care?” in Eric J. Cassell, Doctoring: The Nature of Primary Care Medicine (New York: Oxford University Press/Milbank Memorial Fund, 1997).

5. Barbara Starfield, “Primary Care and Health: A Cross-National Comparison,” Journal of the American Medical Association, 1992; 268:2032–2033.

6. Avedis Donabedian as quoted by Fitzhugh Mullan in “A Founder of Quality Assessment Encounters a Troubled System Firsthand,” Health Affairs, 2001; 20(1):138.

7. Peter M. Senge, The Fifth Discipline: The Art and Practice of the Learning Organization (New York: Doubleday Currency, 1990) p. 3.

8. Important sources on the history of primary care in the context of the medical system in general are Rosemary Stevens, American Medicine and the Public Interest (Berkeley and Los Angeles: University of California Press, 1971; 1998), and Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982). The later chapters of John Duffy, The Healers: A History of American Medicine (Urbana: University of Illinois Press, 1976), are also helpful. The essays in John D. Stoeckle and George Abbott White, Plain Pictures of Plain Doctoring: Vernacular Expression in New Deal Medicine and Photography (Cambridge: MIT Press, 1985), tell a great deal about rural medicine in the pre–World War II period—particularly the chapter entitled “Primary Care in the 1930s” (pp. 52–80).

9. Committee on the Cost of Medical Care, Medical Care for the American People: The Final Report of the Committee on the Cost of Medical Care, Publication No. 28 (Chicago: University of Chicago Press, 1932), p. 63.

10. American Medical Association, Directory of Approved Internships and Residencies, selected years as cited by Stevens, American Medicine, and the Public Interest, p. 393.

11. Kerr White, T. Franklin Williams, and B. G. Greenberg. “The Ecology of Medical Care,” New England Journal of Medicine, 1961; 265:885–893.

12. This discussion of the history of family medicine is drawn from Family Practice: Creation of a Specialty: A Narrative of Events Leading to the Establishment of the American Board of Family Practice in 1969 and Reminiscences of Men Who Were on the Scene (Kansas City, Mo.: The American Academy of Family Physicians, 1980); Stanley R. Truman, M.D., The History of the Founding of the American Academy of General Practice (Kansas City, Mo.: Warren H. Green, Inc., and the American Academy of General Practice, 1969); R. Neil Chisholm, “The History of Family Practice” in Family Medicine: Principles and Practice, ed. Robert B. Taylor (Kansas City, Mo.: Springer-Verlag, 1978) pp. 7–12; and David P. Adams, “Evolution of the Specialty of Family Practice,” Journal of the Florida Medical Association, 1989; 76:325–329.

13. For a more complete discussion of the history of the nurse practitioner and physician assistant professions please see chapter 3 of this volume, “The New Clinicians.”

14. Association of American Medical Colleges, AAMC Data Book: Statistical Information Related to Medical Schools and Teaching Hospitals, January, 1999. Table B-13, p. 31.

15. The Registered Nurse Population, March 2000: Findings from the National Sample Survey of Registered Nurses—March 2000 (Washington, D.C.: Department of Health and Human Services, Health Resources and Services

16. American Academy of Physician Assistants, Information Update, October 8, 1999, Alexandria, Va., p. 3.

17. Sarah Brotherton, Frank Simon, Sandra Tomany, “U.S. Graduate Medical Education, 1999–2000,” Journal of the American Medical Association, 2000; 248:1121–1126.

18. Robert M. Wachter and Lee Goldman, “The Emerging Role of ‘Hospitalists’ in the American Health Care System,” New England Journal of Medicine, 1996; 335(7):514–517.

19. A. Fernandez, K. Grumbach, L. Goitein, K. Vranizan, D. H. Osmond, A. B. Bindman, “Friend or Foe?: How Primary Care Physicians Perceive Hospitalists,” Archives of Internal Medicine, 2000; 160(19):2902–2908.

20. Mary O. Mundinger et al., “Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians: A Randomized Trial,” Journal of the American Medical Association, 2000; 283:59–68.