One obstacle to primary care sustainability is the primary care personality itself. People who go into primary care are selfless and self-sacrificing. That's nice, but their aversion to getting paid what they're worth means they can't hire good staff, because they don't earn enough to pay their staff what they're worth; and young trainees don't go into primary care, because they quite reasonably want to be able to afford a mortgage and send their kids to college.

Medical specialists and their associations fight for their pay. Primary care professionals shrug.

This self-destructive selflessness has deep, unconscious Puritan roots, like so much in modern Western countries. Dan Pallotta gave an influential 2013 TED Talk on the unsustainability of nonprofit work, explaining that in the Puritan mind, "Financial incentive was exiled from the realm of helping others."

High-functioning and appropriately-compensated primary care is NECESSARY to every country's health. That won't happen until leaders save primary care from itself.

Thanks Merilee, I agree! I also laugh as this is so pertinent to me today - why have I been accepting a lower pay grade that I should ? I will check out Dan Pallotta's Ted talk. Talking about pay with colleagues can feel like an 'unEnglish' and impolite thing to do, which is ridiculous. I will enjoy chewing this over with friends...

Thank you for asking your fundamental question!

Ted Pallotta's TED talk explains a lot. We go into primary care like we're doing charity.

LInk: https://www.ted.com/talks/dan_pallotta_the_way_we_think_about_charity_is_dead_wrong/transcript?subtitle=en