Dr. Lisa Rosenbaum tells committee primary care needs more resources, warns measurement can 'dumb down' care

Dr. Lisa Rosenbaum, a cardiologist and host of a primary‑care series for the New England Journal of Medicine, told a legislative committee that the United States has chronically undervalued primary care and must direct more resources to it.

“There is no primary care without a relationship,” Rosenbaum said, arguing that policy focused narrowly on measurable metrics — blood pressure targets, screening checklists and other value‑based indicators — misses core, relationship‑based work.

The committee had invited Rosenbaum in advance of an incoming Senate bill on primary care. A committee member asked whether the discussion referred to S.197; members noted the bill’s timing depends on Senate scheduling. Rosenbaum declined to offer a specific legislative prescription but stressed broad goals: restore clinician autonomy, invest in community‑based training and fund care teams that help patients with social needs.

Rosenbaum described how an initial assignment to study concierge medicine revealed deeper problems in primary care: when physicians have resources to spend longer with patients, they can act as a care “quarterback,” but the system’s incentives often push toward specialist referrals and throughput. She cited an economics study in which the loss of a primary care physician was associated with increases in mortality, emergency department visits and hospitalizations and — the study’s estimate — about $46,000 in additional Medicare spending associated with each departing PCP. The reading she presented also noted only about 23 percent of patients form a new long‑term relationship with another PCP after losing one.

Committee members pressed Rosenbaum on operational questions. A retired family nurse practitioner told the panel that building relationships is hard to operationalize given infrequent visits; Rosenbaum replied that autonomy and community‑specific approaches matter, and that investing in rural family medicine residencies and Federally Qualified Health Centers can help build clinician pipelines and sustain local practice.

Rosenbaum also criticized the modern emphasis on checklists and screening performed as data‑collection tasks rather than clinical conversations. On depression screening, she said turning a sensitive topic into a checkbox can reduce opportunities for authentic discussion and is less helpful if communities lack referral resources.

She noted the cost and administrative burden of capturing quality data — EHRs and staff time — and questioned whether many current quality measures have meaningfully improved care outside narrow inpatient safety checklists. “Quality matters,” she said, “but it’s gone too far as a costly industry that may not match what actually makes care good.”

Members raised policy options. One member described a personal preference for broad access to timely primary care and floated the idea of state support for more direct or concierge‑style access; Rosenbaum said direct primary care models cost far less than concierge medicine and could, in theory, be structured to expand access (she cited proposals that would use primary care dollars to support direct models and suggested Medicaid could explore coverage pathways).

Rosenbaum offered to provide the committee with podcast episodes and written essays she has published and encouraged the panel to focus on community‑specific solutions, training investments and funding care teams who can address mental health, nutrition and other social supports. The committee closed by asking her to share resources through the committee assistant and adjourned.