The Opinion piece “Do We Need Primary Care?” by Douglas Iliff, MD [June 2007], generated a significant number of responses, many of them lengthy. Below are excerpts from selected letters. — FPM

Thank you for Dr. Iliff's editorial. In the last six months in our community, five primary care physicians have called it quits. Some have gone into hospital medicine, some have gone into the more controlled atmosphere of nursing home medicine, some have gone into the fringe of nutritional medicine and one will simply be driving a truck cross-country commercially. The rest of us are running as fast as we can. We cannot accept any more patients. The medical students from the local university have decided on careers out of primary care. They are not as blind as we were entering practice.

Family doctors need to be able to unify as a group and tell payers to take a hike, but it is illegal to do this and legislators are not about to let this change. Doctors are only allowed to write letters while payers have access to lawmakers. It doesn't take a rocket scientist to see how this scenario is going to end.

Dr. Iliff has wonderfully articulated the frustration - if not despair – that I and others have lived with for decades. He is clearly a very worthy advocate. Dr. Iliff writes with an attitude that I hope will be generalized among family physicians: informed, strong, articulate and courageous.

Remarkable. Dr. Iliff has clearly earned the right to talk about primary care. Capitalism abhors a vacuum at least as much as nature, and the gap between the supply of primary care physicians and the demand for primary care will increasingly be filled by those unencumbered by knowledge or experience. They will, however, be skilled at self-marketing.