Why Primary Care Needs a Redesign
Jan Van Acker set the stage by describing a “perfect storm”: aging populations, rising chronic disease, physician shortages, and burnout that threaten the foundation of care globally. Primary care receives a fraction of health spending in many countries, yet carries the weight of coordinating complex, lifelong conditions.
When asked what must be addressed first, Susan Edgman-Levitan was unequivocal: “Payment models are absolutely critical.” Without fixing how primary care is funded, she warned, even the most innovative ideas will fail to scale.
Others emphasized the need to zoom out and start from first principles. Dr. Per Mattsson urged countries to step back and ask: If we removed existing structures, how would we design care around the patient? Every system has constraints, he argued, but redesign begins with re-imagining.
Team-Based Care, Technology, and Meeting Patients Where They Are
Across regions, panelists agreed: primary care can no longer be the work of one clinician alone.
Caroline Goldzweig underscored the importance of empowering full care teams; nurses, coordinators, and specialists, to manage patients with complex, chronic needs. Better coordination, she said, leads to better outcomes and better use of resources.
In Singapore, Professor Lee described the “Healthier SG” teams, modular groups combining physicians, community nurses, and “well-being coordinators” who follow patients over their lifespan. Physical care, virtual tools, and community partnerships work together to deliver value.
Dr. Luxemburg shared how in Israel, the lines between hospital and community care are blurring, intentionally. Specialists spend mornings in hospitals and afternoons as primary care clinicians; digital tools bring care into the home; and HMOs increasingly manage conditions once treated only in hospitals. The goal: strong, integrated care delivered where people live.
Do We Still Need Primary Care Physicians in the Age of AI?
The panel’s answer was a resounding yes.
Edgman-Levitan noted that physicians remain the anchor of continuity and trust. But she warned that the U.S. system, where primary care receives only 5% of health spending, cannot sustain the role without structural change.
Singapore’s model, Lee added, ensures physicians work within supported teams rather than alone, a structure strengthened, not replaced, by technology.
Dr. Luxemburg emphasized that AI should free clinicians to return to what they love, real connection with patients, rather than replace them. Digital tools, she said, must enable more time “looking the patient in the eye, not typing behind a screen.”
Burnout, “Pajama Time,” and the EMR Burden
Burnout remains one of the most pressing issues.
As Caroline Goldzweig explained, pajama time refers to the hours physicians spend at home, late at night, finishing the electronic documentation that doesn’t fit into their clinic schedule. It is the hidden second shift that sits on top of an already overwhelming clinical workload.
At Cedars-Sinai, Goldzweig shared, more than 60% of primary care physicians reported burnout in recent internal surveys, a trend that intensified during the pandemic . When leaders went on listening tours to understand the root causes, two issues surfaced repeatedly: insufficient staffing—much of it lost during the pandemic—and an expanding documentation and EMR burden that consumed disproportionate time and emotional energy.
One recent study, she noted, found that PCPs spend a median of 62 hours per week on work, despite having only 36–40 hours of scheduled clinic time. “That,” she emphasized, “is a lot of after-hours pajama time” . And it is this invisible workload—rather than a lack of resilience or need for more mindfulness programs—that is pushing many clinicians to the brink.
AI tools like ambient scribing hold promise, but panelists warned of risks. Patient feedback at Mass General showed discomfort and mistrust when ambient AI was introduced without clear communication about privacy and data use. Some patients even sought new PCPs.
The message: technology must reduce burden and strengthen trust, not erode it.
Home-Based Care: Trying, Adjusting, Iterating
Dr. Per Mattsson shared Sweden’s experience bringing complex care, from heart failure monitoring to chemotherapy and transfusions, into patients’ homes. The model is still imperfect, he admitted, but reflects a philosophy of “try, adjust, try again.” Transformation rarely waits for perfect reimbursement; systems must evolve alongside practice.
What Should FOH Do Next?
In closing, Van Acker asked each panelist what FOH should do next to turn ideas into action.
Caroline Goldzweig: Prioritize mental health, especially AI-enabled triage tools that support PCPs managing rising demand.
Osnat Luxenburg: Establish a shared vision for primary care transformation, then exchange concrete implementation strategies across countries.
Professor Lee: Bring the “dreamers and designers of care” together to co-create models that can be adapted to each jurisdiction.
Dr. Per Mattsson: Create spaces where people who rarely collaborate, primary care, hospitals, technologists, policymakers, can problem-solve together. “Multidisciplinary Sunday lunches,” as he put it.
Edgman-Levitan: Redesign primary care with all stakeholders at the table, but ensure a clear path to sustainable funding, or reforms will fail.
The Takeaway
Across geographies and systems, one message echoed throughout the session:
Strengthening primary care is essential, not optional, for managing chronic disease, sustaining the workforce, and delivering equitable, high-value care.
But transformation requires more than vision. It demands aligned incentives, empowered teams, thoughtful use of technology, and a willingness to redesign, together.
