Not Otherwise Specified Alive and Kicking
Oct 15, 2025
Asaf Bitton, a primary care physician and health system innovator at Ariadne Labs and Harvard Medical School, discusses why primary care is undervalued. He explores the gap between patient relationships and a system that rewards episodic, high-cost care. Conversation covers AI and team-based care, payment and academic incentives, workforce challenges, and guarded optimism for reform.
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Patients Surprised By Primary Care's Wide Scope
- Patients often don't realize the full scope of primary care services, like skin biopsies, toenail removal, or Suboxone treatment.
- Ben Davis (quoted by Lisa) and a Seattle PCP recount new patients surprised primary care can handle many procedures.
System Favors Episodic Care Over Longitudinal Primary Care
- The U.S. system privileges episodic, procedure-driven care while underinvesting in longitudinal primary care.
- Asaf Bitton notes primary care's core functions are trusted continuous relationships and coordination, yet spending on primary care has fallen to ~3.5–5% of total health dollars.
AI and APPs Are Augmentation Not Replacement
- Replacing primary care with APPs and AI misunderstands primary care's complexity and relational role.
- Bitton argues team-based care augmented by AI is augmentation not replacement, because primary care manages social context, multimorbidity, and care coordination.