Andy Bonner
VerifiedArticles by Andy Bonner
Canada’s primary care investment is missing a North Star
Something remarkable is happening in Canadian health policy right now. After decades of incremental change, provinces and territories are making serious, sustained investments in primary care. These bilateral health agreements represent a genuine federal-provincial commitment, billions of dollars directed toward the kind of team-based, patient-centered care that Canadians have been asking for. The people designing these investments care deeply. The intent is right.
What clinical research nurses do that no one sees
A clinical trial may be remembered for a breakthrough treatment, a new therapy, or a headline-making discovery. But its true story begins with people. Behind every promising result is a patient placing their trust in the unknown, and a clinical research nurse or study coordinator standing beside them every step of the way. When people think about clinical trials, they often think about physicians, sponsors, study results, and scientific discoveries.
Private equity in direct primary care is winning
The independent medicine community celebrated when the numbers dropped. Eighty-three percent growth in practice sites. Seventy-eight percent more clinicians. Conference decks updated overnight. Nobody asked who owns them now. The Health Affairs data is real. The growth is real. What the numbers do not show is ownership. And ownership is where the story changes.
Why pediatric direct primary care belongs at the door
It starts the same way every time. A parent sends a text at 10:47 p.m. Their two-year-old has had a fever for three days. The urgent care closed at nine. The ER is 45 minutes away and will cost them $400 before anything is done. The on-call nurse line put them on hold. So they do what parents in 2026 do: They scroll, they worry, and they wait for morning. I built my practice so that text comes to me instead. I am a board-certified pediatrician in Charlotte, North Carolina. I see children ages 0 to 22.
The direct primary care HSA rule did not fix access
In a few weeks, the direct care community will celebrate the one-year anniversary of getting what it had been asking for. By the end of the first quarter, before the rule had been in effect for a single full billing cycle, it was already clear that the more consequential effect was not affordability. It was market design. As I wrote in January, when tax-advantaged dollars enter a care model, they reorganize incentives, accelerate intermediary involvement, and clarify who holds leverage.
How to assess liver fibrosis in primary care
A 22-year-old came to my office because he wanted to “get on track” with his health. He was not in crisis. He did not feel sick. His labs were concerning, but not unusual for primary care: triglycerides in the 250s, a hemoglobin A1C near the diabetic range, elevated blood pressure and central obesity. Then I reviewed his liver stiffness measurement. F3 fibrosis. That result was hard to believe. Over time, it prompted me to reconsider how I evaluate metabolic risk in my practice.
3 fixes for primary care access in the ChatGPT era
A new patient in her 40s recently walked into one of our clinics with a printout of a ChatGPT conversation. For three days, she had been typing her symptoms into the chatbot, describing chest tightness and a fatigue that was not going away, asking whether she should be worried. The reason she turned to AI was straightforward. She had tried to schedule a primary care appointment with her previous provider and was told the next available slot was six weeks out.
Fragmented care needs clinical direction, not more data
Patients often assume that someone is directing their care. That there is a clinician who sees the whole picture, integrates the information, and guides what happens next. In many cases, that is not how modern care is structured. Patients move between clinicians (primary care, specialists, urgent care, consultants), each focused appropriately on a specific aspect of the problem. Each encounter may be thorough. Each decision may be reasonable. Each plan may be appropriate within its context.
Primary care, bloodletting, and what medicine got right [PODCAST]
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes! Robert C. Smith is best known for arguing medicine lost its mind. This episode he explains why he is still proud to be a doctor. Primary care physicians deliver 75 percent of the nation’s mental health care without training for it, and Smith has spent his career trying to fix that.
Primary care crisis requires new training and skills
The primary care crisis has been well documented. Experts cite low pay, lack of respect and administrative burden, all of which have contributed to burnout and a growing shortage of primary care physicians (PCPs). But even if we solve those problems, are PCPs well-prepared to care for an increasingly older, sicker population saddled with psychiatric disease? For many PCPs practicing today, the answer is no. There are myriad reasons for this, many of them beyond the PCP’s control.
Primary care access is the real problem, not the system
Primary care is often described as broken, but that diagnosis misses the real issue. The clinical foundation remains strong. The problem lies in how access to care is designed and delivered. Primary care isn’t broken; access is. People can manage nearly every aspect of their lives instantly through technology, yet health care still relies on outdated models that require patients to wait days or even weeks for routine care. This creates frustration for patients and unnecessary strain on clinicians.
I Googled my own name and a corporate clinic I’ve never worked at appeared [PODCAST]
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes! What happens when a physician searches her own name online and gets redirected to a billionaire-backed corporate clinic she has no connection to? Stephanie Waggel, a physician and founder of Improve Medical Culture, explains how vertical integration in health care is quietly suffocating independent practices while most doctors and patients have no idea it is happening.
AI is already reading your dental X-rays and you probably have no idea [PODCAST]
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes! When was the last time your dentist mentioned that artificial intelligence was scanning your X-rays before you even sat down in the chair? General dentist Sowjanya Gunukula explains how AI is quietly transforming routine dental checkups in ways most patients never hear about.
Why relationship-centered care matters in medicine
I started volunteering on Saturday mornings out of a feeling of restlessness. Having been in primary care for several years, I was looking for something new, to break from routine, and to feel like I was doing real good. Which is how I ended up at our medical student-run free clinic, and have been blessed with an opportunity that has grown into a primary passion of mine. We see mostly Spanish-speaking patients, many undocumented, who come with a variety of both medical and social challenges.
The hidden clinical cost of HCC coding in primary care
I am in the exam room, leaning forward hearing my elderly patient describe weeks of worsening fatigue. Her daughter fills the gaps as her mother, hard of hearing and anxious, struggles to find the right words. Her recent lab work shows a steep drop in her blood count. We are working together to understand what is going on.
Balancing part-time clinical work and motherhood
It was a typical weekday morning. I woke up at 5:20, started a load of laundry, showered, dressed, unloaded the dishwasher, got the kids breakfast and lunch together, fed the pets, etc. After sending my husband off to work, I got the kids up and ready for the day. Things were going smoothly. I got my kids to school on time, and got into work early enough to go through email and have a meeting with one of the resiliency leaders to discuss revamping our department peer support program.
Why primary care physicians are fighting back against pajama time
I really tried to have AI come up with an innocuous-sounding title for this piece: “Caring Hearts, Lighter Wallets: The Financial Reality of Primary Care.” But my poor judgment prevailed so I just decided to insult all of my colleagues right from the start. I assure you, for better or worse, that this article is my original opinion although with AI editing for grammar and clarity (but unfortunately not brevity).
The cost of time constraints in primary care: Why doctors feel rushed
A patient comes in with hip pain. It is not dramatic hip pain. There is no trauma and no fall. It is just a gradual ache that now wakes her up at night. She cannot sit comfortably. Getting in and out of the car is harder, and she is worried. The X-ray is normal. Now what? In another era, this is where medicine began, not ended. It began with history, examination, and watching her walk. It meant assessing range of motion, thinking about the kinetic chain, and considering lumbar referral.
Primary care compensation models: Why wRVUs are obsolete
It is time to dethrone the office visit as the king of primary care physician compensation and how the work of a primary care physician is defined. Several months ago, a reporter asked me how many patients I see in a typical day. I told her that the question should not be how many patients I see each day, but how many patients I take care of each day, a number that is significantly greater. Why office visits rule is no mystery.
Securing physician autonomy with employer-sponsored direct primary care
I play Go. Not chess. Not checkers. Go: the ancient strategy game where the objective is not to capture pieces but to claim territory. In chess, you attack. In checkers, you jump. In Go, you place. Each stone lands quietly. Each position builds on the last. The opponent is still arguing about three moves ago while the board is already decided. The board has been built one placement at a time.
The economic shift from fee-for-service to direct primary care
According to the Primary Care Collaborative, primary care accounts for roughly 5 percent of health care spending, yet it influences nearly 90 percent of downstream costs. That statistic is not a compliment. It is a diagnosis. And for a profession that has spent decades accepting influence as a substitute for economic ownership, it is long past time to read it that way. For decades, physicians have been told their value lies in prevention, coordination, and stewardship.
Primary care receives only five cents of every health care dollar [PODCAST]
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes! Family physician and health benefits advisor Jonathan Bushman discusses his article “The 5 percent problem: the low value of primary care.” Jonathan contrasts the grueling decade of training and massive debt required to become a doctor with the thirty-minute process of obtaining a health insurance broker license.
The necessity of getting lost to find yourself
We are born into corridors, measured, labeled, painted neutral, walls rising before we learn how wide our thoughts can stretch. Lines are drawn early: This is far enough, this is acceptable, this is where you stop. We are told our ideas must sit quietly, folded into boxes like unused maps, that imagination is dangerous if it wanders, that questions should behave and answers should already be known. Life, they say, is safest when it stays inside the margins.
Primary care offers unexpected financial and emotional wealth [PODCAST]
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes! Primary care physician Jerina Gani discusses their article “The hidden rewards of a primary care career.” Jerina challenges the common narrative that general practice is merely a stepping stone filled with paperwork and low wages. She explains how physicians can unlock scalable income and schedule flexibility to build a prosperous career in health care without sacrificing personal well-being.
Senior financial scams: a guide for primary care physicians
In an increasingly digital world, older adults are often viewed as prime targets for financial scams. These malicious schemes exploit vulnerabilities inherent in aging, such as social isolation, cognitive decline, and trustfulness. As primary care physicians, we are in a unique position to recognize the signs of vulnerability in our older patients.
Waking up at 4 a.m. is not required for success [PODCAST]
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes! Physician, former health care executive, certified coach, speaker, and organizational consultant Laura Suttin discusses her article “Why the 4 a.m. wake-up call isn’t for everyone.” Laura shares her personal struggle with the popular productivity advice that claims early rising is the only path to high performance.
Patient expectations in primary care: the structural mismatch
Patient frustration is something many of us carry home at the end of the day. Much of that frustration, however, isn’t personal; it’s structural. Many patients don’t realize that different primary care models are designed to deliver fundamentally different experiences. They expect concierge-level access and time within insurance-based practices. They want same-day appointments, unhurried visits, and immediate physician availability, regardless of the model they’re in.
Why the primary care system failure forces unnecessary referrals
A patient with diabetes, hypertension, and obesity comes in for her annual wellness visit. The physician has already spent 20 minutes on chronic disease management and lifestyle guidance. As the visit wraps up, the patient mentions daily heart palpitations that started a month ago. The exam was benign. The physician has two choices: spend another 20 minutes performing an EKG, discussing differential diagnoses, and developing a workup plan; or refer to cardiology. The physician refers to cardiology.
Why they aren't interchangeable
I read Zoe Crawford’s thoughtful KevinMD essay on the limitations of direct primary care (DPC) with great interest. Her frustration as a medically complex patient navigating a fragmented health care system will resonate with anyone who has struggled to obtain timely imaging, referrals, or specialty care.
The hidden depth of the rural primary care shortage
Today I am a urologist, a cardiologist, a psychiatrist, a rheumatologist. But truly, I am a rural family medicine doctor in one of the most underserved counties in the country. And I am tired. I do not pretend to have the depth of each specialist. What I have is necessity, a toolkit built on scarcity. Practicing medicine on an island, where specialists are rare, calendars are full for months, and visiting clinics are as fleeting as rainbows, means my boundaries dissolve.
Direct primary care limitations for complex patients
All of the arguments for direct primary care (DPC) from a provider perspective are valid. As a psychotherapist and psychoanalyst, I have essentially run a direct care practice for the last 15 years. I don’t accept insurance and see patients as often and for as long as therapeutically necessary. So when DPC practices started rising in popularity, I was excited to try it.
Is primary care becoming a triage station?
Let’s discuss primary care. That’s primary care, as in P-R-I-M-A-R-Y C-A-R-E. Why the emphasis? Because I believe high-quality primary care is the bedrock of a well-functioning health care system. Because I believe access to primary care is a marker of a healthy nation. Because I believe quality primary care can save lives, extend lifespan and healthspan, and importantly: Because I believe quality primary care can reduce health care costs. Sadly, I don’t believe we have any of the above today.
What heals is the mercy of being heard
There are pauses in life that stretch like thin threads between two cliffs fragile, invisible, yet holding everything that matters. In those long silences when the air thickens and the mind becomes a loud companion, I wonder are these pauses gifts of grace, spaces to gather courage, a chance to map the next step forward? Or are they doorways through which fear seeps in and takes its seat inside my chest?
Why modern dentists must train like pilots [PODCAST]
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes! Dentist Lincoln Harris discusses his article, “How cloud-based simulation training is revolutionizing dentistry.” Drawing on his background as a pilot, Lincoln exposes the critical training gap in modern dentistry, arguing that dentists (unlike pilots) are not prepared for real-world, high-stress scenarios.
Is direct primary care sustainable in a downturn?
Primary care innovation has always been framed around access, autonomy, burnout, and patient experience. Direct primary care (DPC) in particular is often positioned as a solution for physicians exhausted by fee-for-service complexity and for patients who want a more personal relationship with their doctor.
The Silicon Valley primary care doctor shortage
Not long ago, a friend told me, “I switched insurance and can’t find a doctor who will take me.” Another said, “I left Kaiser after going on Medicare and now no one will see me.” These aren’t isolated complaints. They’ve become the new reality in Silicon Valley: It’s easier to buy a multimillion-dollar home than to find a new primary care doctor. I saw this problem firsthand before I retired from full-time practice at the end of 2020.
Direct primary care in low-income markets
Even the most “affordable” DPC models struggle in lower-income markets because the behavioral economics of these populations create high churn and unstable revenue. Practices that succeed in underserved areas nearly always diversify into employer partnerships, institutional contracts, or expansion into higher-income neighborhoods. Without understanding these behavioral and economic realities, physicians risk building a model the community cannot sustain long-term.
The 5 percent problem: the low value of primary care
I spent 11 years becoming a family physician. Four years in undergrad, four in medical school, three more in residency. That’s a decade of delayed income and about $300,000 in debt, all for the privilege of practicing in one of the most critical, underappreciated corners of medicine: primary care. I came out idealistic. I wanted to build relationships, prevent disease, and guide people through the chaos of a broken system.
Why physicians must not suffer in silence [PODCAST]
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes! Neurologist Scott Abramson discusses his article “Why ‘the best physicians’ risk burnout and isolation.” In this YouTube-optimized episode, Scott reflects on the ancient Talmudic teaching that warns how pride and perfectionism can become a physician’s downfall. He explores how the culture of grit, self-sacrifice, and fear of vulnerability leads many doctors to burnout and emotional isolation.
Silicon Valley's primary care doctor shortage
Not long ago, a friend told me, “I switched insurance and can’t find a doctor who will take me.” Another said, “I left a leading integrated health plan after going on Medicare and now no one will see me.” These aren’t isolated complaints. They’ve become the new reality in an affluent U.S. region: It’s easier to buy a multimillion-dollar home than to find a new primary care doctor. I saw this problem firsthand before I retired from full-time practice at the end of 2020.
A poem about being seen by your doctor
I come to you with stories I cannot name. They press against my chest waiting for a moment when it feels safe for them to be set free. Pain is a language I find difficult to speak aloud, and the silence between us feels like a waiting room that will never empty, pressing in on me, catching my breath. Two strangers, white walls between us, your eyes move toward the clock, while mine look at my folded hands resting in my lap.
Why humanity matters in medicine [PODCAST]
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes! Certified coach and professor Kathleen Muldoon discusses her article, “The humanity we bring: a call to hold space in medicine.” She shares how her experience as a mother in the neonatal intensive care unit transformed her understanding of empathy and reshaped how she teaches future clinicians.
Why are we devaluing primary care?
The first day I walked into my residency clinic, I realized this was the part of medicine I understood the least. The waiting room was full, and every patient carried not just a diagnosis but the weight of a system already stretched thin. We learned to triage, to document, and to move quickly. But we did not learn how to lead, how to build continuity, or how to see the clinic as the heart of medicine. In training, the hospital was where the “real” work happened.
Why direct primary care (DPC) models fail
I’m going to say something controversial: the DPC community’s obsession with “purity” is missing the point. After two decades designing health care financial models, negotiating payer & vendor contracts, and building compliance frameworks, I’ve learned that most alternative payment models don’t fail because they’re impure. They fail because someone forgot to do the math.
Leadership is about pulling others up
When I first stepped onto a college campus, I was the first in my entire family to do so. Coming from a humble immigrant background, community college was my gateway. Like many community college students, I was nontraditional, new to the country, starting from scratch. This was my first exposure to the American educational system, and I was just trying to figure it out while working multiple jobs.
The Cap'n Crunch philosophy of medicine
Cap’n Crunch never held a true naval rank; he was called “Cap’n” because he was the highest-ranking person present, not because he replaced someone more qualified. In some clinics, it is the same: the system is built so you rarely, if ever, see a real doctor. Whoever is around with the right badge simply gets the title and responsibility by default. This “Cap’n Crunch” phenomenon is not limited to one quirky clinic; it is happening all over America.
How one physician redesigned her practice to find joy in primary care again [PODCAST]
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes! Primary care physician Jerina Gani discusses her article “My journey to loving primary care again.” Jerina shares her deeply personal story of nearly walking away from medicine after burnout, exhaustion, and endless administrative burdens drained the joy from her work.
The hidden rewards of a primary care career
The overlooked treasure of primary care: Why this field is more rewarding than most realize Primary care often carries a reputation: long hours, too much paperwork, and not enough pay. Many providers see it as a burden, a stepping stone, or simply “less glamorous” than other specialties. But here is the truth most clinicians overlook: Primary care holds hidden rewards, both financial and emotional, that can transform not just your practice, but your life.
Unity in primary care: Why I believe physicians and NPs/PAs must work together toward the same goal
In today’s health care system, primary care is stretched thin. Patients face longer wait times, providers are burned out, and practices are under constant pressure to do more with less time in their hands. In the middle of this strain, I have noticed a troubling trend, divisions between physicians (MDs, DOs) and nurse practitioners (NPs) or physician assistants (PAs). I strongly believe that patients and even all of us do not benefit from division. We all benefit from collaboration.
This isn't burnout, it's moral injury [PODCAST]
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes! Family physician Jonathan Bushman discusses his article, “The hidden moral injury behind value-based health care.” He shares the story of a young physician who was told to remove her most complex patients from her panel to protect the health system’s performance metrics. Jonathan uses this powerful example to explain moral injury: a deep, ethical wound that is fundamentally different from burnout.
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