• Center on Health Equity and Access
  • Clinical
  • Health Care Cost
  • Health Care Delivery
  • Insurance
  • Policy
  • Technology
  • Value-Based Care

Top-Down Demands on Primary Care Creating Medical Populism in Response to Burnout, AJMC® Commentary Says


The forces leading to detachment and depersonalization among burned-out primary care physicians are similar to the factors responsible for populist movements—the perception of a rigged system favoring a managerial elite, according to a commentary in the December issue of The American Journal of Managed Care.®

(CRANBURY, N.J. — December 6, 2018) – In a thought-provoking commentary in the current issue of The American Journal of Managed Care® (AJMC®), a family physician draws parallels between populist movements in society and physician burnout in primary care and warns that the failure of healthcare leaders to recognize the systematic issues facing the profession portends a worsening shortage of primary care doctors.

James O. Breen, MD, a board-certified family medicine practitioner with Lee Physician Group in Fort Myers, Florida, writes frankly about the anger felt by physicians as they grapple with an ever-increasing set of regulatory burdens, obsession with quality metrics, and struggles with reimbursement imposed from the top of the medical elite—governmental payers, agencies, state medical boards, legislators, and medical associations.

Comparing the frustration felt by doctors with that of people who feel that they are not being heard by their government, Breen notes that populist movements, whether they are disparaged or commended, are based on sharp distinctions between “everyday people” and “elites.”

“The perception of corruption, opacity, and technocratic complexity leads adherents to challenge a rigged system tilted in favor of those who make the rules at the expense of everyone else. This alienation thus undermines the legitimacy of established institutions of governance and order,” he writes in the commentary, “Primary Care Burnout and Populist Discontent.”

One signal of this discontent, Breen says, is growing interest in an alternative payment model called direct primary care (DPC), in which providers forgo insurance arrangements in favor of monthly payments from patients, with whom they can then spend more time. (DPC is different from concierge practices, which may still bill insurance companies in addition to collecting fees from patients for an enhanced level of service.)

By rebuffing all payers, DPC physicians also remove themselves from some administrative burdens, Breen notes.

Failure of healthcare leaders to do more than tweak work environments with stress-relief initiatives or similar marginal efforts to tackle burnout will only fuel the growing discontent among primary care doctors, who may in turn remove themselves from the established medical system by continuing to set up DPC arrangements, create alternatives, or seek early retirement, Breen warns.

For more information, visit www.ajmc.com.

About The American Journal of Managed Care®

The American Journal of Managed Care® (AJMC®) is a peer-reviewed, Medline-indexed journal that keeps readers on the forefront of health policy by publishing research relevant to industry decision makers as they work to promote the efficient delivery of high-quality care. AJMC.com is the essential website for managed care professionals, distributing industry updates daily to leading stakeholders. Other titles in the AJMC® family include The American Journal of Accountable Care® and two evidence-based series, Evidence-Based Oncology and Evidence-Based Diabetes Management. These comprehensive offerings bring together stakeholder views from payers, providers, policymakers and other industry leaders in managed care. To order reprints of articles appearing in AJMC® publications, please contact Gil Hernandez at 609-716-7777, ext. 139.

AJMC® Media Contact

Alexandra Ventura, 609-716-7777, ext. 121


John Patricolo, 609-325-4630, ext. 133


Related Content
© 2023 MJH Life Sciences
All rights reserved.