This issue of the journal headlines articles on primary care physicians. I am both pleased and saddened with what we are able to present in this issue of the journal on this critical health reform topic. At the end of the day, there is little that is systematic that is underway, resulting in improved care on the topic of reorganization of primary care practice (Jackson et al., 2012). While I am eternally hopeful, I find myself in the camp of those such as Wilensky (2012) who do not place faith in pilot projects alone as the way to go forward in health reform. For all the hoopla on accountable care organizations, for example, Medicare has enrolled about 2 million enrollees in accountable care organizations. As a country we are facing a significant budget crisis and there are needs for cuts-now-that the federal government could address in a more aggressive, systematic manner that focuses on improving outcomes while saving money (Goldfield et al., 2012).

That said, this issue of the journal points a way forward on the reorganization of system including payment for primary care professionals. Stephen Davidson provides an evidence-based overview of the influences on clinical decision making by physicians. Enough ink has been spilled trying to tease apart the financial from the nonfinancial influences on physician decision making. There is much that we do not know. While this for sure will not be the last word on this topic, Davidson provides much food for thought and hopefully specific ideas that can be tried in a systematic manner.

Jerry Reeves and Brian Kapp provide an excellent summary of an exciting pilot, yet large-scale medical home implementation. Nancy Borkowski and colleagues detail results of another pilot effort that aims to improve primary care physician efficiency in safety net settings. Edison Tsui and colleagues discuss a case-control intervention that implemented a multilingual health intervention program. It is not a profound statement that we are living in a multicultural society. A successful medical home will need to mirror that demographic fact. If systematic change primary care physician practice is to occur, the resulting impact will be, for example, a decrease in hospital readmissions. Richard Fuller and colleagues highlight several clinical characteristics that need to be taken into account in effort to make apple-to-apple comparisons between hospitals.

Talya Salant and colleagues highlight a cautionary tale with respect to implementation of any intervention. While one can point to any number of actions that could have been taken, I appreciate, in my own work, the challenges that we all confront as we attempt to implement well thought out experimental strategies.

Peter Boland reviews a book that highlights the importance of consumer engagement in the entire health care redesign process. He believes that this point and many others are well highlighted in this book titled interestingly "The Creative Destruction of Medicine."

Mark Holt closes our issues with an ever-interesting exploration from the Republic of Texas.

-Norbert I. Goldfield, MD

Editor

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