The Wonderful and Broken Heart of Primary Care

In the small town of Skowhegan, Maine, a young physician named Ann Dorney once built a life around medicine that was as personal as it was demanding. She delivered more than 1,200 babies, cared for grandparents, parents, and children across generations, and sat beside patients as they made decisions about how they wanted to face death. Her patients trusted her because she knew them—not just their charts, but their families, their worries, and their lives. This was primary care at its most wonderful: a calling rooted in trust, continuity, and compassion. Yet it was also primary care at its most broken: long nights on call, an endless stream of patients, and financial models that made such devotion unsustainable. By the time Dorney retired in 2021, she described herself as “completely burned out,” a casualty of a system that demanded too much while giving too little in return.

In his new book Wonderful and Broken, physician and health policy leader Troyen A. Brennan traces the evolution of primary care in America, beginning with stories like Dorney’s and the Skowhegan Family Medicine group she helped pioneer. These doctors embodied what many of us hope health care can be: deeply human, relationship-centered, and comprehensive. But as Brennan shows, the pressures of fee-for-service medicine, low reimbursement, and overwhelming workloads chipped away at that ideal. By the 1990s, the vision of one doctor guiding a family through every health need had already begun to fade. And in its place grew a system where productivity targets, electronic medical record burdens, and fragmented care pushed many physicians to the breaking point.

Primary care is more than just a point of entry into the health system. It’s the foundation for preventive medicine, equity in access, and healing that addresses the whole person. Yet the United States consistently underfunds it, undervalues it, and asks clinicians to shoulder impossible workloads. Brennan argues that this trajectory is unsustainable. Burnout is rising. Fewer medical students choose primary care. Patients struggle to find doctors who know them well. And the costs of neglect ripple outward in poorer health outcomes and higher systemwide spending. Brennan highlights how new models—particularly value-based care and team-based approaches—offer hope for a future where primary care is both sustainable for clinicians and more effective for patients. 

Wonderful and Broken tells the stories of real clinicians like Ann Dorney who devoted their lives to medicine, only to be worn down by a system that couldn’t support them. These stories remind us that reform isn’t abstract. It’s about the people we rely on when we’re sick, the trust we place in our doctors, and the kind of health care we want for our communities. For policymakers, health professionals, and concerned citizens alike, this book gets to the heart of American medicine and the wonderful relationships that make healing possible, as well as the broken structures that threaten to extinguish them.