In systems as big and complex as the U.S. healthcare system, movement does not come easy. Change is hard, and institutional inertia is the norm. The default is to wait and see. Right now, the vast majority of our healthcare system doing just that. It’s seven months into waiting and seeing what healthcare reform ultimately has in store. Before that, it waited to see what healthcare reform would look like. It’s waiting to see what the insurance companies will do, what hospitals will do, what accountable care organizations will do, and so forth.

But the question that healthcare practitioners and industry watchers are increasingly asking is, do we really have time to wait? According to the most recent U.S. Census projections, as the population approaches 341 million by 2020, the demographics of those seeking healthcare will shift to an older, more ethnically diverse, and more infirm mix of consumers. Healthcare providers will face far wider gaps in education and income. By that time, our nation faces a projected shortage of around 96,000 physicians. It’s estimated that 45 percent of that shortage will be primary care doctors, often patient’s first and most frequent point of contact with the medical system. Estimates show that the nation will be short 148,000 nurses by 2020, with that shortfall set to exceed 260,000 nurses by 2025, of which we estimate 85 percent will be in primary care. I know the healthcare community is struggling with the question of time because I spent the better part of the past year facilitating a highly structured, rigorous conversation about this daunting primary-care challenge among more than 100 of the most respected and inventive doctors, nurses, community workers, entrepreneurs, insurance executives, luminaries, and health policy experts in the country. We convened the group to formulate recommendations on what the healthcare system should do to address the challenge.