KEEPING THE GATE:

Doctors say primary care is growing fragmented and turning into more of a commodity, with physician access based on what consumers will pay.

"I think the role of primary care has diminished ... and I don't see encouraging signs that it is having a renaissance," said Dr. Robert Berenson, a researcher at the nonpartisan Urban Institute, which studies health care issues.

The shift began more than a decade ago and has accelerated in recent years, the result of technology and competition creating more convenient options for care that does not require an in-person doctor visit. Insurance reforms have also contributed by pushing patients to shop around for the best price.

These changes have helped make basic care more accessible to patients and lowered the cost per visit for many consumers.

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