One morning during my medical residency many years ago, one of the senior doctors pulled me aside after rounds, as was his routine, to review the status of patients in the intensive care unit. A few had single-organ failure  their lungs weren’t doing well, or their hearts weren’t beating efficiently. A few struggled with double-organ failure. But the majority of patients were battling multisystem organ failure, and their prognoses were not good.

“People can survive one organ system failing and even two,” the senior doctor said to me after we were finished. “But when that third one goes ...”

He leaned forward and looked me in the eye. “Three strikes, and the game is over.”

That remark came to mind recently when I thought about the crisis in primary care and President-elect Barack Obama’s plans to make health care accessible to all.

Primary care is delivered in a variety of settings by a variety of professionals, including nurses and physicians’ assistants, but it is anchored by family-practice doctors, general internists, pediatricians and, for many women, gynecologists. As the nation’s front-line doctors, primary care physicians address everything from chronic diseases, like diabetes, heart disease and high blood pressure, to more acute conditions, like pneumonias, intractable flus and potentially cancerous masses and lumps.