My neighbor does not use our practice for her “medical home“. In fact, although she has a pediatrician for her children and an internist for herself she keeps her own “primary care” counsel. We have lived next door to them for several years and I often find myself being asked to comment on the quality of care received by her or her family across the porch rail. I don’t know whether to be amazed at her resourcefulness (she keeps several orthopedics groups on speed dial for her active son) or chagrined for our profession’s lack of “hominess”(she showed me a “lesion” on her daughters foot which was clearly a wart but she was searching for a dermatologist to give her the definitive diagnosis and treatment not available from her pediatrician). I hope that adequalte payment for the activities associated with being good primary health care such as coordination of care and delivery of competent first contact care will be a part of the reforms that are projected to arrive. I also hope that primary care physicians are up to the challenge.