Conflicts of interest: author reports none. And the likelihood of an emergency department visit did not change for those aged 18 to 40 years and those aged 65 years and older, but increased for those aged 41 to 65 years. PURPOSE Benefit of lung cancer screening using low-dose computed tomography (LDCT) in reducing lung cancer–specific and all-cause mortality is unclear. The Annals of Family Medicine is indexed in the MEDLINE, Science Citation Index Expanded, Current Contents/Clinical Medicine, EMBASE, and CINAHL databases. 1 Nov 2020 . Data provided by Johansen and Richardson16 help lay to rest the health-care-system-as-a-balloon concern that as visits to primary care physician offices have decreased, visits to other providers and settings have increased. For the first time, fewer than one-half of physicians work in practices they own.7, These many changes were designed for generally laudable goals: to promote access to care, reduce costs of care, enhance quality of care, emphasize primary care and prevention, shape services around the needs of patients, and create a better patient experience. Source Normalized Impact per Paper (SNIP) Source Normalized Impact per Paper (SNIP) measures contextual citation impact by weighting citations based on the total number of citations in a subject field. Vol. Surely, some changes will have largely reached their goals, but other changes will have had only a small impact and not be worth their costs. The first paper, “National Trends in Primary Care Visit Use and Practice Capabilities, 2008-2015” by Rao et al,15 draws on annual National Ambulatory Medical Care Survey (NAMCS) medical record abstraction data collected from a nationally representative sample of adults’ office visits to primary care physicians.21 Over the 10-year study period from 2007 to 2016, primary care practices became more likely to use EMRs and to offer secure messaging, e-mail consults, and after-hour visits to patients. As Rao et al point out,15 it might be that patients and physicians feel the need for fewer office visits now that visits are more comprehensive and between-visit capacity for outreach to patients is greater and communications are easier. The likelihood of being hospitalized similarly fell for adults overall and all age groups. 5.02 %. Taking this wider look is key to detecting unintended effects from changes in a system often likened to a balloon that, when squeezed from some sides, responds by bulging in other directions. The findings of these 2 studies taken together more convincingly suggest than either alone why the average number of yearly visits to primary care physicians is decreasing. And the positive effects of still other changes must be weighed against their unanticipated negative effects. © 2002—2020 Cactus Communications. The definition of journal acceptance rate is the percentage of all articles submitted to Annals of Internal Medicine that was accepted for publication. One can intuit the contributions of a broadening health care team in these data that show more services provided during office visits that are only modestly longer in duration and patients having more communication avenues. for 1+3, enter 4. Thank you for your interest in spreading the word on Annals of Family Medicine. 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