It is estimated that 30 million people will gain access to medical care beginning in 2014, with implementation of the Patient Protection and Affordable Care Act (ACA). Administratively, the federal government and most states have not worked out the details of how patients will gain access to the healthcare system, let alone receive care. Primary care providers (PCPs) are ill-prepared to accept this enormous influx of new patients, which will place an even greater strain on the already strapped primary care workforce. Estimates are that an additional 17,000 PCPs are currently needed, and another 40,000 PCPs may be needed by 2025 to care for the nation’s aging population. How best to handle this large influx of patients into the healthcare system is at issue.