I've worked as a certified internal medicine physician in multiple settings since certification in 1974, and in private community-based internal and geriatric medicine in Glen Cove, Long Island, NY since 1980 (yes, that makes me an experienced, but nearly extinct doc). While maintaining this part-time insurance-based practice, I'll be devoting the remainder of my professional life to develop a new species of ambulatory primary care delivery system, distinct from traditional insurance plans or hospital systems. Through partnering with other groups and organizations of like-mind, this future model will bring true privatization for primary care in the form of multiple small businesses studded about the country, whose staff that will practice as a team. There will be a negotiated 'contract' of care between each patient and the team. Obviously, a new form funding and financial organizing needs to be developed, but should include non-profit organizations, wealthy individuals and companies, grants at all levels of government, medical universities and health care foundations, private investment venture groups. This primary care team will partner with all other aspects of the health care pie, but financially it will stand on its own. Each person cared for within the system will have high quality, very private care (concierge for the masses), and the only goals for the staff will be based on good outcomes and patient satisfaction. The driving economic force will be preventing hospitalizations and long-term nursing home care, maintaining health through preventive and lifestyle approaches, avoiding expensive and unnecessary testing. Those that understand the dynamics and incentives of health insurance companies, pharmaceutical companies, hospitals will know that what I'm proposing here is nothing less than a complete 'changing of the gods'; and--if successful--may even halt and reverse the downhill spiral of a falling empire.