Complexity is an important part of this in two perspectives. There is complexity in terms of how a primary care practice best meets the needs of its patients. As we advance in our understanding of the many dimensions that include health above and beyond the typically narrow medical care that doctors have always provided, we think more and more about how to serve those needs and it is increasingly impossible for a physician as single person to meet the narrow medical needs and broader social needs that a patient has in maximizing their health and wellness.
From that standpoint it is more complex and certainly advances in medicine have made care more complex and mastering care more complex.
As a single technological advancement, the electronic medical records is one that we have to be honest about, because so far its implementation has been not an aid to efficiency of the physicians' time.
Unfortunately, we have taken yesterday's model of documentation where the doctor did the documentation and continued that with electronic medical record and that has been shown time and again, in both quantitative and qualitative ways, to be a burden on physicians cognitively and on their time, way out of proportion to what documentation used to be. There is an added complexity that has been brought on by that tool as well.