JASMA

If you’re old enough to remember Blockbuster, you probably also remember the emotional roller coaster of Friday night movie selection: optimism at the entrance, panic in aisle three, despair at the “New Releases” wall, and acceptance at the checkout counter when you realized you were going home with Air Bud. You also remember the late feesthose tiny financial paper cuts that made you feel personally judged by a barcode scanner.

Primary care isn’t a video rental store (thank goodnessno one wants to sanitize DVDs in 2026), but the story of Blockbuster is still a masterclass in what happens when a market changes faster than an organization’s willingness to change. And primary care is in one of those moments right now: consumer expectations are rising, new entrants are rewriting convenience, workforce shortages are intensifying, and payment models are shifting under everyone’s feet.

This article uses Blockbuster’s rise-and-fall as a surprisingly useful mirror for primary care. We’ll keep it practical, a little funny, and deeply grounded in what’s happening across U.S. healthcare: value-based care, telehealth, retail disruption, and the uncomfortable truth that “the way we’ve always done it” is not a strategyit's a bedtime story you tell yourself to fall asleep.

Why Blockbuster still matters (even if your kids think DVDs are coasters)

Blockbuster didn’t disappear because people stopped loving movies. People loved movies more than ever. Blockbuster disappeared because customers wanted the same outcomeentertainmentbut with less friction, fewer penalties, and more control. Netflix, kiosks, and on-demand options didn’t just offer a different product. They offered a different experience.

Primary care is facing a similar “experience rewrite.” Patients still want care. They want relief, clarity, prevention, continuity, and someone who knows their story. But they increasingly want it with less waiting, less paperwork, fewer surprise bills, and more digital conveniencewithout losing trust or quality.

Blockbuster’s real problem wasn’t technology. It was inertia.

1) The late-fee trap: loving the revenue your customers hate

Blockbuster reportedly generated a massive chunk of revenue from late fees at one pointprofitable, yes, but also an emotional tax customers resented. That’s a classic “business model booby trap”: revenue that looks great on spreadsheets but quietly erodes loyalty. When a competitor removes the pain point, customers don’t just switchthey leave with a little bit of celebration.

2) Convenience beat selection (and “good enough” beat perfect)

Blockbuster had breadth. Netflix had a simpler loop: browse at home, receive by mail, no late fees, repeat. Later, streaming made the loop even tighter. It wasn’t about having everything. It was about making the process effortless.

3) Culture and incentives shaped decisions more than strategy decks

Big organizations can “see the future” and still lose because internal incentives reward protecting the current system. If store traffic and late fees keep the lights on, anything that reduces store traffic looks like sabotageeven if it’s the exact move required for survival.

Primary care has its own version of “late fees”

Let’s be blunt: patients experience friction in primary care all the time, and most of it isn’t clinical. It’s operational. It’s administrative. It’s the “why does this feel harder than ordering groceries at 11 p.m.?” problem.

Here are primary care’s modern “late fees”not always literal fees, but costs paid in time, stress, and trust:

• Access delays: long waits for appointments, limited after-hours options, endless phone trees.
• Administrative overload: forms, prior authorizations, referrals, portals that feel like escape rooms.
• Fragmentation: patients repeating their story to multiple clinicians who don’t share context.
• Billing confusion: opaque coverage rules and surprise patient responsibility.
• Clinician burnout: less time with patients, more time with clicks.

That last one matters because burnout doesn’t just harm clinicians. It harms access, continuity, and quality. When the workforce is strained, the patient experience degradesand the system becomes even less adaptable.

Lesson 1: Don’t fall in love with the revenue you’ll need to replace

Blockbuster’s late fees were easy moneyuntil they weren’t. Primary care’s analog is not “late fees” themselves. It’s overdependence on volume-driven economics that reward short visits, reactive care, and coding gymnastics rather than outcomes, prevention, and relationship-based medicine.

When your margins depend on squeezing more visits into the day, you end up with a treadmill clinic: fast, exhausting, and oddly stationary. You can feel the effort but not the progress.

What adaptation looks like in primary care

• Shift from “visits” to “care”: invest in care management, proactive outreach, and team-based workflows where a physician isn’t the bottleneck for every need.
• Diversify payment models: evaluate value-based contracts, employer arrangements, and subscription-like approaches (such as direct primary care) where appropriate and compliant.
• Monetize what patients value: access, responsiveness, coordination, and trustnot just face time.

The goal isn’t to “chase a trend.” The goal is to reduce dependence on revenue streams that discourage the very changes patients are demanding.

Lesson 2: Win on convenience without turning care into fast food

“Convenience” in primary care shouldn’t mean “cheap and rushed.” It should mean easy to start, easy to continue, and hard to fall through the cracks.

Convenience upgrades that protect quality

• Same-week access: protect open slots, use smart scheduling rules, build nurse/APP pathways.
• Asynchronous care: secure messaging for common questions, medication adjustments, and follow-ups.
• Hybrid visit design: in-person for what truly requires it; virtual for what doesn’t.
• One-tap refill workflows: fewer clicks for patients, fewer interruptions for staff.
• Real-time transparency: “Here’s what happens next” after every encounter.

Blockbuster’s aisles were friction. Streaming made the customer the director. In primary care, convenience means building pathways that respect patient time and clinician attention.

Lesson 3: Build an omnichannel “front door” (patients don’t live in your office)

Blockbuster treated stores like the center of the universe. The market moved to living rooms, laptops, and phones. Primary care sometimes makes the same mistake: acting like the exam room is the only legitimate theater for healthcare.

But patients live everywhere. Care has to travel.

Omnichannel primary care, done well

• Digital intake: symptoms, history, and goals captured ahead of timeso visit time is used wisely.
• Remote monitoring: blood pressure, glucose, weight, and symptom tracking where it actually improves outcomes.
• Community connections: food insecurity, housing support, transportationaddressing barriers that block adherence.
• Care navigation: help patients cross the specialist/lab/imaging maze with fewer wrong turns.

Omnichannel doesn’t mean “more technology.” It means the patient doesn’t have to guess which door to useand doesn’t get punished for choosing the “wrong” one.

Lesson 4: Personalize with datawithout becoming creepy

Netflix learned what you liked and served it back to you with frightening accuracy. Primary care has the chance to personalize in ways that truly matter: risk identification, preventive outreach, and timely interventions. The difference is that healthcare carries a trust contract that entertainment doesn’t. You can’t “recommend” your way through someone’s diabetes care like it’s a romantic comedy.

High-trust personalization examples

• Proactive prevention: outreach for overdue screenings, vaccines, and chronic disease labs.
• Risk stratification: identifying patients who need more touchpoints before they spiral into the ED.
• Medication safety: closing gaps, reducing duplications, catching interaction risks.

The win is not “better dashboards.” The win is fewer preventable crises, fewer missed diagnoses, and a patient who feels seen.

Lesson 5: Remove friction like you mean it

Blockbuster customers didn’t want to manage return dates. Primary care patients don’t want to manage your internal processes either. They don’t want to be the courier between departments, the translator between portals, or the project manager of their own referrals.

Friction reduction is a competitive advantage. It also happens to be the compassionate thing to do.

Friction-busters that pay off quickly

• One simple scheduling journey: fewer handoffs, fewer phone tags, clear expectations.
• Warm referrals: “We scheduled it for you” beats “Call this number and good luck.”
• Care team clarity: patients know who to message for what.
• Pre-visit planning: staff tee up refills, labs, and care gaps before the clinician enters.

If you want a humor-free truth: friction is a health equity issue. People with fewer resources get hurt more by systems that require extra time, extra travel, and extra persistence.

Lesson 6: Partnerships can be survivalif they’re designed, not improvised

Blockbuster could have partnered more effectively with emerging platforms, but partnerships are only helpful when they come with operational integration and aligned incentives. In primary care, partnerships are increasingly necessary:

• With specialists for faster consults and smoother co-management of complex patients.
• With behavioral health to address anxiety, depression, substance use, and trauma in a coordinated model.
• With hospitals to reduce avoidable admissions and improve post-discharge continuity.
• With community organizations to address health-related social needs in real life, not just in care plans.

The best partnerships don’t create more steps. They delete steps.

Lesson 7: Retail disruption is realbut it’s not a guaranteed win for retailers

Many clinicians view retail and tech entrants as the “Netflix of healthcare.” Sometimes that’s fair: they raise the bar for convenience and transparency. But healthcare is harder than shipping DVDs. Some big retail healthcare ventures have expanded; others have scaled back or closed clinics when economics didn’t work.

The takeaway for primary care isn’t “retail always wins.” The takeaway is: consumer expectations don’t roll back just because a competitor stumbles. Once patients taste easier access, they don’t want to go back to fax machines and hold music.

Primary care’s advantage is trust, continuity, and clinical depth. Your job is to combine that advantage with modern delivery, so “trusted” doesn’t mean “slow.”

A practical adaptation playbook for primary care leaders

In the next 90 days: quick wins that change patient perception

• Audit third-next-available appointment time and protect access slots.
• Fix the top 3 scheduling pain points (phone tree, portal confusion, referral dead ends).
• Standardize refill workflows and reduce “bounce-back” tasks to clinicians.
• Implement pre-visit planning for chronic care visits.
• Measure clinician and staff friction (not just patient satisfaction).

In 12 months: redesign care delivery, not just templates

• Expand team-based care (RNs, MAs, pharmacists, social work, care managers) with clear roles.
• Build a hybrid care strategy: in-person + virtual + async pathways.
• Use data for proactive outreach to close care gaps.
• Negotiate contracts that reward prevention, coordination, and outcomes.

Over 3 years: build resilience against policy and market swings

• Diversify revenue so policy changes don’t feel like a trapdoor.
• Invest in workforce sustainability (panel design, documentation support, well-being).
• Create “care journeys” for chronic conditions that reduce ED utilization and improve outcomes.
• Make the patient experience consistently excellentonline, phone, and in-clinic.

What to measure so you’re not “flying blind” like a video store in the streaming era

Blockbuster could count rentals. Primary care can count visits. But adaptation requires metrics tied to outcomes and experiencenot just throughput.

• Access: third-next-available, same-day capacity, after-hours utilization.
• Continuity: percentage of visits with the patient’s own care team.
• Clinical outcomes: BP control, A1c control, preventive screening rates.
• Utilization: avoidable ED visits, readmissions, total cost patterns (where available).
• Team sustainability: EHR time burden, after-hours work, turnover, burnout signals.
• Patient experience: trust, clarity, responsiveness, and navigation success.

Conclusion: primary care doesn’t need to “be Netflix.” It needs to be adaptable.

The moral of Blockbuster is not “technology wins.” It’s “friction loses.” Blockbuster lost because it protected the past longer than it prepared for the future. Primary care can’t afford that patternnot with workforce shortages, rising complexity, and patients who expect care to meet them where they are.

Adaptation in primary care is not about shiny tools. It’s about redesigning care so the system is easier to use, more proactive, more human, and more sustainable for the people delivering it. The practices and organizations that win won’t be the ones with the fanciest portals. They’ll be the ones that remove friction, protect relationships, and evolve their business model before the market forces it.

And if you’re wondering whether this is urgent, here’s a simple test: imagine your patient can get convenience elsewhere, but they only get trust from you. Then ask yourself: are you making trust easy to accessor hiding it behind two months of waiting and a voicemail labyrinth?

Field notes: of real-world adaptation experiences in primary care

I once watched a clinic “improve access” by adding online schedulingand accidentally created a new competitive sport: patients racing for appointments like it was concert ticket day. The clinic proudly announced the change; the next week, half the schedule was filled with the wrong visit types and the other half was triage chaos. The lesson wasn’t “online scheduling is bad.” The lesson was that adaptation fails when you bolt new convenience onto old workflows without redesigning the rules underneath.

Another practice took a different approach. Before adding any new tech, they mapped the five most common reasons patients contacted the office: refills, results, scheduling, billing confusion, and “I’m sick but not sure if I should come in.” Then they asked: Which of these truly needs a physician? The answer wasn’t “none.” It was “not all of it.” They created a standing-order refill process, a results-review script, and a same-day nurse triage pathway with clear escalation steps. Clinicians suddenly had fewer interruptions, patients got faster answers, and the practice’s “responsiveness” ratings improved without hiring an army.

In a health system setting, I’ve seen care teams succeed by treating the EHR like a toolnot a lifestyle. One team built “documentation guardrails”: pre-visit planning so the chart was ready, templated phrasing only where it saved time (not where it sterilized the note), and protected end-of-day blocks for closing loops. The surprising outcome wasn’t just less burnout. It was better clinical thinking. When a clinician isn’t drowning in clicks, they notice patterns: the patient who always misses follow-ups because of transportation, the blood pressure that spikes every winter, the anxiety that looks like chest pain.

I’ve also watched retail-style convenience backfire when it lacked continuity. Patients loved quick access for minor issues, but complex patientsdiabetes, heart failure, depressionkept “resetting” at each visit because no one owned the long game. One clinic fixed it with a deceptively simple move: every patient got a named care team. Not a building. Not a brand. A team. Messages went to the team, not the void. Follow-ups were scheduled before patients left. Care gaps were addressed like a checklist with empathy, not like a scolding. The clinic didn’t become a tech company; it became a better medical home with modern pathways.

The biggest adaptation experience I’ve seen is cultural: leaders who stop treating change as an “initiative” and start treating it as a muscle. They pilot small, measure honestly, and iterate fast. They don’t wait for perfect. They build learning loops. That’s the core Blockbuster lesson for primary care: survival favors the organizations that can let go of yesterday’s comfort, design for today’s expectations, and keep evolving without losing what makes primary care sacredrelationship, trust, and whole-person care.