As access to primary care narrows nationwide, exit ramps toward the free market are widening. Physicians taking these off-ramps may find higher incomes and restored joys of practice. Patients who can afford membership fees for concierge or DPC practices may also benefit from these models. Yet trade-offs — in the form of decreased access for patients and increased strain on PCPs in traditional primary care — are borne by the rest of society. Primary care’s shift from common good toward free-market commodity increases the urgency for payers and policymakers to strengthen traditional primary care practices, even as newer models take hold. For individual patients and physicians, this shift also provokes deeper questions about what it means to have a primary care doctor — and to be one.