The need for primary care investment has never been greater. Nationally, primary care is in high demand and yet many factors make it difficult to increase the number of practicing primary health health care professionals, including salaries, educational debt, and practice redesign. These primary care workforce challenges are particularly acute in Delaware, which is the second smallest state by area, the sixth smallest by population, the third highest in per capita total health expenditures, and the 31st in health outcomes. As a family physician serving as Cabinet Secreatry for the Department of Health and Social Services, I faced a challenging fiscal environment my first year in office in which health care costs contributed to a budget shortfall.