Medicare graduate medical education funding is not addressing the primary care shortage: We need a radically different approach

A growing body of evidence shows that areas in the United States with robust primary care systems tend to have better outcomes and lower per capita costs than areas that rely more on specialists.1 Over the past several decades, the US medical education system has produced an increasingly specialized physician workforce without any strategic direction toward achieving a socially desirable mix of primary care physicians (PCPs) and specialists.2 At the same time, health care reforms, such as patient-centered medical homes and Accountable Care Organizations (ACOs), rely more on PCPs and other providers who are equipped to coordinate their own care with the care of specialists. Demographic trends signal a growing need for such coordination as the population ages and patients with multiple chronic conditions become more prevalent.3 Despite these trends, physicians in training tend not to select primary care or related specialties.