A Misplaced Trust

To the Editor: As students, we put trust in our institutions to impartially expose us to a broad range of specialties. But perhaps this trust is misplaced. To us, it has become clear that significant effort and resources are placed into recruiting students to subspecialties, while primary care remains an afterthought. This disparity persists despite an ongoing primary care physician shortage, projected to increase to 49,300 by 2030.1 NYU School of Medicine’s decision to offer tuition-free education was proposed as a solution to this shortage, as it may help tip the scales for those significantly, negatively affected by educational costs.2 But as critics have suggested, far more goes into choosing a specialty than debt or anticipated financial need. What administrators miss by framing the conversation in financial terms is the bias that goes into how students are exposed to different specialties, particularly during the critical clerkship year. We have observed this bias in our primary care clerkship firsthand. Clinical training sites were seemingly not chosen with particular criteria in mind. Practices engaging in newer models of care were not sought out. Preceptors specifically committed to primary care were not recruited. Students were not able to select family medicine, rural medicine, or other underserved practices. It felt as though primary care did not warrant the same resources and respect as other specialties. This same attitude was reflected in a decision by our hospital system to move primary care clinics to a remote facility with minimal public bus access and no plans for a patient shuttle.3 The move was well intentioned: Consolidating primary care with ancillary services could save money for patients and the institution. But pushback from the community has signaled the breach of trust that this move entails. Those served by the soon-to-be-closed clinics were not involved in the decision, and their needs—access to primary care services—were placed on the back burner. Building trust between institutions and underserved communities is a multifaceted problem. But encouraging medical schools to foster interest in primary care and family medicine is an important step toward building that trust. Shunella LumasThird-year medical student, Yale School of Medicine, New Haven, Connecticut.Pavithra VijayakumarThird-year medical student, Yale School of Medicine, New Haven, Connecticut.Ashley Odai-AfoteyThird-year medical student, Yale School of Medicine, New Haven, Connecticut; [email protected]