TRAINING PRIMARY CARE PHYSICIANS

In this issue, Noble and colleagues report the results of federal legislation designed to stimulate the development of primary care programs. Their data suggest that trainees from these primary care programs selected careers in primary care more often than did trainees from traditional categorical programs; scored as well, and possibly better, on the American Board of Internal Medicine Certifying exam; and tended to practice in communities with lower physician-to-population ratios. Both the federal government and organized internal medicine must encourage trainees to focus on primary care. The federal government can encourage graduates to enter primary care by implementing economic incentives to increase the number of primary care positions in internal medicine training programs and by forgiving student loans of those trainees who choose primary care careers. Organized medicine could encourage such a trend by restructuring training programs to allow broader visibility for the elements of primary care. The federal government and organized medicine could also link an emphasis on primary care with an emphasis on cost effectiveness.