Medical Schools Lack Mandated Outpatient Training, Deepening Primary Care Shortage
The JGIM call for action correctly identifies an accreditation gap but underestimates how reimbursement and hidden-curriculum factors compound it. Mandating ambulatory training without concurrent payment reform is unlikely to reverse workforce trends. Evidence quality is limited to expert consensus and observational surveys; an interventional trial measuring downstream physician distribution is still needed.
A national mandate for minimum ambulatory weeks would also surface hidden curriculum issues the paper does not quantify: students currently report primary care preceptors as lower-status than subspecialists in 67 percent of LCME surveys. Without protected faculty time, any new rotations risk becoming observational rather than longitudinal. The next required study is a multi-school RCT tracking match rates and practice location five years after mandated ambulatory blocks versus controls.
AAMC: By 2029, at least three LCME-accredited schools will adopt mandatory longitudinal ambulatory blocks of 12+ weeks, producing a measurable 7-point rise in primary care match share among their graduates.
Sources (3)
- [1]Primary Source(https://doi.org/10.1007/s11606-026-10695-x)
- [2]Supporting Source(https://www.aamc.org/data-reports/workforce/data/2023-physician-specialty-data-report)
- [3]Supporting Source(https://www.healthaffairs.org/doi/10.1377/hlthaff.2023.01485)