The article, authored by medical education experts writing on behalf of the Society of General Internal Medicine and the Association of Chiefs and Leaders of General Internal Medicine Hess Initiative Work Group, was led by Tovah Tripp, M.D., associate professor of Internal Medicine at the Hackensack Meridian School of Medicine. Tripp also serves as the school’s Internal Medicine clerkship director and practices as a primary-care physician within Hackensack Meridian Health, giving her a dual vantage point as both an educator shaping curricula and a clinician experiencing the workforce shortage firsthand. Her team’s central contention is that the structure of American medical education itself contributes to the pipeline problem, and that fixing it will require coordinated action from medical schools and the bodies that accredit them.

At the heart of the paper is what the authors identify as a critical gap in what educators shorthand as med ed. While graduate medical education, the residency phase that follows medical school, mandates ambulatory training, neither the Liaison Committee on Medical Education nor the Association of American Medical Colleges requires specific outpatient exposure during the undergraduate years. The LCME accredits medical education programs leading to the M.D. degree in the United States and Canada, and the AAMC represents academic medicine institutions nationwide, so requirements set by these bodies ripple through every medical school in the country. Without a mandated minimum of outpatient, community-based clinical exposure, the authors argue, students may complete their formative training years with limited meaningful contact with general internal medicine and primary care.

This is a missed opportunity, according to the experts, because the years of medical school are precisely when many students form durable impressions about which specialties are prestigious, intellectually satisfying, and professionally rewarding. The authors write that investing in undergraduate medical education experiences is essential to rebuild the primary care pipeline and to create a generation of physicians who understand the value and role of primary care within the healthcare system, regardless of their ultimate specialty. In other words, even students who go on to become surgeons, radiologists, or hospitalists benefit from understanding what primary care does, and the healthcare system as a whole benefits when future specialists train alongside and respect their generalist colleagues.

To translate that principle into practice, the paper synthesizes existing literature into interrelated pathways for boosting primary care’s importance to doctors-in-training. The first pathway addresses the ecosystem of primary care itself. The authors call for mitigation of the administrative burdens and debt loads that weigh on primary-care clinicians, arguing that these pressures diminish the perceived value of the clinical role to learners. When students watch their mentors spend hours wrestling with documentation and billing rather than caring for patients, the message about the specialty’s day-to-day reality is hard to miss. The authors also point to leveraging artificial intelligence and team models of learning as tools that can lift some of that burden and make the clinical environment more attractive and educational.

The second pathway focuses on the faculty who teach primary care. Clinical educators in general internal medicine often juggle patient care, teaching, and administrative duties without commensurate recognition or compensation. The paper proposes developing faculty through a range of incentives, including educational relative value units, a mechanism by which teaching time is counted and rewarded within clinical compensation systems, as well as tax credits. Additional supports include protected time for educational work and flexible schedules, among other give-backs. The underlying logic is straightforward: a pipeline cannot be built by exhausted, undervalued teachers, and institutions that want to grow the next generation of generalists must invest in the ones they already have.

The third pathway centers on enriching the student’s experience of primary care during clerkships and mentorships. Clerkships are the rotational clinical courses that place third- and fourth-year medical students alongside practicing physicians, and they are widely regarded as among the most influential experiences in specialty decision-making. The authors argue that high-quality, well-mentored ambulatory rotations would heighten the perceived value of primary care careers, giving students a realistic and positive picture of what longitudinal patient relationships, preventive medicine, and community-based practice actually look like. A clerkship that is poorly organized or treated as an afterthought sends the opposite signal, regardless of how meaningful the underlying work may be.

Timing is a recurring theme throughout the paper. The authors emphasize that specialty choices are often solidified long before residency, making early interventions absolutely critical. By the time students apply to residency programs, many have already made implicit decisions shaped by their clinical exposures, their mentors, their debt levels, and their perceptions of different specialties’ lifestyles and prestige. Waiting until graduate medical education to cultivate interest in primary care, the authors suggest, is too late for many learners. Accordingly, they call on medical schools and accrediting bodies to mandate minimum ambulatory rotation requirements to ensure that primary care remains a visible and viable choice when the time comes for students to commit to a specialty.

The authors are careful to frame their proposals with appropriate humility. There is not a single fix for this kind of systemic problem, Tripp said, but well-thought-out strategies can nudge the trend in a positive direction. That framing reflects the reality that the primary-care shortage is the product of many converging forces, including compensation disparities between primary care and procedural specialties, administrative workload, educational debt, and the cultural status of different specialties within academic medicine. No curricular mandate alone can undo all of that, but the authors contend that a coordinated set of reforms across the ecosystem, the faculty, and the student experience can shift the trajectory meaningfully over time.

The paper, titled Improving the Ambulatory General Internal Medicine Experience in Undergraduate Medical Education: a Call for Action, was published on August 10, 2026, and is presented as a commentary rather than an original research study, synthesizing existing evidence into an actionable framework for educators and policymakers. The authors report no funding or financial support for the completion of the paper. Its publication arrives at a moment when the shortage of primary-care physicians has become a pressing national concern, with communities across the country struggling to recruit and retain generalists. By directing attention to the earliest stage of physician training and calling for national coordination among medical schools and accreditors, the HMSOM-led team hopes to convert a widely acknowledged problem into a concrete agenda, one clerkship, one mentor, and one policy change at a time.

Subject of Research: Strengthening the primary care physician pipeline through reforms in undergraduate medical education

Article Title: National call-to-action needed to strengthen primary care pipeline in medical education: HMSOM Educators

Article References: National call-to-action needed to strengthen primary care pipeline in medical education: HMSOM Educators. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: primary care, medical education, undergraduate medical education, ambulatory care, clerkships, LCME, AAMC, physician workforce, general internal medicine, faculty development, mentorship, health policy