The Supply of Primary Care Physicians

To the Editor.  —The article by Politzer et al¹ makes a number of excellent points regarding increased output of primary care physicians by US medical schools. In particular, the recommendation to increase funding for training research and initiatives deserves careful analysis. Two related phenomena that were not mentioned warrant examination. They illustrate how perverse incentives within the funding mechanisms for medical schools can lead to the shortage of primary care physicians.First, students are actively dissuaded from primary care careers during medical school.² Second, medical schools in this country have become very expensive enterprises. Deans and department chairpersons have come to depend heavily on overhead from research grants to operate the institutions.^3,4The 8% overhead allowed for training and faculty development grants is not likely to capture the attention of deans to the same extent as the near 50% overhead for basic research. Unless the benefit to