Even More to Do and Even Less Time: Resident Education and the Future of Primary Care

As internal medicine residents at an urban academic medical center who are interested in primary care, we face many of the challenges discussed in the article by Fiscella and Epstein.¹ Their review of the patient-centered medical home supports increased efficiency of the primary care environment through increasing roles of ancillary staff. Given that a minority of medical trainees are entering primary care careers, it is important to consider whether the changes proposed by Fiscella and Epstein¹ can increase internal medicine resident interest in primary care fields by providing a more appealing work environment.² This is especially important because, unfortunately, internal medicine resident satisfaction with their continuity clinic is suboptimal.³ In our own institution, residents state that primary reasons for their dissatisfaction with their continuity clinic are inadequate ancillary staff and time to provide quality care.