Fifty years ago, most doctors were generalists. Today, sharing your dreams of becoming a family doctor with medical school classmates or residents generates looks of confusion. Some call me “brave” while others call me “crazy.” Truthfully, pursuing primary care in today’s health system doesn’t make much sense. Much of the allure of family doctoring no longer exists. The era of the trusted doctor who knew your name, family, and history has given way to faceless specialist networks operating out of distant corporate health systems. Sometimes, this shift toward specialization seems like progress, but Americans are sicker than ever, with record rates of preventable diseases like obesity, diabetes, and heart disease.
For anyone who has recently searched for a primary care doctor, the workforce shortage needs little explanation. Experienced doctors are retiring early or leaving medicine altogether in unprecedented numbers, and fewer medical students than ever are choosing to pursue primary care. This is even evident at my public medical school, which proudly boasts being top ranked in primary care education. Despite this distinction, only a small fraction of students actually match into family medicine programs. Curious about this disconnect, I decided to informally and anonymously survey my classmates to get the unfiltered “word on the street” about family medicine. The responses I received were brutally honest and revealed several key themes that explain why students avoid this specialty.
As students graduate with enormous debt, often approaching half a million dollars, the return-on-investment is top-of-mind when choosing a specialty. As a classmate succinctly put it, the “pay sucks” in primary care. Another student commented that more would pursue family medicine if the pay was better. Even with loan repayment, which is essential albeit insufficient, students are smart and can quickly calculate the seven- to eight-figure difference in lifetime earnings between some specialists and family doctors.
Beyond compensation, students expressed concerns about the workload, describing the rushed, rapid-fire slew of appointments and overwhelming documentation burden. One student wrote “short appointment times with patients, high patient volume, and lots of administrative work” as reasons not to pursue family medicine. Students come into medical school wanting to make a difference in their communities, form lasting relationships with patients, and provide comprehensive care. Unfortunately, this is far from reality in many primary care offices because the system does not provide the time or resources to do that job.
Though respected, family practice is often viewed as the bottom of the hierarchy. The lack of prestige is a tough sell for students that sacrifice immensely to pursue medicine. One student describes the “stigma,” saying, “Even if you want to do primary care, people respect internists more.” Similarly, others commented on scope encroachment, with one worried that “the job is going to be replaced by PAs and NPs.” Getting into medical school is a competitive process, encouraging gap years and selecting for the ambitious. Unfortunately, the ambitious tend not to go into family medicine.
Amid all this criticism, there’s still hope. The few students considering family medicine are enthusiastic about its broad scope and meaningful patient connections. I find myself among this minority, drawn to family medicine because I want to be that complete physician who can deliver babies, counsel teenagers, manage chronic diseases, and comfort the elderly. For me, this comprehensive role represents medicine at its finest. But, in a system that undervalues primary care, most of my peers choose other paths, and truthfully, I don’t blame them.
The system itself needs to attract students to family medicine rather than push them away. Medical schools should encourage primary care mentorship and mandate family medicine clerkships, a requirement that some schools currently lack. More broadly, the health system must re-prioritize primary care and fund it as the “backbone of health care.” This will demonstrate to medical students that family medicine is valued, and perhaps more of my classmates will join me in primary care.
What will it take to make family medicine a specialty students actually choose? Share in the comments.
Jason Denoncourt is a medical student at UMass Chan Medical School in Worcester, MA. He is interested in family medicine and health policy. He enjoys running, skiing, and cooking in his free time. Jason is a 2025–2026 Doximity Op-Med Fellow.
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