As of 2020, annual federal and state support for graduate medical education (GME) had grown to nearly $19 billion, which funds 139,848 physician training positions in 1,657 teaching hospitals across the United States. These public subsidies are provided with the understanding that the training institutions will use this governmental funding to meet the health care needs of society, both now and in the future. Decisions about how that funding is further allocated are deferred to individual training sites. This arrangement represents an implicit social contract between teaching hospitals and the American public with the reciprocal responsibilities being sustained government funding that enables GME training programs to produce a workforce that can meet communities’ and the broader society’s needs. ^6,7 Surprisingly, this social contract contains little accountability for how that public funding is used.

Continuity of care (COC) a foundational dimension of primary care, has demonstrated associations with a range of patient outcomes. Still unknown are its relationship with measures of health equity, especially along disease specific utilization measures in primary care. Understanding if specific features of the clinician-patient relationship, such as language concordance, are associated with beneficial ambulatory care measures in Latino children with asthma might provide insight into the relationship between COC and health equity.