Graduate medical education (GME), the training of resident physicians, is funded by GME payments to hospitals and health systems, largely from Medicare and Medicaid. The number, specialty, and practice locations1 of future physicians is heavily dependent on how GME positions are determined and placed. In 2015, Medicare alone provided $12.5 billion in GME payments to teaching hospitals. Yet, shortages persist in select specialties, such as primary care, and in rural and underserved areas.

The modern era of medicine has brought about incredible advances in science and technology to improve the care of patients and population health. Additionally, major social changes are occurring that im-pact society, patients, physicians, medicine, health care, and medical education. Medical professionals are governed by ethical codes, and make a commitment to competence, integrity, morality, altruism, and support of the public good. This is a social contract, a covenant of trust with patients and society, that determines medicine’s values and responsibilities in the care of the patient.

The first significant expansion of allopathic medical schools since the 1970s was anticipated to produce more physicians capable of addressing the nation’s current and projected primary care shortages. However, our analysis of the early outputs of new allopathic medical schools suggests that these students were nearly 40% less likely to specialize in family medicine than existing schools.

The likelihood of future shortages of adult primary care physicians is of great concern for policy makers as the US population grows and ages.