General internal medicine and primary care:
the field the health system runs on

At a glance

Every path on this site involves a trade, and primary care’s is the plainest: you give up the highest incomes and a measure of professional prestige, and you get one of the broadest scopes in adult medicine, years-long relationships with patients, strong job security and broad geographic flexibility, and work that is genuinely foundational to the health of the country. The uncomfortable part runs through the whole of internal medicine — the payment system underpays the cognitive, time-intensive, relationship-driven care that is the entire substance of the job. This page treats that as the central fact, refuses to sell primary care as a fallback for residents who could not match elsewhere, and is equally clear about the burden that defines the modern outpatient day: the electronic-record inbox.

What it involves

An outpatient general internist is the longitudinal, first-contact physician for adult patients — the doctor who knows the whole person over years rather than one organ over one admission. The daily material is the full breadth of adult disease: hypertension, diabetes, hyperlipidemia, obesity, COPD and asthma, depression and anxiety, thyroid and kidney disease, osteoporosis, and above all the coordination of care for patients carrying several chronic conditions at once. Alongside that sit the acute, undifferentiated complaints — fatigue, dizziness, pain that could be nothing or the first sign of something — and the preventive work of screening, immunization, and risk-factor modification. The internist is the hub: the one who orchestrates specialists, hospitalizations, imaging, prior authorizations, and social needs into something coherent for the patient.

The work is overwhelmingly cognitive. Procedures are limited — joint and soft-tissue injections, skin biopsies, cerumen removal, point-of-care testing, and in some practices contraceptive procedures — and the value is generated in reasoning, judgment, and the relationship, not at a bedside table of instruments. It is also relentlessly broad: a single clinic session can move from dermatology to psychiatry to endocrinology to a musculoskeletal complaint to a goals-of-care conversation, with no pre-selected referral population to narrow the field.

The pathway to it is short and direct. After a three-year ACGME-accredited internal medicine residency, a physician is eligible to sit for the ABIM certification examination and can be hired straight into outpatient general practice; most employers expect board eligibility at hiring and full certification within a set period. There is no fellowship and no fellowship Match to navigate — the transition is a job search, not a second competitive application cycle. Many residencies offer a dedicated primary care or ambulatory track running parallel to the categorical program, often using block (“X+Y”) scheduling that separates inpatient from outpatient months to protect continuity-clinic time. Both the categorical and primary care tracks lead to the same ABIM certificate; the track simply provides enhanced or more concentrated ambulatory training. Optional post-residency add-ons — a chief-resident year, or fellowships such as geriatrics, addiction medicine, obesity medicine, or clinical informatics — can shape a niche, but none is needed to practice general outpatient internal medicine.

A day in the life

The outpatient day has a rhythm the numbers only hint at. It often begins before the first patient, with a pass through the electronic inbox — results to interpret and act on, refill requests, patient-portal messages, and forms — because whatever is not cleared early waits until evening. Then a clinic session of roughly eighteen to twenty-four patients in fifteen- to thirty-minute slots: a diabetic whose control has slipped, a Medicare wellness visit, a worried-well patient with three weeks of fatigue, a hypertension follow-up that turns into a conversation about depression, a new patient carrying a decade of unmanaged disease and a bag of records. Between rooms the work continues invisibly — a prior authorization, a specialist’s message, a nurse’s question, a form to sign before a patient can return to work. Lunch is often documentation. The afternoon repeats. And when the last patient leaves, a second shift begins: the notes not finished between visits, the results that arrived during clinic, the messages that accumulated all day — the after-hours “inbox” work that has become the single most-studied burden of the field. On a well-staffed day, with a real team absorbing that load, it is deeply satisfying work; on an understaffed one, the inbox follows the physician home. Which of those two days a job produces is decided less by the specialty than by how the practice is built — the subject of a later section.

Why so few choose it

This is the field’s defining paradox, and it is worth meeting head-on. Because there is no fellowship, entry is not competitive — a graduating resident who wants outpatient primary care can have it. The problem is upstream: fewer and fewer residents choose the field at all. Fewer than one in ten internal medicine residents now plan a general-internal-medicine career — roughly half the share of a decade ago⁵.

Read that the way a mentor would, not as a market signal. The decline is structural — it tracks how the work is paid and, just as much, what residency trains residents to feel comfortable doing. It is not a verdict on the value of the work, which by the evidence is among the highest in medicine. A resident who dismisses primary care as a “lesser” or fallback choice has usually absorbed the signal of a training system tilted toward the hospital, not weighed the career itself. Some residents, after genuine exposure, thoughtfully decide the longitudinal, outpatient, inbox-heavy rhythm is not their fit — that is a legitimate judgment of personal fit, and a different thing from the unexamined reflex this page is describing.

Skills & personality

Thriving in longitudinal outpatient medicine rewards a specific temperament, and the fit matters. Those who do well are drawn to breadth — to being the generalist “quarterback” across the whole of a patient’s health rather than confined to a single organ system. That is not a taste for shallowness: many generalists cultivate deep areas of expertise, and on the problems they manage most they can match or outstrip a subspecialist’s command of them. The draw is the range of what a patient brings, not the mastery of one domain to the exclusion of the rest — and those who would rather live inside a single narrow field are usually happier subspecializing. They also share a tolerance for ambiguity and undifferentiated complaints: much of the work is sorting the benign from the dangerous with incomplete information, through watchful waiting and probabilistic reasoning rather than definitive answers.

The rest is relational and organizational. Satisfaction here comes largely from years-long relationships with patients and families, so those who find their reward in single dramatic interventions may feel unfulfilled. Much of chronic-disease management is relational and strategic — motivating and negotiating with patients, sequencing the long game of a condition, and above all building and sustaining the trust and consistency that make someone willing to act on a plan over years. This is precisely the part that residents trained mostly on the wards find hardest, because it asks the patient, not a team, to be the one who carries it out. It demands communication, negotiation, and behavior-change skill as a core competence, not a soft extra. And because the internist orchestrates specialists, labs, imaging, prior authorizations, and social needs, care coordination and systems thinking are central. Two more traits are quietly protective: efficiency and boundary-setting, because the inbox expands to fill whatever time you give it, and comfort with volume and interruption, because employed practice often means eighteen to twenty-four patients a day and a steady stream of messages.

Who tends to be unhappy? Physicians who dislike paperwork and inbox work; who want procedural variety or high-acuity intervention; who are frustrated by short visits and productivity pressure; or who find chronic disease with slow or absent “cures” demoralizing. The meaning of the relationships has to carry you, because on money and adrenaline alone the field will not.

Lifestyle & the inbox

Outpatient primary care offers predictable daytime clinic hours and little traditional overnight call, which is a genuine and major draw — but that headline is offset by the single biggest lifestyle and burnout issue in the field, which is the electronic health record. This is not a soft complaint; it is one of the best-documented burdens in medicine.

In a landmark study of primary-care workload combining event-log data with direct time-motion observation, physicians spent 5.9 hours of an 11.4-hour workday inside the EHR, including roughly 1.4 hours of after-hours work — the “pajama time” that has become shorthand for the whole problem — with clerical and administrative tasks accounting for nearly half of all EHR time⁶. The messaging load has only grown since, with patient-portal messages now a standing part of the outpatient day.

The deeper structural point is that the work is more than one physician can do alone. Delivering all guideline-recommended preventive, chronic, and acute care to a nationally representative adult panel would take a physician working solo about 26.7 hours a day — an impossible number that falls to roughly 9.3 hours with team-based care⁷. That single comparison is why the panel a physician can responsibly carry depends less on a raw headcount than on the team around them: nurses, medical assistants, pharmacists, and advanced-practice providers absorbing the work one physician cannot. When people say a traditional panel is “too large,” this is the arithmetic they mean.

Two features soften the picture. The field is unusually amenable to part-time work, job-sharing, and telehealth — a reason it draws many who prioritize work-life balance — and lifestyle varies dramatically by model, with direct-primary-care and concierge practices deliberately shrinking panels to restore time per patient. But go in clear-eyed: in the dominant employed, volume-based model, the schedule is humane and the inbox is not, and managing that burden through team-based care, efficiency habits, and firm boundaries is the difference between a sustainable career and burnout.

Compensation & the value it undersells

Primary care sits near the bottom of the physician pay scale. The numbers are healthy in absolute terms, but the gap against procedural fields is large, and it is a major financial driver pushing residents to subspecialize — one of several, alongside role models, clinical exposure, procedural interest, and lifestyle. Because residents care about what the field pays now, this page leads with the one source that is a public primary anyone can check, then names the proprietary surveys.

The US Bureau of Labor Statistics, in its May 2025 Occupational Employment and Wage Statistics, put the mean annual wage for general internal medicine physicians at $267,200 and the median at $256,560, across about 67,150 salaried physicians in that category¹. One caveat is essential: BLS surveys employers and excludes self-employed physicians, so practice owners are absent from the count. (A note for anyone comparing across years: BLS changed how it collects high wages after May 2023, so its older top figures were capped and are not cleanly comparable to these.)

The proprietary surveys agree on the direction, and are worth quoting directly — with one caveat. Medscape’s 2026 report put internal medicine’s average total compensation at about $307,000, and Doximity’s 2025 report at $326,116³; both label the broad “internal medicine” category, which blends outpatient, hospitalist, and mixed practice, so read them as running above employed office-based primary-care pay rather than as a match for it. MGMA’s freely-published 2026 summary reports a median total compensation of about $345,852 for primary care physicians — higher still, but a broad employed-medical-group grouping rather than an office-based-PCP figure⁸. Set against roughly $611,000 for orthopedics and $575,000 for cardiology in the same Medscape report², procedural fields earn on the order of twice what the generalist does. Those figures are self-reported and statistically modeled rather than audited payroll, so treat them as directional; the roughly two-to-one gap, not any single dollar amount, is the durable point.

Why the gap. In a fee-for-service system, reimbursement rewards procedures and volume, not cognitive complexity or continuity. Primary-care income comes almost entirely from evaluation-and-management billing — office visits — and the field performs few high-RVU procedures. A cardiologist or gastroenterologist billing procedures to commercial payers will out-earn a generalist substantially. None of that reflects the value of the care; it reflects what the payment system has chosen to pay for.

And the value is real, which makes the gap sting. By a large and consistent evidence base, the care primary care delivers is among the most valuable in medicine: more primary care physicians per capita tracks longer life expectancy and lower total health-care costs, and the United States spends more on health than any wealthy nation while directing strikingly little of it to primary care itself. The field the data most reward is the one the payment system least does. The full evidence — effect sizes, sources, and the international comparison — is laid out in the companion analysis, the value the system underpays.

The levers that exist. Two models let physicians step outside insurance-driven volume. In direct primary care, the practice charges a periodic membership fee — monthly, quarterly, or annual — as an alternative to fee-for-service billing, does not bill insurers or government programs, and deliberately keeps panels smaller⁹. Concierge practices charge an annual retainer, often alongside conventional insurance billing, and likewise shrink the panel to buy back time per patient. Both can raise take-home pay while cutting volume, but the economics depend entirely on how many patients will pay and stay. Compensation is also often higher in underserved and rural markets that pay recruitment premiums, and can be higher in private-practice ownership.

One offset the annual gap hides. Choosing primary care means an attending’s income immediately, rather than one to several more years at fellowship pay — years of earlier saving, loan repayment, and compounding that narrow the lifetime gap against a subspecialty, even though for most fields they will not close it. Weigh the ten-year picture, not only the annual ceiling.

Intellectual scope

If the paycheck is the field’s weakness, its intellectual life is genuinely underrated — and the appeal is breadth and the diagnostic challenge of the undifferentiated patient. The internist’s craft is Bayesian reasoning under uncertainty: distinguishing the fatigue that is benign from the small fraction that signals serious disease, without the luxury of a pre-selected referral population. A single clinic session can span half a dozen organ systems and a preventive counseling visit, and doing that well — integrating a complex, self-conflicting medication list, a new symptom, and a patient’s own priorities into one coherent plan — is difficult in a way procedural depth is not, and for the right person deeply satisfying.

The scope also expands in directions that suit the generalist perspective. Quality improvement and population health are a natural fit given panel management; health-services research and implementation science are where academic general internal medicine lives; medical education runs through every continuity clinic; and clinical informatics — optimizing the very records that burden the field — is a growing subspecialty (though formal board certification now generally requires a fellowship). For the entrepreneurially inclined, direct primary care, telehealth, and digital-health advising are real destinations rather than exotic exits. Few fields ask you to synthesize as much of medicine at once, or leave as many doors open across a career.

Pathways & job market

The employment models span the full range — employed group and health-system practice (the norm), independent private practice (more autonomy and ownership upside, more overhead and business risk), community health centers, the VA, academic general internal medicine, and the direct-primary-care and concierge models described above. Non-clinical and hybrid options are unusually strong for a generalist: clinical informatics and chief-medical-information-officer roles, physician-executive and medical-director positions, utilization management and payer roles, telehealth clinical leadership, and population-health and value-based-care leadership all draw naturally on the generalist’s systems-level view.

The payment model is shifting, slowly. The economics are moving, unevenly, from fee-for-service toward accountable care — and it helps to be precise about what that means. Accountable-care arrangements mostly layer responsibility for quality and total cost onto existing payment: many ACO clinicians continue to bill fee-for-service and may then share in savings (or losses), while newer models — such as the 2025 ACO Primary Care Flex model inside the Medicare Shared Savings Program — test prospective, panel-based primary-care payments that give practices more predictable revenue. The Centers for Medicare & Medicaid Services has set a goal of having every person in Traditional Medicare in an accountable care relationship by 2030; as of January 2025, 53.4% — more than 14.8 million people — already were¹⁰. If the prospective models scale, they could reward exactly the coordination and continuity that fee-for-service underpays — though payment policy is politically contingent and worth watching rather than banking on.

The workforce math is stark, and it is the field’s strongest practical selling point. The Association of American Medical Colleges projects the United States will be short 20,200 to 40,400 primary care physicians by 2036, within a total physician shortfall of 13,500 to 86,000⁴. HRSA’s workforce modeling points the same way, projecting a shortage of about 70,610 full-time-equivalent primary care physicians by 2038¹¹. The direction is not in doubt: demand is rising with an aging, chronically-ill population, and the pipeline is thinning.

Geography and loan forgiveness. Demand is strongest in rural, Southern, and Mountain-West markets and in federally designated shortage areas, and several programs reward service there:

• National Health Service Corps Loan Repayment Program — up to $75,000 for a full-time, two-year commitment as a primary care physician at an approved site in a primary-care Health Professional Shortage Area, with a further one-time $5,000 enhancement for Spanish-language proficiency, and continuation contracts that can retire most remaining debt; NHSC loan repayment is exempt from federal income tax¹².
• Public Service Loan Forgiveness (PSLF) — forgives federal student loans after 120 qualifying payments while employed by a government or 501(c)(3) employer, which covers the VA, many community health centers, and many academic centers.
• State loan-repayment programs — many states run their own, often matched to NHSC, with their own eligibility rules.

Ground your expectations in one sentence: a general internist can usually find opportunities across a wide range of locations and settings, job security is strong — with the greatest bargaining power in rural and underserved markets — and broad demand is likely to remain strong, all within a compensation band that the payment system, not scarcity, sets, and against an administrative load you must actively manage.

Choosing your program & first job

More than in most fields, a primary-care career’s quality is set by two choices the headline salary never captures: the residency that trains you, and the practice that first employs you. Because the ACGME’s outpatient requirement is broad — at least ten months of outpatient experience and a continuity panel, but with wide program discretion over how they are filled¹³ — two programs can both satisfy it while preparing residents very differently for independent primary care. And because a primary-care job’s daily reality is set by its design more than its specialty, two offers at the same salary can be a sustainable career and an exhausting one.

Evaluating a residency for primary-care preparation

If you are a student or applicant who wants to practice outpatient primary care, ask each program how the ambulatory training is actually built:

• How is the ten-month outpatient requirement filled — how much is comprehensive general-internal-medicine continuity and ambulatory care, versus subspecialty clinic?
• Is continuity clinic a traditional weekly half-day or a block (“X+Y”) schedule — and do residents keep meaningful ownership of their own patient panel?
• Who manages a resident’s results and messages while they are away on inpatient rotations?
• Are residents taught the ambulatory bread and butter — musculoskeletal and joint injections, skin procedures, office gynecology, behavioral health, and addiction and obesity medicine?
• Are pharmacists, social workers, behavioral-health clinicians, and care managers genuinely integrated into the clinic — or named on a certificate but absent from the room?
• Are the primary-care faculty respected, adequately staffed, and visibly satisfied with their own careers?
• Can residents rotate through the VA, community health centers, rural clinics, home-based care, or direct primary care?

Comparing practice models

Most of the field’s settings are legitimate careers rather than fallbacks, and each trades something for something else. Concierge and direct primary care draw outsized attention because they are novel, but for most graduates the real choice is among the employed, academic, and safety-net models.

Reading a first-job offer

Normalize competing offers before you compare them, because the design decides the day — and keep the compensation terms straight, because base salary, guaranteed first-year pay, production (RVU) pay, quality incentives, and total compensation are not interchangeable. For primary care, the operational details below often decide quality of life more than the headline number does.

IMG considerations

If you are an international medical graduate, read this section closely, because primary care is the most navigable path in American medicine for you — and because the way it is often described to IMGs contains one claim that is no longer true. International graduates make up a large and disproportionate share of the internal medicine and primary-care workforce, and they are especially concentrated in the underserved settings where the need is greatest. But the workforce data also hold a genuine tension worth naming honestly.

The tension: IMGs report wanting general internal medicine less, yet the system has long routed them into it. In Paralkar’s data, graduating from an international medical school was independently associated with lower odds of choosing a general-internal-medicine career (adjusted odds ratio 0.84; 95% CI, 0.77–0.93), after accounting for program type, sex, calendar year, and medical-school location⁵. That fits a common pattern — many IMGs arrive wanting subspecialty training, from systems where primary care is less developed. In practice, though, IMGs have disproportionately staffed primary care and shortage-area medicine. Why intent and practice diverge is not settled; no study cited here measures IMG career intent at entry to US residency, so this page does not assert one.

The Conrad 30 waiver is the mechanism, but understand what it does now. Among foreign-national IMGs who require visa sponsorship for residency, many train on a J-1 exchange-visitor visa, which carries a two-year home-residency requirement before moving to an H-1B or green card. (US-citizen and lawful-permanent-resident IMGs need no training visa at all.) The Conrad State 30 program waives that requirement: each state health department may recommend up to 30 J-1 physician waivers per federal fiscal year, in exchange for a full-time (at least 40 hours a week) commitment to practice for at least three years at a facility in a federally designated Health Professional Shortage Area, Medically Underserved Area, or Medically Underserved Population¹⁴. Historically this routed IMGs into primary care — but that is exactly the claim that has changed. Across 2001 to 2020, the program recruited 18,504 physicians and its annual placements rose from 550 to 1,162, yet the share who were primary care physicians fell from 82% to 28%, while the number of non-primary-care physicians it placed grew roughly six-fold¹⁵. The waiver still opens the door to underserved practice; it no longer reliably routes an IMG specifically into primary care. Plan around the visa, not around an assumption that it will choose the career for you.

Underserved-area service is both a visa solution and a career on-ramp. The community health centers, rural clinics, and safety-net systems that advertise “J-1 waiver eligible” positions overlap heavily with the sites that qualify for federal loan repayment, so a single job can address immigration and debt at once — with one important asterisk. The NHSC Loan Repayment Program requires US citizenship or nationality¹², so IMGs on visas generally cannot use it until they adjust status; in practice, most rely on Conrad 30 for the immigration piece and on state or employer loan-repayment programs for debt relief in the meantime. Confirm each program’s current eligibility rules directly, because these details matter and they change.

A timing note that saves people real trouble. Because states fill their Conrad 30 slots at different rates, start the job-and-waiver search 12 to 18 months before residency ends. Less-competitive states — often in the rural Midwest, Mountain West, and rural South — frequently still have slots open later in the year, and the review chain runs from the state health department to the Department of State’s Waiver Review Division to USCIS, which takes time. Visa timelines are fragile and worth planning around; for the wider, faster-moving immigration picture, see the Perspectives piece on the H-1B for physicians in training and the For-IMGs hub. But once you are in a US residency, few post-residency paths are as accessible to you as general internal medicine — alongside hospital medicine — and few align as neatly with the underserved-service routes that make the immigration and debt math work.

Bottom line

Consider general internal medicine and primary care if you value long-term relationships and continuity over episodic or procedural care; you enjoy breadth, diagnostic puzzles, and being the generalist “quarterback” of a patient’s care; you want to practice directly after a three-year residency with no fellowship; you prioritize predictable daytime hours, little overnight call, and strong part-time and telehealth flexibility; you are drawn to mission, underserved care, or population-health and value-based-care leadership; or you are an IMG seeking the most navigable path in medicine, with abundant positions and durable job security.

It may not fit if you want the highest income — you will earn substantially less than procedural and surgical subspecialists; if you dislike documentation and messaging, because the EHR inbox is real and a leading burnout driver; if you prefer deep expertise in one organ system, high-acuity work, or a heavy procedural component; or if short visits, high panel volume, and productivity pressure in employed practice would grind on you — though direct-primary-care, concierge, and value-based models can mitigate that.

A last mentor’s note: the halving of the share choosing primary care is not a signal that the field is a lesser choice. It is what happens when a payment system underpays cognitive, continuity, whole-person care, and a training system steers residents toward the hospital — the argument is laid out in full in the companion analysis. None of that is a verdict on the work, which the evidence rewards more than almost any field in medicine. Primary care offers exceptional breadth, relationships, flexibility, mission, and strong job security, plus one of the most direct routes from residency of any path here, alongside hospital medicine — and you pay for it with a compensation gap and an administrative load you must manage deliberately. Find an outpatient internist at your program, spend a clinic day with them, and ask what makes their practice sustainable, what they would change, and whether they would choose it again. If their answer resonates, this is among the most consequential and most open doors in medicine, and it is yours.

References

1. U.S. Bureau of Labor Statistics. (2026). Occupational employment and wages, May 2025: 29-1216 General internal medicine physicians. Occupational Employment and Wage Statistics. https://www.bls.gov/oes/current/oes291216.htm Mean annual wage $267,200; median $256,560; employment 67,150. Excludes self-employed physicians. ↩₁ ↩₂
2. McKenna, J. (2026, April 10). “A return to normalization”: Medscape physician compensation report 2026. Medscape. https://www.medscape.com/slideshow/2026-compensation-overview-6018217 Self-reported total compensation from 5,916 physicians, then modeled and weighted to the AMA physician-distribution database; a smoothed estimate, not audited payroll. Proprietary; figures are industry-reported. ↩₁ ↩₂
3. Doximity. (2025). 2025 physician compensation report. https://www.doximity.com/reports/physician-compensation-report/2025 Internal medicine average $326,116 (calendar-2024 data). Self-reported by full-time US physicians (≥ 40 hours/week); averages, not medians, and not audited payroll; the report does not itemize what “compensation” includes. Proprietary; figures are industry-reported. ↩₁ ↩₂
4. Association of American Medical Colleges. (2024). The complexities of physician supply and demand: Projections from 2021 to 2036. https://www.aamc.org/media/75236/download ↩₁ ↩₂
5. Paralkar, N., LaVine, N., Ryan, S., Conigliaro, R., Ehrlich, J., Khan, A., & Block, L. (2023). Career plans of internal medicine residents from 2019 to 2021. JAMA Internal Medicine, 183(10), 1166–1167. https://pmc.ncbi.nlm.nih.gov/articles/PMC10463168/ ACP In-Training Examination surveys, N = 61,991. Fuller analysis of the career-plan trend is in the companion Perspectives piece. ↩₁ ↩₂
6. Arndt, B. G., Beasley, J. W., Watkinson, M. D., Temte, J. L., Tuan, W.-J., Sinsky, C. A., & Gilchrist, V. J. (2017). Tethered to the EHR: Primary care physician workload assessment using EHR event log data and time-motion observations. Annals of Family Medicine, 15(5), 419–426. https://pmc.ncbi.nlm.nih.gov/articles/PMC5593724/ ↩
7. Porter, J., Boyd, C., Skandari, M. R., & Laiteerapong, N. (2023). Revisiting the time needed to provide adult primary care. Journal of General Internal Medicine, 38(1), 147–155. https://pmc.ncbi.nlm.nih.gov/articles/PMC9848034/ ↩
8. Medical Group Management Association. (2026). Provider compensation and productivity data report: Key benchmarks and trends (freely-published summary). https://www.mgma.com/ MGMA’s freely-published highlights summary (not the gated DataDive). Reports median total compensation of about $345,852 for primary care physicians — a broad employed-medical-group grouping (family, internal, and pediatric primary care), which runs above office-based BLS figures. Employer-reported; grouping-level, not a specific PCP salary. ↩
9. American Academy of Family Physicians. (n.d.). Direct primary care. https://www.aafp.org/family-physician/practice-and-career/delivery-payment-models/direct-primary-care.html ↩
10. Centers for Medicare & Medicaid Services. (2025). CMS moves closer to accountable care goals with 2025 ACO initiatives [Fact sheet]. https://www.cms.gov/newsroom/fact-sheets/cms-moves-closer-accountable-care-goals-2025-aco-initiatives ↩
11. Health Resources and Services Administration, Bureau of Health Workforce. (2025). State of the primary care workforce, 2025. https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/State-of-the-Primary-Care-Workforce-2025.pdf Projects a shortage of 70,610 full-time-equivalent primary care physicians by 2038, superseding the prior (2024) projection of 87,150 FTEs by 2037. ↩
12. National Health Service Corps. (n.d.). NHSC Loan Repayment Program. Health Resources and Services Administration. https://nhsc.hrsa.gov/loan-repayment/nhsc-loan-repayment-program ↩₁ ↩₂
13. Accreditation Council for Graduate Medical Education. (2026). ACGME program requirements for graduate medical education in internal medicine (including FAQs). https://www.acgme.org/globalassets/pfassets/programrequirements/2026-prs/140_internalmedicine_2026.pdf Requires at least 10 months of outpatient clinical experience (4.11.c.1) and a longitudinal team-based continuity experience with a patient panel for the duration of residency (4.11.f.2). The outpatient requirement may be satisfied by subspecialty, urgent-care, home-care, and ambulatory-block experiences — the continuity panel may even be held in a subspecialty clinic — and there is no required continuity percentage or panel composition, so programs retain wide discretion over how much is comprehensive primary care. ↩
14. U.S. Citizenship and Immigration Services. (n.d.). Conrad 30 Waiver Program. https://www.uscis.gov/working-in-the-united-states/students-and-exchange-visitors/conrad-30-waiver-program ↩₁ ↩₂
15. Ramesh, T., Brotherton, S. E., Wozniak, G. D., & Yu, H. (2023). Evaluation of the Conrad 30 Waiver Program’s success in attracting international medical graduates to underserved areas. JAMA Health Forum, 4(7), e232021. https://pmc.ncbi.nlm.nih.gov/articles/PMC10383001/ ↩

Figures here are survey- and model-based and shift over time; payment, loan-repayment, and visa rules change frequently. Verify against the primary source before relying on any figure for a career, contract, or immigration decision. This page is educational and is not career, financial, immigration, or legal advice.