ABSTRACT
Most physicians stay close to where they go to medical school and are trained, and all the financial and cultural incentives after medical training push people away from primary care, and into specialty training. The medical education and health workforce is tilted so hard that it is difficult to know who is leading whom, or what is leading what. But not enough young people can ever survive a distorting, alienating training system to build a healthcare system that is community and relationship-based, as well as personal, rational and just. All other things being equal, US health services training fails in four interrelated areas: diversity, career laddering, affordability, and community focus. These failures build on one another to create a workforce that is elitist, self-involved, self-referential and self-serving, and that workforce effectively undermines any community focus that the healthcare system might have left. A just medical education system would have no barriers to entry.
