Residency trains you for the critical or severe cases, leaving the seemingly simplest cases to be the most challenging. Shadowfax reflects on an example where a 1-week old infant presented vomiting blood.

Similarly, when I first started primary care I was comfortable running codes and knowing what to do in an acute MI. It was the rashes that I saw in the office that I found more challenging.

Residency prepares you well for hospital medicine – which is one reason why many new graduates prefer hospitalist positions. It’s in their comfort zone.

If we want more Internal Medicine primary care doctors, residencies need to do a better job teaching office-based medicine.

Or else it is no wonder that only 2 percent of Internal Medicine graduates enter primary care.