Primary Care Medicine Tracks
Written by Lindsey Ulin, MD
If you are an internal medicine applicant you may have seen programs offering primary care (PC) tracks. This is something I didn't know existed until the fourth year of medical school, and while it might sound intuitive, there is a lot of variability in PC tracks out there. This post will demystify PC tracks and answer the questions you may not want to pose to faculty evaluating you. If it sounds like something you may be interested in, I encourage you to email the program director (PD) and ask to be considered for both the categorical and primary care tracks. This was an option that was offered to categorical applicants at many of my interviews, so I’m here to tell you it’s not too late-although this will be program-dependent.
Primary care tracks are a good option for applicants interested in primary care or general internal medicine, although interest in a fellowship should not count you out- see common FAQs below. Besides additional time in the clinic, you also get a tight-knit family within a family of the categorical program, another layer of mentorship and support, and more didactics ranging from ambulatory care to structural determinants of health and advocacy work. From an organizational standpoint, there is variability in primary care track experiences. Some programs have more flexibility with “a choose your own adventure experience”, where you opt into additional clinic opportunities and didactics. While others have the three years pretty built out for you with the flexibility offered in electives and how you spend your time on primary care blocks as a second and third year. It’s also important to consider how integrated you want your PC track to be within the categorical program. Some programs have PC residents do inpatient rotations at different hospitals from the categorical residents, while at others you wouldn’t know the difference on inpatient rotations unless you ask someone if they’re a categorical or PC resident.
Common FAQs:
Do I have to commit to doing primary care after residency? What if I want to do a fellowship? No, it’s understood that you can change your mind. A solid foundation in primary care will serve you well regardless of what you end up going into. Additionally, many subspecialties spend a lot of time in the ambulatory setting!
How much time will I spend in the clinic? Your intern year will likely look similar to categorical intern schedules. Most of the PC programs I interviewed at have residents spend half of their time as second and third years on clinic blocks or electives, with the option to add a second continuity clinic site during those years.
Are there any downsides to doing a PC track instead of a categorical internal medicine program? Because of how much time you spend in the clinic as a PGY2 and PGY3, you may have fewer inpatient elective opportunities, but this will vary by program.
How does applying to PC tracks affect how I rank programs? You get to rank them separately. For example, my program has two PC tracks, so I submitted three separate ranks for the two PC tracks and one for the categorical medicine program. One downside was it drove up the cost of my application fees.
What if I want to do primary care but I match to a program that doesn’t have a primary care track? This is more common than being a primary care physician after doing a PC track since this isn’t offered at all IM programs. You will go on to be an excellent primary care physician!
