Despite decades of warnings of a primary care crisis and the fact that some 60 million patients are without primary care doctors, the medical profession has continued to produce legions of specialists. When asked, most of my colleagues will point to the system that determines how medical charges are reimbursed by insurance, and how doctors in different areas of medicine are paid. Put simply, our payment system pays more for procedures performed by specialists. Specialists, therefore, have greater earning power, so more doctors choose to train to be specialists. Careers in specialties like radiology, dermatology and neurosurgery offer lifetime earnings several million dollars higher than those in primary care. It is no surprise that medical students emerging from the educational mole hole saddled with hundreds of thousands of dollars of debt choose more lucrative fields.