The thing that confuses me the most is the fact that rural Appalachia does not have a "primary care" shortage - it has a physician shortage PERIOD. This sudden shift to try to spew out primary care doctors in no way solves the fact that patients literally have to travel >1 hour on average in order to receive specialty care. What good does it do our patients to go see a primary care provider only to have to be referred out when many do not have the time or means to travel to their specialist appointments?