This seems like a funny place and time to debate this stuff, but I don't think that UW emphasizes only rural/urban underserved primary care in its education or in its admissions process. Their entire clinical program is fantastic, and they are a research giant as well. They are consistently #2 or #3 in NIH grants in the country, and they are #6 on the US-News research ranking this year, #7 the last two years. None of the students I know at UWSOM are interested in primary care, and none of them pretended that they were during the application process. A couple are research oriented, but most are interested in various specialties of clinical care. Not to say that primary care for the underserved isn't an important element for UW, but it is only one of several. Again, it's really impossible to know exactly what they're looking for in applicants, and it's also impossible to know what your fellow applicants offer as competition. You never know who will read your application, who will review your application, who will interview you, who will discuss you at the excom meetings, what their personal ideas about who would make a great physician are, what mood they are in that day, what sort of applicant will have come just before you with whom you will be compared, etc. Apparently ~500 WA candidates applied this year who had the qualifications to be med students at UW (taking into account the competitive pool and the number of students accepted directly after their interview), and they had to choose 100 of them. That's the way it is at all med schools. I don't know about you guys, but I applied to 18 schools and went to 8 interviews knowing that my chances at any one school were not that great. I spent an ungodly amount of money that I didn't really have. That's the odious, arduous, inefficient (in my mind) and at least somewhat capricious process.