Demand exceeds supply because there’s not a whole lot of incentive for people who devote years of study to medicine to not add a couple more years and become a specialist at twice the income. People come out of medical school in the United States often with a great deal of debt, and if they are committed to a primary care career, they might also worry that they’ll have difficulty paying off their loan,” says Dr. Peter Ubel, a physician and behavioral scientist at Duke University’s Fuqua School of Medicine. “It can be really hard in rural Texas to get a primary care appointment, compared to Houston, but many physicians, when they finish training, might not want to live in a very rural area, so we may need to help make it easier for them, or incentivize them to do that,” Dr. Ubel suggests.