Primary care is often called the front door to health, the place where prevention, early intervention, and continuity of care begin. Yet for nearly 3 million Americans living in primary care Health Professional Shortage Areas (HPSAs), that door is frequently closed.

In Arizona, the challenge is especially acute. According to the Arizona Center for Rural Health, only 35.4% of the state’s primary care needs are currently being met. Shortages span nearly the entire state, with 14 of Arizona’s 15 counties designated as partial or complete primary care shortage areas. While urban communities feel the strain, the most severe gaps persist in rural, Tribal, and border regions.

Looking ahead, the Health Resources and Services Administration projects a shortage of 3,680 physicians by 2030. As Arizona’s population continues to grow and its primary care workforce ages, the gap between supply and demand is expected to widen — intensifying access challenges for communities statewide.

A New Model for Training and Retaining Physicians

The University of Arizona College of Medicine – Phoenix is tackling these workforce shortages through the development and expansion of its Longitudinal Integrated Clerkship (LIC). Rather than serving as a standalone program, the LIC is part of a broader, integrated workforce strategy that rethinks how physicians are trained, supported, and retained, particularly in underserved communities.

This approach intentionally combines medical education, community partnership, and workforce planning to create long-term, sustainable impact.

What Is the Longitudinal Integrated Clerkship?

The LIC is an evidence-informed educational model designed to prepare future physicians for practice in rural and underserved settings. Medical students participating in the program are embedded within a community for approximately 8–10 months, allowing them to engage in sustained, longitudinal clinical training.

Instead of rotating through short, specialty-specific blocks, LIC students work continuously with:

• A core faculty preceptor
• An interprofessional care team
• A dedicated panel of patients

This structure allows students to follow patients over time, observe the full trajectory of care, strengthen clinical reasoning, and develop a deep understanding of community health dynamics.

Expanding Impact Across Arizona

Students in the LIC are currently placed in six rural and underserved communities:

• Flagstaff
• Gila River
• Page
• Payson
• Safford
• San Luis

To date, the program has trained 49 LIC alumni, including 45 graduates from the University of Arizona College of Medicine–Phoenix and four from the University of Arizona College of Medicine–Tucson.

These placements reflect the program’s expanding statewide footprint and its commitment to strengthening Arizona’s healthcare workforce where it is needed most.

By emphasizing continuity, mentorship, and deep community engagement, the LIC creates a high-fidelity training environment that mirrors real-world primary care practice, preparing students to be truly practice-ready.

Training the Whole Physician for Whole-Patient Care

Dr. Jonathan Cartsonis, MD, Assistant Dean at the University of Arizona College of Medicine – Phoenix, emphasizes that the LIC is grounded in holistic patient care.

“The LIC is centered around understanding the whole patient — their setting, their family, and the broader context of their lives,” Cartsonis explains. “It’s not just about the person in front of you and their immediate need; it’s about understanding the full picture.”

He also highlights the program’s impact on systems-level thinking.

“The LIC is especially effective in helping students develop a systems-level understanding of healthcare and public health efforts,” he says. “It’s part of a larger, integrated plan. We have other ideas that piece together into a whole strategy that we believe will make a real difference in meeting Arizona’s workforce needs.”

From Education to Real Workforce Outcomes

The LIC is already translating into measurable workforce results:

• Two new residency programs have been established
• Three program graduates from the University of Arizona College of Medicine – Phoenix and the University of Arizona College of Medicine – Tucson have returned to Payson to practice in rural healthcare settings

“My longitudinal experience at Payson highlighted how continuity of care meaningfully shapes both patient outcomes and the student-patient relationship. Repeated encounters with the same patients allowed me to move beyond addressing isolated complaints and instead appreciate the broader context of their health, including social factors, health literacy, and barriers to care. Over time, I was better able to recognize subtle changes in symptoms, follow up on prior plans, and understand how patients responded to treatments or recommendations, reinforcing the importance of continuity in providing thoughtful, individualized care.” – LIC Medical Student

These outcomes underscore the power of intentional, longitudinal exposure to rural practice environments, and the role education plays in long-term retention.

Beyond clinical training, LIC students engage directly with diverse and often marginalized communities, addressing critical issues tied to the social determinants of health. Dr. Cartsonis points to one student who took this commitment even further by founding a clinic at the warming center in Payson.

The student recruited faculty, developed policies and procedures, and created a welcoming clinical space that now delivers vital services to individuals experiencing homelessness, opening access to care where it had previously been out of reach.

Learning and Leading as Interprofessional Teams

Interdisciplinary collaboration is a cornerstone of the LIC. Students train alongside:

• Physicians
• Social workers
• Physical therapists
• Nurse practitioners
• Physician assistants
• Pharmacists
• Other healthcare professionals

Physician assistant students from Northern Arizona University participate in the same cohort, strengthening team-based care and fostering shared learning across disciplines — a critical skill set for modern primary care practice.

“The response from the community is powerful.  The community enjoys the students. They get to know them and exchange Christmas cards.  They become attached to the students and grieve when they leave.  It’s not just the medical community; all of Payson embraces the role in training the next generation of rural physicians who they hope will take care of them.”– Dr. Judith Hunt, Payson LIC Site Director 

Accelerating Pathways Into Primary Care

In addition to the LIC, the U of A College of Medicine – Phoenix is advancing a three-year medical school curriculum focused on primary care. This pathway allows select students to move directly into residency training, either through LIC-based rural sites or at Banner–University Medical Center.

By reducing barriers associated with the traditional match process and keeping training localized, the program helps retain future physicians in Arizona.

“This is about keeping physicians here,” Cartsonis emphasizes. “When training, residency, and community are aligned, we create pathways that support retention and strengthen care delivery where it’s needed most.”

Opening the Door to a More Accessible Future

Together, these efforts represent a comprehensive, community-centered approach to healthcare workforce development, one that empowers local communities, supports healthcare professionals, and prepares the next generation of physicians to deliver high-quality, equitable care across Arizona.

For communities where the front door to healthcare has long been closed, the Longitudinal Integrated Clerkship is helping to open it, creating opportunity, strengthening collaboration, and building a more accessible future for care statewide.

By: Jocelyn Romero | February 11, 2026