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Hello! I am a second-year medical student and very strongly considering a Primary Care career. I absolutely agree that there is an image problem to be addressed, but I think that you might underestimate the reimbursement issue. Dermatology has a terrible image problem among medical students. It is thought of as boring, not on the forefront of anything and populated by the vain. We recently had our dermatology block and some of our faculty had a conversation about that image with a group of us, and there really are a lot of parallels to how people see primary care. That said, there is huge competition for derm residency spots. It is really unfortunate, but I think the difference is a many many years' history of reimbursement difference. While it might be image more than reimbursement that medical students respond to, the two do seem to be connected. I think until there is some significant equalization, the prestige will fall short.