Primary-care medicine requires long hours and, compared with other medical specialties, pays poorly. Small wonder that America suffers from a shortage of family doctors, the physicians who should be on the frontline of U.S. medical care. Small wonder that American health-care costs are so high.

We expected the graduates of Brown University’s medical school to choose such specialties as neurosurgery, otolaryngology and orthopedic surgery over family medicine. That’s the national trend. However, things are worse than we expected: Only four of Brown’s 86 medical-school graduates seeking a residency this year picked family medicine. About a fifth chose internal medicine, and many of those will eventually move into cardiology, gastroenterology or other specialties. These are worrisome numbers.

Some experts say that medical-school debt drives students into the higher-paying specialties. A radiologist, for example, can make three times what a primary-care doctor does. However, Dr. Philip Grupposo, associate dean of medical education at Brown, doesn’t see medical-school debt as the driving force. The students are “intelligent enough to know they’re going to be able to pay back the debt,” he says. Rather, they want more money for the finer things and to avoid the grueling hours that a family practice often consumes.

Clearly, any health-care reform must change the economic incentives to favor primary-care medicine. The American College of Physicians, which represents internists, has called for a federal program to pay the costs of medical education for students who pursue careers in primary medicine and work in underserved parts of the country. It also wants Medicare payment policies changed to benefit doctors whose practices center on preventive and coordinated care, as opposed to surgery.

Alan Sager, a health-policy expert at the Boston University School of Public Health, has suggested paying primary-care doctors $250,000 a year to work under a capitation system. The doctors would be earning considerably more than they do now. And because they would treat a set number of patients at a fixed yearly cost, adjusted for medical risks, the doctors would have no financial reason to offer more care than necessary.

Here’s a case where primary-care doctors win, and so does the public. Specialists may oppose any potential loss of business, but promoting primary-care medicine is an essential element of health-care reform.