There is a particular kind of institutional memory baked into medical training, and Santina Wheat MD, MPH thinks it is quietly doing harm. When experienced physicians who never learned to manage HIV or Hepatitis C in their own residencies keep transferring those patients to specialists, they are not just making a clinical choice. They are teaching one. Residents watch, absorb the implied boundary, and inherit it. Meanwhile, the broader primary care those patients needed, cancer screenings, metabolic health management, falls entirely through the gap.
Wheat holds a dual role that puts her at the intersection of these problems: she runs a family medicine residency program while also serving as Vice Chair of Health Equity. That combination is deliberate. Health equity in physician training has long been handled as what she describes as an isolated lecture, a module attached to the curriculum rather than threaded through it. Her program operates on a different premise. "Equity isn't an isolated lecture," she has said. "It's cultivating a shared understanding daily that addressing structural and social barriers is just as vital as managing pathophysiology."
What that looks like in practice is less top-down than the description might suggest. Trainees are now frequently the ones driving these conversations, introducing approaches that faculty haven't considered. The learning, in other words, moves in both directions. Wheat describes health equity as acknowledging "the complex layers each patient navigates" and treating those barriers as fundamental to clinical care rather than as context to be noted and set aside.
"A repeating gap is inherited specialist deferral. Experienced physicians, who didn't learn HIV or Hep C management in their own training, frequently transfer these patients out. This models a false boundary for residents, leaving broader primary care—like cancer screenings and metabolic health—completely ignored. Residency must actively break this cycle, equipping trainees with the confidence to provide full-scope primary care rather than inheriting outdated referral habits."
Breaking that cycle, in Wheat's framing, requires more than clinical confidence. There is a third gap she identifies, one that sits further upstream. Residents see constantly how administrative hurdles and rigid workflows compromise the care they are trying to deliver. They adapt. What they are rarely taught is how to push back. Wheat calls systemic advocacy within health systems the missing essential skill, and the absence of it has consequences beyond individual appointments. Physicians who only learn to work around flawed care environments, rather than to analyze root causes and collaborate with leadership toward structural change, end up reinforcing those environments by their accommodation of them.
The question her work raises is whether training a physician to be a capable clinician, without also training them to recognize and act on system-level barriers, produces a kind of competence that stops short of what patients actually need. If the answer is yes, the implications reach well past any single residency program.
