Louisiana's need for primary care physicians remains among the highest in the nation. The state's rural nature, the aging of current family and general practitioners, the low output of new family physicians, and an increased demand for generalists as a result of changes in health care delivery has exacerbated the situation. Despite the need, the state's medical schools have lagged in terms of the entry of its graduating medical students into primary care, especially family medicine. The tertiary nature of the medical school setting and lack of generalist role models on the faculty have contributed to the declining interest in primary care. Several encouraging changes are underway in medical education in Louisiana that may support the production of more generalists, although the pipeline is long.