The Red Blocks

I stared at the spreadsheet. Each red block represented a student—one without a clinical placement, without a chance to step into their family medicine clerkship. A student who had sacrificed greatly, some already carrying the heavy burden of financial debt. That worry now had a geometric shape: a puzzle of red and green blocks on Excel.

What if we couldn’t turn red into green? What if we could not show the true breadth of primary care, its challenges and its rewards?

Sitting beside my coordinator, I stared at the screen. Green meant a student had a home, a clinic placement. Red was the dreaded gap; someone still floating, unanchored, at risk of losing out on the experiences that might shape their career. Each red block felt heavier than the last, as though a student’s future sat inside that little square.

When I began, our family medicine clerkship had only five students at a single site. In just a few short years, it rapidly expanded to 22 students per block across 13 sites. That growth was possible because community family doctors took on the challenge of teaching. They did so despite already-full patient schedules with waitlists and endless charting time. Many also persisted despite the moral injury they faced during the COVID-19 pandemic and continue to face as the health of our communities is pulled into political crossfire.

On paper, the expansion was progress. In practice, it was fragile, an expanding patchwork held together by busy physicians, many of whom already felt stretched to their limits.

She shook her head. “I can’t do this. My patients need me. The pajama time I spend charting, the short staffing, the two months it takes to get patients in; adding a student will slow everything down. People will wait even longer than they already do.”

My colleague was not wrong. She was speaking the truth: teaching takes time, and time is scarce in primary care.

Maybe we were asking too much. Maybe the red blocks on my spreadsheet were not just gaps to be filled but reminders of the limits of an already-strained system.

Weeks later, we talked again. “Yes, without a student you can add two more patients, but who will see your patients in twenty years? If we do not train them now, there will not be anyone left to do it.”

She paused, then said, “Let’s give it a try.”

Months later, when I visited again, her tone had softened. “It’s hard,” she admitted, “but it has brought joy. It keeps me sharp. It reminds me why I became a doctor in the first place.”

That shift, from the urgency of now to the vision of the future, was my teaching moment. As the clerkship director, I realized my job was not simply to direct the clerkship but to carry the mission into every room, every conversation, and every negotiation. Faculty needed to see that teaching was not an added burden but part of a larger purpose: shaping the workforce that would one day care for their own patients, their own communities, and their own families.

The spreadsheet became more than a tool. Green blocks came to symbolize not just logistics but belonging: students anchored, preceptors renewed, the mission alive. Red blocks became something different too, not just gaps, but opportunities. Each red square was a chance to bring someone new into the story, to invite them into something perhaps larger.

Over time, there was transformation—faculty who once hesitated began to speak with pride about their role in education. “It keeps me up to date,” they would say. “It makes me feel young again.” The coordinator who once worried only about logistics came to see herself as the glue of the system, connecting students and teachers in ways that shaped both. And students, placed across diverse settings, began to glimpse the breadth of family medicine and imagine themselves within it.

Now, as I prepare to step away from this role, I find myself reflecting on what this journey has taught me. The worries, the lessons, and the small victories hold value for others in leadership and education. Yes, we can add patient slots today by cutting out teaching. But if we do, the exam rooms of tomorrow will stand empty. Scaling a clerkship taught me a lesson I carry into every aspect of leadership: logistics may build a program, but only mission sustains it. Numbers do not inspire people, meaning does.

That is why the red blocks on my screen will always stay with me. They are reminders that mission must come first. As Maya Angelou said, “When you learn, teach. When you get, give.”¹