RE “BYPASS the insurance, these doctors say’’ (Page A1, April 20): The pursuit of an easy life with a higher income is a common American goal, but it should never be the rationale for the practice of primary care medicine.

Medical training is largely subsidized with federal taxpayer dollars, and I’m pretty sure I missed the course at Tufts Medical School, more than 40 years ago, that taught us how to take care of rich people. It is shameful that the Massachusetts Medical Society and the insurance commisioner allow the practice of shedding or denying care to patients who are not able to pay the extra fee for this so-called personalized care.

While doctors such as those mentioned in Priyanka Dayal McCluskey’s article cut their patient load to a paltry 600, the national and local shortage of primary care doctors and nurses continues to grow to an alarming degree, with an expectation that we will need more than 40,000 new primary care doctors and at least as many nurses within four years.

States that have allowed the practice of direct primary care to grow without control, such as Florida, New York, and California, have seen access to care suffer and the public deprived of decent primary care.

Rather than highlighting the joys of limited work and increased income, we should be demanding limitations to this egregious practice.

Dr. Martin P. Solomon

Brookline

The writer is medical director of Brigham and Women’s Primary Care of Brookline.