In my more exasperated moments of residency, I must admit I was envious not only of what my supervising doctors knew, but also who they treated.

Residents in our clinic, doctors in training just out of medical school, generally picked up patients they cared for in the hospital — with lots of medical problems, little medical care and often without a place to stay. The attending physicians who supervised us, it seemed, built their patient panels handing out business cards in luxury suites at Patriots games. Over time, as we transferred patients from one graduating resident to the next, our panels came to embody the city’s deepest and most recalcitrant social challenges.

This was, of course, good training, if only in the art of seeing patients with six conditions on 12 medications in 15 minutes. But what strained our abilities was not our patients’ medical complexity, but their social problems: They were poorer, less educated, more isolated, from rougher neighborhoods. We quickly learned that while it’s hard to dose insulin, it’s harder still for a patient who speaks no English, has no refrigerator and regularly has his medications stolen.

This dynamic is not unique to my clinic, nor to residents versus attendings. Across the country, some doctors, hospitals and clinics care for a disproportionate share of disadvantaged patients. But we’ve been largely unable — or unwilling — to consider social disparities among patients in how we support and pay doctors.