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Match Hype Hinders Health Access Solutions

In this time of avoiding the Truth, perhaps primary care training will be exposed to the truth as well. Each year the annual residency match generates numerous promotions of various types of programs as being primary care solutions. Sources low yield for primary care are not good sources for care where needed. The Match may indicate more medical students who begin training in primary care, but few will enter primary care and even fewer will stay in primary care.

Claims of nurse practitioner and physician assistant solutions for primary care are just as spurious. Those entering primary care and remaining in primary care continue to fall to lower levels. 

This year the claims of international graduates as solutions for underserved areas are prominent. About 50 - 90% of the services provided where the underserved need care are provided by primary care. International graduates fail as good sources of care where needed due to

20% loss to home or other nations45% choosing lowest primary care y…

Payment Prevents Primary Care Result - No More Match Follies

Year after year various primary care associations get excited to find out the results of the match or residency choices of medical students. It is quite interesting to see how so little change is promoted so much. Even a small increase of a few dozen graduates is celebrated.

Such celebrations hide the tragedy shaped by primary care payment design. This is best seen in family medicine, by far the best remaining source of primary care.

Changes over time indicate the likely result of increased family medicine graduates. The increase from 2900 to 3200 seems significant at 10% growth. But over the same time period family medicine residency graduates have been choosing other career paths involving emergency care, hospitalist careers, urgent care, and other specialties. The specialty once 90% retained in primary care is down to below 70%. The impact of the actual primary care result is shown below:


Annual GraduatesIncrease in GraduatesActive in FM Positions Over CareerActual FM Result By Clas…

Can Primary Care Survive Devaluation by CEOs and Government

Unprecedented decreases in morale and productivity have been seen across primary care in recent years. It is very clear that team members have faced rapid changes and increasing care demands along with declining support while patients and situations have increased in complexity. Health care leaders are not paying attention. There has been no progress to improve support or to decrease the challenges.

Even worse, primary care leaders get poor ratings as they spend their time and effort and scarce resources on areas that will not reverse marginalization, burnout, turnover, and productivity problems.

A recent RAND study was very relevant and indicated increasing concerns regarding the ability to best care for patients and have been sent through formal family medicine channels. Studies document the proliferation of additional work hours before and after patient care. Numerous studies indicate the higher costs from HITECH to MACRA and for primary care medical home. These are designs that can …

Good Better and Best Value in Primary Care Leadership

Panelists push payment reform for primary care. This is a great title for a blog posting, but is family medicine really moving forward? Will more meetings, more reports, and more blog postings do anything of value for primary care? Since value ratings have become popular, some ratings can be assigned regarding the activities of primary care associations. Good, better, and best value ratings can be assigned to panels, postings, reports, and other efforts.

Good Value Would Be An End to Valueless Distractions and Diversions

Good value would be an end to endless, pointless, and valueless discussions, conferences, or reports regarding building or rebuilding the primary care workforce. It is difficult to maintain primary care with 55% of visits and only 6% of health spending. This is made worse by more burdens as mental health, primary care internal medicine, and general surgical specialties collapse also by payment design.

There is no point to a focus on training interventions until the fin…

How Can CMS Improve Value In the Most Valuable?

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Arguably the practices of most value are those with lower cost relative to patients seen or outcomes achieved. Small and rural practices have long been paid the least and cover more complex patients often without access to local resources or other local types of providers. They have demonstrated same or similar outcomes. They are also the most valuable as their existence is often the difference between access to care and no access to care. So how can CMS improve value in practices most valuable.

Despite greatest value, CMS apparently sees the need to improve value. One would think that CMS would have the small and rural practices instruct others and the nation about value, but such is not the case. A new grant program has been promoted by CMS and the usual associations to increase value in the most valuable practices. 

This latest grant is another in a long series of 100 million dollar CMS grant distractions. Apparently associations such as AAFP will continue to promote this even though…