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Showing posts from August, 2011

Comparing Family Practice Sources

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The nation’s MD, DO, NP, and PA graduates that remain in family practice are by far the most important solution for health access. Only family practice can be demonstrated to distribute according to the population and not according to concentrations of workforce or health spending. It is important to understand that not all sources remain in family practice in the years after graduation.
Family Practice Retention Using Different Measures

Advance for PA and NP surveys have more detailed information that goes beyond just training program. AANP data indicates training or main specialty, but is limited in actual work components. Workforce cannot be defined without important components that define the actual work - such as positions and employment – especially for the most flexible primary care training sources (NP, PA, IM) where over 65% of graduates are found outside of primary care delivery. Family medicine remains over 90% in family practice employment throughout a career. The distortio…

Rural Workforce 2000 to 2010

Uncle Sam says "I want you" to serve in rural locations. Uncle Sam's design says "I don't want you" to serve in rural locations. Dozens of special programs can no longer hide the fact of an aberrant basic design that fails rural Americans.
The last major contribution that has remained specific to rural locations is family medicine. Family medicine during the decade from creation until the 3000 annual graduate level in 1980 has been the only consistent contribution for rural workforce increase. Other sources old and new have steadily departed primary care, family practice, and more general types of careers. These are all departures away from rural locations and toward top concentrations of existing workforce - according to Uncle Sam's design for health spending and health workforce. .
From 2010 to 2020 the nation can expect declines in primary care retention and lower proportions in rural locations. No projections of rural workforce from 2010 to 2020 sho…

Countdown to the 2012 Primary Care Armageddon

There are about 132 days until January 1, 2012 when Medicare will be forced to cut fees to physicians by a flat rate of 29.5%. These cuts have already been enacted by Congress. To prevent this action, the current Congress would need to take action – a major problem with this Congress. Before the end of the year you will hear much about these cuts and why these should not take place. This has been the case each year for a number of years. The fact of the matter is that many of the physician fees should be cut, but there are some fees that should not be cut. Primary care cuts are a very bad idea at the current time. Even if Congress does miraculously decide to act in a timely fashion, with time enough to allow those delivering services to prepare (too late already), it is likely to cut fees paid for services in a simplistic way. These cuts will include primary care fees along with all others. Across the board cuts are likely as few in this nation understand important differences such as…

Finance-me-cratic Constants in the Bureaucratic Universe

America has come to a standstill in many important areas - health, education, leadership, and more. Recessions have always found ways to blame any number of individuals or types of people. In fact, recessions have a common cause involving the relationship between finance-me-crats, aristocrats, and bureaucrats.
(Note Finance-o-crats was changed to Finance-Me-Crats - a better term with those that have self-interest above nation and political party.) "Let me end my talk by abusing slightly my status as an official representative of the Federal Reserve. I would like to say to Milton and Anna: Regarding the Great Depression. You're right, we did it. We're very sorry. But thanks to you, we won't do it again." November 8, 2002 by Ben Bernanke (the current Chairman of the Federal Reserve), as he agreed with Friedman in blaming the Federal Reserve for its role in the Great Depression. Bernanke should remember that "Hell hath no fury like a bureaucrat scorned." -- …

Still the Health Access Solution for Most Americans: Family Practice

Health access workforce solutions have always been and will always be the broadest scope generalists. Other workforce even with slightly greater specialization or limitation in age range or limitation in scope will remain limited in distribution. Other sources fail to remain in primary care and fail to distribute outside of locations where workforce is already saturated at top concentrations Inside of Concentrations - About 3400 zip codes clustered together in 4% of the land area enjoy top health spending per capita, all lines of revenue, and the top reimbursement in each line. This is where 72% of workforce and 70% of all primary care except family practice is concentrated. These zip codes with top concentrations of physician workforce are dominated by hospital, academic, and subspecialty interests – the same interests that dominate health professional associations and health education associations and the panels that influence government designs for revenue and for workforce. Consist…

Revisiting Physician Distribution by Concentration Coding

Geographic coding often involves concentrations of people relative to land area such as rural or urban or most urban. Why do studies of physician workforce use coding based on ratios of people to land area? Why not use ratios of health workforce or physician concentrations as compared to people? Top concentrations, marginal concentrations, and underserved concentrations are more relevant to those seeking care, and are most relevant for basic health access where local or adjacent zip code care is a priority. Geographic coding such as rural versus urban actually has problems when compared to physician concentration coding. Isolated rural and small rural locations (Cooperstown NY, Marshfield WI) can have top concentrations of physicians. Rural Concentrations of physicians are about 3% of United States physicians and about one-third of rural physician workforce. Also using workforce concentrations, types of workforce can be compared. One important area stands out. The MD, DO, NP, and PA fam…