Standard Primary Care Year Estimates 2012 Class Year


It is not enough just to graduate primary care - especially with US policies that drive primary care graduates away from primary care before training, during training, and each year after graduation.

The Standard Primary Care Year estimate = Average Career Years X % remaining in PC for a career X % active for a career X % volume.

Update for 2014 Class Year


Clinician Activity Over a Career Primary Care Retention Volume per FTE Career Years Standard Primary Care Years Office Primary Care Product
Duluth 80.0% 43.8% 99.4% 34.0 11.85 35.1%
Top Osteopathic 80.0% 33.2% 98.7% 34.0 8.92 26.6%
Caribbean MD 80.0% 30.5% 97.4% 34.0 8.08 24.4%
Physician Assistants 75.0% 42.4% 75.0% 31.0 7.39 31.8%
US DO 80.0% 22.3% 95.0% 34.0 5.77 17.9%
International NonCit MD 80.0% 19.7% 94.5% 34.0 5.05 15.7%
NP Masters 60.0% 50.0% 70.0% 23.0 4.83 30.0%
US MD 80.0% 17.0% 95.8% 34.0 4.43 13.6%
NP Doctoral 60.0% 50.0% 70.0% 21.0 4.41 30.0%
US MD Top 20 PC USNews 80.0% 16.6% 96.5% 34.0 4.37 13.3%
US MD Top MCAT 80.0% 11.7% 94.5% 34.0 3.01 9.4%
Designed FM 80.0% 95.0% 100.0% 36.0 27.36 76.0%
100% FM School 80.0% 92.0% 100.0% 34.0 25.02 73.6%
100% FP in PA 75.0% 92.0% 75.0% 31.0 16.04 69.0%
100% FP Masters NP 60.0% 92.0% 70.0% 24.0 9.27 55.2%
100% FP Doctoral NP 60.0% 92.0% 70.0% 22.0 8.50 55.2%


Rural primary care is estimated by the rural percentage times the SPCYr. Top primary care delivery goes to those with the longest careers, most primary care retention, most activity, and most volume. Family medicine with only 10% of annual primary care graduates will contribute 36% of the primary care delivery result for 2012 and higher proportions of rural or underserved result for the nation.

NP not FNP
FNP Trained
PA not FP Start
PA with FP Start
FM Trained
IM Trained
PD Trained
MPD Trained
% Primary Care
15%
54%
10%
50%
91%
15%
39%
43%
Years in Career
24
24
33
33
33
32
33
32
% Remaining Active
70%
70%
75%
75%
84%
82%
82%
82%
Volume Relative to FM
70%
75%
75%
80%
100%
86%
95%
95%
SPC Years Per Graduate
1.76
6.30
1.86
9.90
25.23
3.38
10.03
10.72
Rural SPC Years/Grad
0.176
1.764
0.186
2.970
5.550
0.338
0.802
1.715
Underserved SPCYrs/Grad
0.212
0.945
0.223
1.782
3.784
0.305
0.902
1.286
Outside SPCYrs/Grad
0.670
3.465
0.613
5.445
13.369
0.948
2.807
4.288
Proportions of Primary Care
Rural % for Career
10%
28%
10%
30%
22%
10%
8%
16%
Underserved % for a Career
12%
15%
12%
18%
15%
9%
9%
12%
Outside of Concentrations %
38%
55%
33%
55%
53%
28%
28%
40%
Primary Care Grads at 28,340
4,000
4,000
5,500
1,300
2,800
7,300
3,000
440
Proportion of Grads
14.1%
14.1%
19.4%
4.6%
9.9%
25.8%
10.6%
1.6%
Total SPCYrs for 2012 at 185,470
7,056
25,200
10,209
12,870
70,631
24,710
30,077
4,716
Proportion of SPCYrs (Class Yr)
3.8%
13.59%
5.5%
6.94%
38.08%
13.32%
16.22%
2.54%
All NP
All PA
All FM
All IM
All PD
All MPD
2012 Average of 6.89
SPCYrs per Grad
4.03
3.39
25.23
3.38
10.03
10.72



Lowest primary care delivery goes to those with the shortest careers, lowest primary care retention, lowest activity, and lowest volume. United States primary care delivery has decreased from 18.6 SPCYrs per graduate in 1980 to less than 7. Annual primary care graduates have increased from 14,000 to 28,000 since 1980. Decreases from 260,000 to 195,000 indicate a 25% decline in primary care delivery capacity for the class of 2012 compared to the class of 1980.

Steady declines in primary care retention for NP, PA, IM, PD, and MPD have resulted in less primary care delivery per graduate. The doubling of NP and PA annual graduates each 6 to 12 years since 1980 has made this less apparent. SMART analysis specific to primary care delivery is required to understand career contributions - not training type or the first years in a career.

Basic health access workforce calculations are not complex to understand. A nation that desires primary care workforce, rural workforce, workforce for underserved areas, and workforce for 65% of the population (outside of current concentrations) places a priority upon permanent broad generalists in designs for training and designs for practice support. As graduates depart primary care and family practice, they depart most needed careers and locations. 

With zero growth in annual graduates for family medicine over the past 30 years, the nation has avoided the choice of the most specific solution. Similarly steady departures from family practice for NP and PA across the class years and across the years after graduation have limited the health access result.

The dedicated family practice component is critically important and yet remains virtually unrecognized for this stellar health access contribution.

Perhaps the upcoming Primary Care Week will decide to recognize this retention where most needed, the only positive area in a dismal year for primary care with more dismal times to come as revenue declines and costs of delivering primary care mount.

Departures from primary care have negated primary care delivery result for 5 out of 6 primary care sources. The US designs have shaped annual graduate expansions emphasizing those most generic and least specific to family practice and primary care. The result has been minimal primary care, rural, and underserved result - least health access by design.

The result of the US primary care design
has been maximal result for non-primary care
and for zip codes that already have top concentrations of workforce.

Basic Health Access Contributions in Primary Care for the Class of 2012

Rural (RUCA) Location
NP not FNP
FNP Trained
PA not FP Start
PA with FP Start
FM Trained
IM Trained
PD Trained
MPD Trained
Rural SPC Years/Grad
0.176
1.905
0.278
3.564
5.550
0.338
0.802
1.715
Location % for Career
10%
28%
10%
30%
22%
10%
8%
16%
35,661
706
7620
1531
4633
15539
2471
2406
755
Proportion By Source
2.0%
21.4%
4.3%
13.0%
43.6%
6.9%
6.7%
2.1%
Underserved (Shortage High Poverty Zip Code)
Underserved SPCYrs/Grad
0.212
1.021
0.334
2.138
3.784
0.305
0.902
1.286
Location % for Career
12%
15%
12%
18%
15%
9%
9%
12%
25,638
847
4082
1838
2780
10595
2224
2707
566
Proportion By Source
3.3%
15.9%
7.2%
10.8%
41.3%
8.7%
10.6%
2.2%
Outside of Concentrations (30,000 Zip Codes, 65% of the US Pop, 200 million)
Outside SPCYrs/Grad
0.617
3.742
0.975
6.534
13.369
0.948
2.807
4.288
Location % for Career
35%
55%
35%
55%
53%
28%
28%
40%
85,954
2470
14969
5360
8494
37434
6919
8422
1887
Outside PC Proportion
2.9%
17.4%
6.2%
9.9%
43.6%
8.0%
9.8%
2.2%

SMART focus upon primary care results in improved basic health access result. When small proportions of the annual graduates deliver multiple times the needed health access result, designs should favor what works best rather than what ends up as non-primary care or in top concentrations of existing workforce. Designs that fail for basic health access fail most Americans.

The United States needs more primary care, rural primary care, underserved primary care, and primary care outside of existing workforce concentrations. SMART requires a focus upon what works - not generic expansions or technology or innovation - but people to deliver primary care where needed.



Thanks to all 12,000 who have visited Basic Health Access in 2011.


Robert C. Bowman, M.D.        Basic Health Access Web    Basic Health Access Blog

Dr. Bowman is the North American Co-Editor of Rural and Remote Health and a Professor in Family Medicine at A T Still University School of Osteopathic Medicine. He was the founding chair of the Rural Medical Educators Group of the National Rural Health Association, he was the long term chair of the STFM Group on Rural Health, he is the founding director of Priority Infrastructure at http://www.infrastructureamerica.org/ and he is the author of the World of Rural Medical Education, and Physician Workforce Studies
SMART – Specific, Measurable, Achievable, Realistic, Timely




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