Distribution Failures Behind By Many Designs

The 3138 US Counties can be coded by physicians, by types of physicians such as active family physicians seen here, by population and by other demographics, including those age 65 that are increasing rapidly and even more in health care demand.

As previously noted, the locations with top concentrations of physicians have lowest proportions of family physicians and primary care. 

Numerous forces interact to shape higher proportions of family physicians where care is most needed and where higher proportions of elderly are found. These are counties most behind in education, employment, and poverty in addition to health spending, health facilities, and health care workforce.




Slowest population growth is seen in counties most concentrated in health workforce. Highest cost of living and health care may shape most Americans elsewhere, especially the elderly and those on fixed or lower incomes. 

Designs for health, education, and economics fail where needed. Population based distributions are more important where care is needed but are falling behind due to sequestration, cuts in Social Security, cuts in SNAP (nutrition), cuts in child development, cuts in early education, cuts in primary care and basic services, readmission penalties, pay for performance, and other impairments specific to small facilities, small practices, and care where needed. 

As more funds are diverted outside of the county for consultants or software or technology in education and health care, less remains to deliver care. 

High costs of recruiting teachers, clinicians, and others plus high costs of retaining them make it even more difficult.

Simplistic changes in small areas will not resolve health access and other problems.

Designs must be specific to the counties and populations in need.


William T Butler, MD, in his Academic Medicine's Season of Accountability and Social Responsibility

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Dr. Bowman is the North American Co-Editor of Rural and Remote Health. He was the founding chair of the Rural Medical Educators Group of the National Rural Health Association and the long term chair of the STFM Group on Rural Health.

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