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The Essential True Reform Restores Primary Care and Much More

The list of distractions from True Reform are impressive. For decades True Reform has been specifically avoided as primary care worsens within practices and from outside. The demise is most specifically about the financial design. Unless there is a focus on True Reform, there is little hope for Basic Health Access. This may not make as much sense to those outside of family medicine. Family physicians not familiar with AAFP may also be clueless. If you think that you can fix primary care with more technology, more rearrangements, more types of health professional graduates, or more expansions of training - think again. None of these have any hope of working without financial design changes - major changes. The following are various concepts that dominate the discussions at AAFP and primary care meetings and media releases of associations and foundations and institutions. Members, staff, media releases, programs, and personnel have been reviewed.  There is little about Tru
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Why not inside out empowerment rather than outside in abuse?

Just in from Annals of Family Medicine (Miller, Rubenstein, Howard, Crabtree) Shifting Implementation Science Theory to Empower Primary Care Practices Hope for primary care, generalists, rural health, and care where needed requires a very different perspective after decades of failed designs. Not surprisingly this will need to come from inside of these practices and places. Not surprisingly policies and practices dictated from outside have been not only a poor fit - but have been abusive to the populations most in need of care and the practices that serve them. There is hope from the primary care research community. The perspective must be inside of practice looking out - instead of outsiders forcing changes. Qualitative research explores and discovers and reflects as Ben, Will, and others taught me along with the various rural family physicians interviewed and researched in the 1990s in Nebraska. The current focus on quantitative research has demonstrated little to
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Patient Beware of the New Primary Care Workforce

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Once again a most important area of primary care is being ignored. The primary care workforce has moved from the most experienced workforce to the least experienced - without so much as a warning. The focus for primary care has been elsewhere other than significant changes in the workforce in areas such as consumer focus, convenience, quality, metrics, or lower costs. But there has not been much about changes in the primary care workforce itself. No, this is not about the movement from physicians to non-physicians, although this change is a big factor in the changing of primary care experience. All of the primary care workforce is impacted - MD DO NP and PA. Fewer enter and even fewer remain. Because they depart and take their primary care experience with them, the remaining workforce is more and more likely to be inexperienced. Not even researchers are asking many of the important questions with regard to primary care.  How is the primary care workforce changing and what
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Is Innovation the Straw that Broke the Back of Primary Care?

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Every day there are articles, blogs, and speeches proposing a fix for primary care. The latest to cross my desk comes from Health Affairs. Another value based plan is proposed to address the needs of patients with dementia. We can agree that individuals with dementia do have complex health care needs and their caregivers are often overwhelmed. We can agree that primary care is the most appropriate care venue for such patients. But I would argue that primary care is currently not capable of the challenge. Before additional proposals are considered such as those involving innovation, digitalization, reorganization, regulation, integration, coordination, or outreach  – the financial design must be addressed. How Does Innovation Hurt Where Practices, Towns, Health Facilities and Resources are Small Innovation Is a Distraction from Real Primary Care Solutions Innovation Focus Forced on Team Members Contributes to Overload Innovation Is More Likely Where Primary Care Is
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We Are Not Growing Primary Care, We Are Shrinking It

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The Reality of Primary Care is quite different than what is presented by various associations, institutions, and foundations. We are not growing primary care. We are shrinking it. AAFP has had its usual promotions of successes in the match as there are incremental increases in the number choosing family medicine. There is nothing to cheer about. FM graduates have had an annual growth rate barely keeping up with the annual population growth rate since 1980 when 3000 graduates were first reached. Given that only half of the 2018 graduates will serve careers in primary care, the actual primary care contributions have decreased much faster. Assumption is not reality. My Standard Primary Care YearPublication never caught on, but is relevant to consider   https://www.rrh.org.au/journal/article/1009  To save time you may want to review this compilation of the primary care delivery capacity estimates over time for 1970 to 2030 graduates. Each source is melting away from primary
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