Basic Health Access

Promotors of generic expansion have commonly mentioned primary care workforce increase. At best primary care workforce remains a side effect of expansion. Training and spending and accreditation in primary care remain subservient to non-primary care interests and influences. Even primary care associations are compromised by members and leaders influenced primarily by non-primary care influences. The US should not expect an increase in primary care because this is what has been designed. Non-primary care is quite another result. Primary care projections are actually quite easy to make. The best estimates are guided by recent decades. Recent decades of stagnation in primary care indicate no growth. Primary care spending is stagnant, permanent primary car such as family medicine is stagnant, and flexible primary care sources have been departing primary care. The US will remain at zero growth even with expansions as fewer remain in primary care during training, at graduation, and afte

This JAMA study from Zip Code 10032 appears to compare nurse practitioner care with physician care. The study aimed low, intending to demonstrate no difference between physicians and nurse practitioners. As we understand more and more about social determinants, it should be surprising that any differences will be found in populations with the most social determinant limitations, such as those in this study. This study can only teach America about a small portion of primary care for primary care delivered 1995 – 1999 in and around zip code 10032 about people that live in or around zip code 10032 some of the time. This study presented in a national journal is one of the least relevant with regard to United States primary care and United States health care. The study uses old data, the sites of practice were different and the nurse practitioners actually changed locations during the study. Zip code 10032 is one of the most densely populated in the US with transportation and

Academics love innovation, new grants, and change. A weakness of academic focus is doing what works -  practical and relevant. Academics often have to be forced to do the practical and relevant. Such is the case with RPAP. The Rural Physician Associates Program has been practical and relevant for 40 years and has facilitated increased primary care and rural services where needed since the first 3rd year medical student began. RPAP is well known to the people at HRSA. During this past two years at least three times I have reminded them about RPAP as a very inexpensive way to increase health services for those in most need - in rural underserved areas. Given the serious problem facing HRSA with designs that would increase primary care demand in the face of failing primary care supply, worse in underserved areas, one would think HRSA would do more. HRSA has been busy elsewhere on reports and programs that are not SMART - specific, measurable, achievable, realistic, and timely. RP

Achievable primary care is one of the weakest areas in the workforce literature. Enough annual graduate expansion of any primary care source will increase primary care, but steady declines in the proportion remaining in primary care in the years after graduation make this a less efficient and less effective process for the purpose of addressing primary care workforce. With primary care graduates departing primary care it is not possible to recover primary care.  Despite projections of primary care increases by government and by major associations, the US is actually losing ground in basic health access primary care. Increases in cost of training, more graduates required for less primary care result, and increases in the costs of locums, recruitment, and retention insure failure in primary care delivery with the current voluntary and flexible design that facilitates departures from primary care. Studies and reports that project primary care workforce place too much emphasis on