Basic Health Access

As noted previously, all primary care RN, MD, DO, NP, and PA are greatly needed. But the probability of actually being in primary care over a career of contribution is small for new graduates in RN (10%), MD (20%), DO (30%), NP (25%), and PA (25%). Steady departures from primary care are seen for all except the small part of MD and DO that is family physicians. Family physicians are the only remaining primary care result that is relatively permanent but are only 7 – 8% of US MD and Non-Citizen IMG choose FM along with about 16 – 18% of DO and 25% of Caribbean US Origin. The NP and PA primary care effort has stagnated because fewer have remained in primary care. The case can be made that unless more health spending is injected into primary care, the NP, PA, IM, and PD contributions will actually shrink. Family medicine is stagnated by 30 years of no increase in annual graduates from the 1980 level of 3000 per year. One would think that common sense observations would reveal the myt...

A study just published in NEJM indicates some of the consequences of specific heart disease and diabetes treatments. “The study, by researchers from the US Centers for Disease Control and Prevention (CDC), singles out 4 drugs and drug classes — warfarin, oral antiplatelet medications, insulins, and oral hypoglycemic agents. Alone or together, they account for 67% of emergency ADE hospitalizations of adults 65 years and older. Warfarin was implicated in 33%, lead author Daniel Budnitz, MD, MPH, director of the CDC's Medication Safety Program, and coauthors write.” Via Medscape   Article at http://www.nejm.org/doi/full/10.1056/NEJMsa1103053#figure=t1 Hospital interventions will not work well to address these situations. Physician interventions have not worked well. Patient interventions are not likely to work mainly because we often understand so little about patients and even fail to include patient factors in most such studies. Health literacy rates are lower in the elde...

For fifty years nurse practitioners and physician assistants have been promoted as primary care solutions, but the primary care result has been negated by a movement from 65% primary care to over 65% non-primary care. The promises of the past have not been realized in the primary care of today. Declines across fifteen class years of recent graduates indicate even less primary care delivery per graduate in the future. NP and PA graduates were few prior to 1980. Since 1980 the NP and PA annual graduates have doubled in number each 6 to 12 years. After 50 years of development, after 50 years of promises and after 30 years of massive expansion, where is the health access workforce? Such writing is never fun. This is not the way to win friends and influence people. Sadly the United States has demonstrated an impressive ability to continue to promote solutions that do not work, innovations that fail, and reorganizations that delay primary care recovery. Perhaps by pointing out innovat...

The cost of primary care training can be compared to primary care delivery over a career.  The Basic Calculations of the Standard Primary Care Year % Primary Care Years in Career % Remain Active % Volume SPCYR Per Grad NP not FNP 15% 24 70% 70% 1.76 FNP Trained 54% 24 70% 75% 6.8 PA not FP Start 15% 33 75% 75% 2.78 PA with FP Start 60% 33 75% 80% 11.88 FM Trained MD 91% 33 84% 100% 25.23 IM Trained MD 15% 32 82% 86% 3.38 PD Trained MD 39% 33 82% 95% 10.03 MPD Trained MD 43% 32 82% 95% 10.72 The product of 4 factors is the SPCYR per Graduates specific to the time of graduation. With primary care retention declines, the overall result for all sources has declined - especially since 1998 graduates.  The cost of training can be divided by the primary care delivery result in SPCYRs. Cost of Training Relative to Primary Care Del...