Health Access Blogs in Order of Viewing

Most Recent Posts

All True GME Reforms Point to Family Medicine

Hotspotting Has Many Spots To Consider - Simple Interpretations Are Inaccurate, Many Different Characteristics Shape the Outcomes, Not Just Geographic Location

Retail Clinic Recoil - Many Side Effects Can Be Anticipated, And More to Come

Global Fails Local But Local Focus Succeeds Globally

Domino Decline By Design - as ERs Close, Those Nearby Face Challenges, as Small or Rural Hospitals Close or Practices Where Needed...

Declines in Health Care Delivery Despite Increases in Health Spending - If We Keep Accelerating Non-Delivery Costs, We Can Continue to Remain Behind Health Care Demand

Health Care Delivery Is No Laughing Matter - Political Cartoons are Nice, but...

Overcoming Barriers to Health Access Including ACA - Exposing the Myth of Coverage Equals Care

Will Teaching CHC Sites Deliver on the Promise of Health Access - More than good intentions are required as sites must train family physicians and be located in states and counties in need of workforce for maximum result

How Bad Health Design Has Been Sweeping the Nation - Designs must focus on care delivery, not compromise

Getting to Rural Practice and Do They Get Rural Practice - Getting to Rural Practice is more of a challenge than ever often becauses our designers duo not understand rural practice, rural people, the specialties needed, or the funding needed.

Have Resident Work Hours Limitations Helped? We now know that quality has not changed and we are seeing the consequences including compromise of health access.

Top Rated Posts

Too Many Clinicians in the United States - Three Dimensions of Non-Primary Care vs Zero Growth in Primary Care 1980 - 2010 – Too much is the rule for US health care costs with three dimensions of rapid growth of non-primary care – the care that cannot be regulated except through limitations of workforce.

Failure of Primary Care Is About Failure to Design Training and Payment Specific to Primary Care - Meeting Primary Care Needs in the Last Half of the 21st Century - A SMART plan actually indicates how the US can meet primary care needs. All that is required is a focus upon specific primary care result rather than primary care that is 70% not primary care in result.
To Follow the Money, Follow the Workforce:

Workforce distribution, or lack thereof, is about health spending. Where the US fails most of its population in spending, it fails most of its population in workforce

The Rural Physician Associates Program: Continuity Longitudinal Integrated Curricula continues to set the bar for rural training and top quality medical education for four decades.

One Million Hearts Saved or 160 Million Lives Improved - Disease Focus Has Consequences.With so few helped at such high cost, so many are left behind.

Major Journals Fail Primary Care Once Again
What can a zip code 10032 study indicate about nurse practitioner versus physicians
Finance-me-cratic Constants in the Bureaucratic Universe

Why are 2008 HRSA Projections of Primary Care Workforce indicating substantial increases when the reality is decreases in primary care?

Failing Primary Care Explained By Policy Failure – Failures in primary care spending include low spending, spending far lower than non-primary care, poor support, rapid increases in cost of delivery, and funding squandered in numerous areas other than support of clinicians and team members to deliver care.

Why Do Primary Care Myths and Misinformations Persist?

Fifty Years of Failed Primary Care Workforce Innovation

Cost of Training per Unit of Primary Care Delivery

What is Killing US is Not Four Diseases Focus - The Myth for the Cure and others in the Disease Focused Crowd Are Now Selling Four Diseases to the United States and to the World Health Organization.

Does Primary Care Experience Matter in the US where Primary Care Workforce Will Soon Be the Least Experienced in the Nation's History? 

Accelerating Cycles of Primary Care Decline
Pounding Poverty Providers with Pay for Performance

Disease Focused Disorder Mentality or Sentimentality
What Do Medical Home Studies Indicate? Those positive about the medical home are promotions that indicate the value of the continuity medical home when the real determinants of better health care are social determinants. The fact is that health care access, cost, and quality are fixed in place by designs. To understand what works, it is important to understand the designs and the designers.
The Black Hole of US Subspecialization spells Workforce Concentration, continued higher costs for health care, and Lack of Access for Most Americans
Comparing Family Practice Sources - The few, the proud, and the distributed arising from the nation’s MD, DO, NP, and PA graduates
Rural Rearrangements of the Deck Chairs - The fact is that rural programming has not been able to overcome overall changes in the US health design.
Failing Primary Care Explained By Policy Failure – Koch’s postulates are satisfied – US Health Policy can rebuild or destroy primary care as illustrated a number of policy periods across 1960 – 2010.
Generic Expansions Are Not SMART – Generic expansions of annual graduates absolutely fail for the purpose of health access. Too few enter and too few remain, even when the training program is a primary care program.
Rural Primary Care: Stark Realities
SMART Primary Care : Family Practice Contributions
The Squeeze Play that Fails - Medicare is supposed to be a design that facilitates health care for the elderly. But...
Still the Health Access Solution for Most Americans - Health access workforce solutions have always been and will always be the broadest scope generalists. 

Myth for the Cure: Essential for Disease Focus - Do no harm is difficult when the focus is eliminating disease.
How the Disease Focused Abuse Health Access
Deifying Disease By Design
Who Really Benefits? Claims of benefit to health access have been pointed out as promotions and promises, impractical, deceptive, or insignificant. Over and over the design deficits do not allow health access recovery. To understand primary care failure, one must understand who benefits from designs that fail for primary care result.
Can We Have Our Billions Back Please?   Why would an advocate for basic health access keep hammering on disease focus? The answer is simple. For decades we have more different researchers and subspecialists creating more reasons to spend dollars anywhere but on basic health care services, especially services needed by over half of Americans.
Standard Primary Care Year Estimates – Only primary care training that results in graduates that enter and stay in primary care and have the longest careers and have the most activity as direct care clinicians and have the top volume delivery and remain where needed at highest levels can help with primary care recovery. Lowest retention, shortest career, lowest volume, and fewest active requires far too many graduates to even maintain primary care levels, much less address primary care for 200 million left behind.
Rural Pipelines Versus Long Term Obligations – Rural pipelines in the US are a failure and have been for the last 30 years because of US health policy.
Uncovering Cover Ups Involving the Front Lines – A British report in WWII indicated the horrific failures of the early years regarding bombing runs. The US needs an objective approach to deal with the failed front lines of primary care.
To Be SMART or Not to Have Health Access – Specific, Measurable, Achievable, Realistic, and Timely is what is required to recover health access. Generic, primary care training not primary care in result, assumption, promotion, delay, and other priorities higher than primary care (even in primary care training) are not going to recover health access.
Rural Workforce 2000 to 2010 - Uncle Sam says "I want you" to serve in rural locations. Uncle Sam's design says "I don't want you" to serve in rural locations
Critique of Commonwealth Fund Report on Ensuring Equity
Revisiting Physician Distribution by Concentration - lack of distribution that is
Rearranging the Deck Chairs: Death Displacement– A focus on deaths prevented or lives saved is only possible with distorted thinking. We all will die. Our overall quality of life is about how our lives are impacted by our efforts and by our national designs
Choices for Higher Priority Areas That Could Make a Difference
Blogs indicate that primary care can be recovered and should be recovered, but it will take 30 consistent class years of improvement for actual recovery. We have to have at least one to begin.


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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