Damn the Reality of Small Practices - Full Speed Ahead

The Graham Center has released a study indicating that 45% of primary care physicians are found in small practices with 5 or fewer physicians. Studies by county and by zip code indicate substantial portions of the American population dependent upon small practices. Studies concede that small practices and hospitals have problems with the rapid changes and redesigns

Can small practices recover after the last 4 years of "Damn the Torpedoes" reorganization and rapid change?

Government, insurance, and foundation designers of health care have facilitated rapid change without consideration of the landscape of health access. Health access workforce where needed:
  • Is about half primary care and half non-primary care clinician
  • Is more likely to involve smaller practices as clinician need increases
  • Is more likely to involve family physicians due to the enhanced distribution of FM
  • Is more likely to involve older physicians nearer to retirement - more vulnerable to the rapid change
Damn the reality, full speed ahead for more specialties added outside of primary care with more added to each specialty for MD, DO, NP, and higher specialization means further concentration into locations that already have top concentration.

There remains the ignorance of the importance of permanent broadest generalist clinicians, most primary care experience, long term continuity of primary care clinicians, insufficient revenue for primary care, consequences of innovative payment designs, consequences of being forced to spend even more while generating less revenue

And all more important in small practices and those most needed for most Americans falling further behind.

Small hospitals and small practices are fragile. Once they are gone, their patients will have no where to go and no way to spend local dollars locally, where care and economic impact are most needed.

Graham Center Small Practices


Family Medicine Needs a New Beginning

Hotspotting Has Many Spots To Consider

Retail Clinic Recoil

Global Fails Local But Local Focus Succeeds Globally

What Veterans Need Is Family Practice

Domino Decline By Design

Declines in Health Care Delivery Despite Increases in Health Spending

Perverse Health Payment Dividing US

How To Resolve Health Access for 40 States Behind By Design

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


Blogs indicate that primary care can be recovered and should be recovered.

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.

Comments

Post a Comment

Popular posts from this blog

Another Fine CMS You Have Gotten Us Into

Perhaps we are indeed back to the time of Another Fine Mess (Laurel and Hardy). In a mad rush to implement innovation and to save all possible costs, CMS is creating complications for people that it is most responsible to protect. As PBS and Ken Burns celebrate the legacy of The Roosevelts, it is tragic to see what has become of over a century of effort involving Social Security, Medicare, Medicaid, and health care equity. The United States has one of the most complex health designs and clearly the various designers often know not what they are doing to others. More cartoons and comedians would find this a ripe area for material if not for the suffering involved. Health and Human Services has a huge role across Social Security and US health care. CMS or the Centers for Medicare and Medicaid Services has a dominant role to play in the design of health care in the United States.  CMS can be progressive or regressive. Interestingly CMS has chosen to appear to be progressi...
Read more

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...
Read more

Innovation Is the Problem Not the Solution for Worsening Health

Image
Innovation is good. Innovation worship is not good. Innovation application without scientific testing or clinical trials is unethical regarding clinical interventions and should be just as prohibited with regard to health policy. Clinical trials can harm hundreds or thousands. Innovative policies can harm millions. It takes a reasonable understanding of health care, health care outcomes, social determinants, and the investments that most improve social determinants to understand the consequences arising from the innovative nightmares past, present, and future. If you review the information sources with a critical eye, you too may find that the innovative policy designs have been disruptive to care, have hurt health care where health care is most needed, have reduced access to care, and have resulted in distortions in the literature. Indeed what is accepted and published in journals seriously lacks consideration of alternative hypothesis, lacks inclusion of many pages of limitatio...
Read more