Basic Health Access

Insiders dominate the designs of health spending and the designs of health professional training. Not surprisingly these insiders shape workforce, services, and spending to just a few states and a few locations. Resident training is even more stacked against care where needed. The determination of practice location is about origin influences, training influences, and specialty choice. Origins, training, and specialty influences are moving away from states in need, away from primary care, and away from care where needed locally. Top Concentration States - Physician and GME - About 6 states receive 50% of the economic impact of US medical education which is 500 billion a year according to AAMC. Actually insider stacking is even more prevalent as only a few dozen counties receive this impact. Origin and training location facilitate concentrations of clinicians in a few states and in a few locations. Top Concentration Zip Codes or Super Centers - About 55 - 60% of residents ar

Recent postings have defended primary care versus urgent care and other care venues. These posts tend to exaggerate the benefits of primary care while pointing out the flaws of urgent, retail, corporate, concierge, emergent, and other venues. Primary care should take a realistic hard look at the competition and the many serious issues facing primary care. It is hard as a primary care and health access advocate to post this - but real change begins with Primary Care Versus the Rest across Specific Measurable Achievable Realistic and Timely. It is common for primary care to defend itself for areas such as continuity and integration – but insurance companies, employer preferences, and other changes insure patient migrations, lack of continuity, and disintegration. Access Issues Facing Primary Care More (and less for others) Primary care has largely refused to adapt to consumers (evening, weekend, phone, internet) has increasing delays until patients can b

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 progressive and in

Water is essential for life, but floods are destructive. Health information is essential for life, but floods of information, software, hardware, techs, consultants, and salespeople are too much -  too much for cost, too much for patients to comprehend, too much for physicians with established practices, too antiquated for new physicians/best business practice/best care. This week is another announcement of another CMS delay/glitches that will impact physicians, their practices, and their patients.  New physicians who are finally in a position to participate - may not gain the benefits. This is like the first round when some states were ill prepared to set up such a program. Delays in payment changes are no longer rare and cut into revenue - the lifeblood of health care delivery. We would never allow high tech to be suddenly practiced upon patients via high tech surgery or high tech medicines without substantial testing, assessment, and development. Even then there would be careful

The United States has 30 states in need of clinicians, needs primary care, and needs clinicians to locate practice where 40 - 50% of Americans are most in need of care. These same locations also are increasing most in population and have higher shares of populations growing faster in demand for primary care and basic services. All true reform for graduate medical education leads to family medicine specific expansions of GME positions.  Primary Care Trained Graduates for Primary Care Result for a Career Only family medicine training leads to 90% primary care result for a career. Declines down below 15% primary care result for IM training and less than 40% for pediatric training represent failure for primary care.  Less than 50% for primary care for nurse practitioners and less than 30% for physician assistant graduates is also failure for primary care Clinician Workforce Where Needed Only family physicians have population based distribution across their careers. This