The Primary Care Medical Home School
Home school is most local by design. Primary Care Medical School is only about primary care without the option to leave primary care after graduation. The Primary Care Medical Home School is local, primary care, where needed by design.
The current health professional training designs for MD, DO, NP, and PA all fail for primary care workforce result. Recovery of primary care is about all influences lined up most specific for recovery.
Medical education is not the only higher education in need of redesign. College is too expensive, fails in relevance to career, and often forces students to leave locations where care is needed to go to exclusive settings attending college with exclusive students. Local, normal, and relevant can go hand in hand with online and other modes of advanced education.
The best model for health access recovery is specific to primary care across preparation/college, medical school, and residency training. A specific design is not difficult to visualize as such a design is the opposite of the current health education design. In the current flawed design, the wrong students from the wrong places are admitted, they are trained in the wrong places with the wrong faculty and the wrong curricula. There is little emphasis upon primary care, local care, and integration of care within the community.
Recovery of Health Access is about:
The Primary Care Medical Home/School must begin with students connected to places in need of primary care, and these students remain connected to these places during training as their online college courses will supplement their local learning in Primary Care Medical Homes/Schools. Their careers will be spent entirely in primary care and all of their preparation, training, and obligation is spent locally. Such a design is specific to instate, primary care, where needed - the only specific formula for primary care recovery.
Current designs prepare and train with the opposite influences, result in less than 30% primary care, and result in far less primary care where needed.
Instate workforce where needed is a result that can be measured. The US medical school outcomes are abysmal in this area, about 2 to 12% of graduates are found with instate care where needed result using the most recent decades of graduates. Instate is defined as instate relative to medical school of graduation and "where needed" is defined as a county with less than 150 physicians per 100,000 as the practice location in 2013.
In the Great Plains states of Kansas and Nebraska, family medicine choice (U of KS, UNMC) is associated with a 12 and 22 times greater instate practice location of need as compared to those not choosing family medicine. Origins, tendencies for instate residency, family medicine, and family medicine distribution all contribute to this stellar outcome.
So why not design even more specific?
Preparation can begin in middle school and high school with community-based preparation, community projects, college and medical school courses delivered to the community-based students (age 14 and up), and increasing health care contributions for the trainees based on their progress.
Instate, Permanent Primary Care, Where Needed is specific. Anything not specific is driven away by payment policies that do not support instate, that do not support primary care, that do not support care where needed.
Training design that is not specific and payment design that is not specific has defeated primary care recovery for decades. These design barriers are the major reason why family medicine, the most specific to recovery, is still just 3000 annual FM graduates as reached first in the class of 1980. The barriers drive all of the more flexible forms away from primary care during and after training. Higher pay outside of primary care drives flexible primary care forms (IM, MPD, NP, PA, PD) away from primary care even for those few that enter primary care after primary care training. Family medicine also cannot maintain 90% remaining in active primary care family practice at the adverse payment policies no longer support such careers.
All routes point to very specific solutions for health access recovery. As long as other agendas dominate primary care training and payment, health access recovery will fail regardless of floods of new generic, flexible graduates.
College for a New Age
The current health professional training designs for MD, DO, NP, and PA all fail for primary care workforce result. Recovery of primary care is about all influences lined up most specific for recovery.
Medical education is not the only higher education in need of redesign. College is too expensive, fails in relevance to career, and often forces students to leave locations where care is needed to go to exclusive settings attending college with exclusive students. Local, normal, and relevant can go hand in hand with online and other modes of advanced education.
The best model for health access recovery is specific to primary care across preparation/college, medical school, and residency training. A specific design is not difficult to visualize as such a design is the opposite of the current health education design. In the current flawed design, the wrong students from the wrong places are admitted, they are trained in the wrong places with the wrong faculty and the wrong curricula. There is little emphasis upon primary care, local care, and integration of care within the community.
Recovery of Health Access is about:
- Instate Training - Training must be specific to states in need of primary care. All influences of instate origin, instate preparation, instate medical school, and instate residency should all be combined for maximal instate result. Graduate training instate is a 20 - 40 times instate multiplier and the other factors all add 3 - 6 times multipliers specific to instate practice result as measured over a career.
- Primary Care Result - The outcome of the training school or program must be 90% or above primary care as measured over an entire career. Training designs that allow departures during and after training represent hemorrhages that must be stopped to hope to recover primary care and to have the most experienced primary care workforce.
- Practice Location Where Needed - Training in locations of need and training with practitioners and teams serving such populations is specific to building up workforce where needed as well as the training most specific to the practice of the graduate. An obligation for the first six years after graduation is a continuation of local preparation and training. This obligation further shapes future practice locations of need in local or adjacent counties. Primary care specific training in counties of need as demonstrated with family medicine training has filled up workforce in local and adjacent counties across studies from the 1980s to the most recent graduates.
The Primary Care Medical Home/School must begin with students connected to places in need of primary care, and these students remain connected to these places during training as their online college courses will supplement their local learning in Primary Care Medical Homes/Schools. Their careers will be spent entirely in primary care and all of their preparation, training, and obligation is spent locally. Such a design is specific to instate, primary care, where needed - the only specific formula for primary care recovery.
Current designs prepare and train with the opposite influences, result in less than 30% primary care, and result in far less primary care where needed.
Instate workforce where needed is a result that can be measured. The US medical school outcomes are abysmal in this area, about 2 to 12% of graduates are found with instate care where needed result using the most recent decades of graduates. Instate is defined as instate relative to medical school of graduation and "where needed" is defined as a county with less than 150 physicians per 100,000 as the practice location in 2013.
In the Great Plains states of Kansas and Nebraska, family medicine choice (U of KS, UNMC) is associated with a 12 and 22 times greater instate practice location of need as compared to those not choosing family medicine. Origins, tendencies for instate residency, family medicine, and family medicine distribution all contribute to this stellar outcome.
So why not design even more specific?
Preparation can begin in middle school and high school with community-based preparation, community projects, college and medical school courses delivered to the community-based students (age 14 and up), and increasing health care contributions for the trainees based on their progress.
Instate, Permanent Primary Care, Where Needed is specific. Anything not specific is driven away by payment policies that do not support instate, that do not support primary care, that do not support care where needed.
Training design that is not specific and payment design that is not specific has defeated primary care recovery for decades. These design barriers are the major reason why family medicine, the most specific to recovery, is still just 3000 annual FM graduates as reached first in the class of 1980. The barriers drive all of the more flexible forms away from primary care during and after training. Higher pay outside of primary care drives flexible primary care forms (IM, MPD, NP, PA, PD) away from primary care even for those few that enter primary care after primary care training. Family medicine also cannot maintain 90% remaining in active primary care family practice at the adverse payment policies no longer support such careers.
All routes point to very specific solutions for health access recovery. As long as other agendas dominate primary care training and payment, health access recovery will fail regardless of floods of new generic, flexible graduates.
College for a New Age
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Blogs indicate that primary care can be recovered and should be recovered.
Robert C. Bowman, M.D. Robert.Bowman@DignityHealth.org
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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