Showing posts from November, 2016

The 25th Anniversary of the COGME Third Report and No Change By Design

Hardly a month goes by without some new proposal for more study regarding physician workforce. New studies funded and implemented and reported will not do anything but cost much more and do even less. There are reports from the 1990s that outline concisely what is needed. There has been little progress as the nation has not acted on the recommendations. 

New reports only allow those with their own agenda to add their own spin. At one point in time the experts were more in tune with workforce needs in the nation. The COGME Reports such as the Third Report have been on target - and they have been ignored.

Findings of the Third Report of COGME in October 1992

The Council's seven major findings identify a series of deficiencies in the current physician supply, medical education financing, and health care reimbursement systems, which hinder health care access. The Council's findings conclude that the Nation has:  Too few generalists (i.e., family physicians, general internists, and ge…

The Four Horsemen of the Primary Care Apocalypse

Payment is easily established as the dominant reason for primary care deficits. Primary care has been to low with too much required for decades. There are indications of worse, not better in the past decade and at the worst possible time in the history of the United States. Lost confidence where primary care practices face the most challenges and the least payments will result in accelerating access deficits.

Unbalanced workforce with too many MD DO NP and PA specialists and subspecialists and too few generalists is entirely about payments too low for the basic services. Since these basic services dominate care where needed where 40 - 50% of Americans most need care, deficits in services and workforce and team members and health care dollars are created by payment design

A nation 23rd worst of 26 developed nations clearly is not investing in generalists, primary care, basic access, care where needed, or the team members to facilitate care delivery and higher primary care functions.…

Please No More So Called Primary Care Solutions

The numerous and increasing so-called primary care solutions have largely been a waste of time. Even worse, these so-called solutions have been a distraction from real solutions. The claims made by a variety of nursing, physician, primary care, foundation, and government leaders are often well-intentioned. They often believe passionately that they represent a solution. 

In fact, it is not possible for primary care innovations, training interventions, and rearrangements to work to restore primary care or basic health access at the current time or in the foreseeable future.

The solution has always been about payment. There will be no future of primary care or future of family medicine or future of care where needed or future of rural health or future of health access without real payment reform.

There is a formula for success in all of these important areas.
Payment needs to be substantially increased Above any increased cost of delivery and Must also be adjusted for the higher complexity…