Basic Health Access

Primary care services have decreased in number steadily, year after year. Payments for primary care services overall have been stagnant as with other basic services taken for granted. Population, demand for care, and complexity are all increasing in ways that should have resulted in much more primary care for anyone who cares about primary care - but there is steadily less primary care. The financial design is broken by stagnant revenue and accelerating costs of delivery. The digital revolution has actually caused regression of primary care via worsening burnout, productivity, and meaningless complexity. The costs of delivering primary care have been increased across multiple dimensions by those who think that they are improving care when actually they are killing small health, primary care, generalists, general specialties, and basic access to care. This little death steadily, slowly over time is also specific to primary care physicians who appropriately describe it as trauma si...

It is clear from the recent Supplement to Annals of Family Medicine that some of the best and brightest primary care researchers have been focused on a specific area. They may not have much choice as primary care research is poorly supported. They have millions of reasons to do "quality improvement" research - 117 million ARHQ dollars. But is this a good choice? AHRQ continues to follow the Bandwagon of quality micromanagement - disappointing for an evidence-based entity because of the evidence basis mounting up against quality improvement efforts set in motion with To Err is Human and accelerated by the Dartmouth Assumptions, ACA, MACRA, CMS, and various associations. Even when primary care association members are hurt, the Bandwagon rolls on and over them. Particularly distressing are the various for-profit entities cashing in on quality improvement claims - often claiming to do it all or improve costs, quality, and more. What is most clear is the tran...

Primary care has always been challenging. It is challenging to maintain the energy, the dedication, and the person to person contact required for continuous, comprehensive, coordinated, first contact care. This has been more difficult as the financial design does not support the number and quality of the personnel to interact with patients and families. But the situations have become much worse as numerous disruptions have been added. Digitalization, regulation, certification, and regulation are already too much. And the Tsunami of Transformation is contributing even more to the overload. Everyone seems to want to change primary care.  Few are willing to support primary care. Many are attempting to work to improve primary care by new and innovative methods that makes sense to them. Few consider the width, and breadth, and scope of the multiple changes going on. No Parent would so disrupt their child so much in so many ways and with so many different activities such th...

Decades of highly promoted interventions have not resolved health access woes facing most Americans. All forms of training have failed as MD DO NP and PA all have the freedom to choose careers providing higher paid services that have much better support. The workforce follows the financial design and concentrates in concentrations - leaving most Americans behind in the basic generalist and general specialty services most important for basic health access. The financial design itself has become distracting, costly, and burdensome. Attempts to improve quality and attempts to cut cost have actually worsened costs and can impact quality negatively. Most importantly, the designs are hurting health access - particularly where most Americans most need care.  Decade after decade of failure indicates the need for a change - but it is clear that no financial design change is coming. The health dollars are even more concentrated where concentrated - even pr...