Basic Health Access

Every day there are articles, blogs, and speeches proposing a fix for primary care. The latest to cross my desk comes from Health Affairs. Another value based plan is proposed to address the needs of patients with dementia. We can agree that individuals with dementia do have complex health care needs and their caregivers are often overwhelmed. We can agree that primary care is the most appropriate care venue for such patients. But I would argue that primary care is currently not capable of the challenge. Before additional proposals are considered such as those involving innovation, digitalization, reorganization, regulation, integration, coordination, or outreach  – the financial design must be addressed. How Does Innovation Hurt Where Practices, Towns, Health Facilities and Resources are Small Innovation Is a Distraction from Real Primary Care Solutions Innovation Focus Forced on Team Members Contributes to Overload Innovation Is More Likely Where Primary Care Is

The Reality of Primary Care is quite different than what is presented by various associations, institutions, and foundations. We are not growing primary care. We are shrinking it. AAFP has had its usual promotions of successes in the match as there are incremental increases in the number choosing family medicine. There is nothing to cheer about. FM graduates have had an annual growth rate barely keeping up with the annual population growth rate since 1980 when 3000 graduates were first reached. Given that only half of the 2018 graduates will serve careers in primary care, the actual primary care contributions have decreased much faster. Assumption is not reality. My Standard Primary Care YearPublication never caught on, but is relevant to consider   https://www.rrh.org.au/journal/article/1009  To save time you may want to review this compilation of the primary care delivery capacity estimates over time for 1970 to 2030 graduates. Each source is melting away from primary