Basic Health Access

Where family physicians are most important, payment is less by design, the population is more complex, local colleagues are fewest, and the local support resources are lowest. The outcomes are more likely to be lower because of inherent social, local, and other non-clinical determinants of health - the most powerful influences. Also innovation, regulation, digitalization, and certification costs are higher as are turnover costs. This is another in a series of posters illustrating that it will take more than words to bring Basic Health Access to half of Americans with low to no access by design. AAFP must address the needs of members in their most important areas. We work hard at what we do and we need more support.  We need associations to focus on Triple Threat rather than addressing all of the consequences of Triple Threat. Support for what we do is too low by design, costs of delivering care are accelerating by designs often supported by our associations, and complexity ...

The designs for training and for payment that worked so well to improve health access during the 1960s and 1970s gave the illusion that training alone could make up the workforce gaps. Such is not the case. The financial design fueled the 1960s and 1970s improvements. The failure of this design since the 1980s prevents further gains - continuing to leave most Americans behind. The family medicine leadership still clings to the 1960s design, but must embrace a 2040s design to continue to lead in family medicine, in primary care, and in health access. It is quite revealing that family medicine associations and leaders have embraced the innovation/regulation/certification bandwagon. There is a willingness to embrace the academic, association, institution, and association designs. But do these designs match up to family medicine now - or in the future? Past family medicine graduates that were active were 90% committed to office family medicine for decades. More recent tracki...

Family physicians are the most likely to encounter vulnerable populations. Addressing the needs of these populations requires more team members with better support. The team members are the ones most compromised in the past three decades of payments too low and cost of delivery too high made worse by rapid chaotic change. Family medicine leaders have set up a series of meetings. The track record of these large gatherings is not stellar.  The first of these meetings addressed access. The second of these meetings focused upon vulnerable populations. There is a third planned to address primary care workforce. The result will be more panels, reports, centers, and initiatives. But this will not address access, vulnerable populations, or primary care workforce. When a single area is important to all of the core missions of family medicine associations, this should be the dominant if not the only focus. Reports, Panels, Centers, and Grants are what CMS does when it cannot t...

Family medicine leaders still cling to traditional academic medicine. Many of the major family medicine efforts arise from family medicine departments and from medical school based family medicine programs. Soon family medicine will have a 50th anniversary. Should family medicine tolerate another 50 years of stagnation?    Constant Strain in the Academic Family   The relationship between academic institutions and family medicine has always been strained - when academia was getting started, when formal family medicine training was started, and continuing to the present.   Family practice general practice predates modern academia in the United States. The dominant physician 100 years ago were connected to local populations across origin, training, and practice. The academic designers consistently built up what became formal academic training. The consequences of such training were seen in just a few decades. Flexner conceded that the distribution of phys...

In this time of avoiding the Truth, perhaps primary care training will be exposed to the truth as well. Each year the annual residency match generates numerous promotions of various types of programs as being primary care solutions. Sources low yield for primary care are not good sources for care where needed.  The Match may indicate more medical students who begin training in primary care, but few will enter primary care and even fewer will stay in primary care. Claims of nurse practitioner and physician assistant solutions for primary care are just as spurious. Those entering primary care and remaining in primary care continue to fall to lower levels.  This year the claims of international graduates as solutions for underserved areas are prominent. About 50 - 90% of the services provided where the underserved need care are provided by primary care. International graduates fail as good sources of care where needed due to 20% loss to home or other nations 45% choosing ...