Basic Health Access

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...

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 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...

As long as we continue to focus 70% of spending upon clinical interventions that can only influence 10% of health outcomes, we will fail to focus attention on the 70% of health outcomes that can be addressed via people factors. Situations, environments, behaviors, relationships, and other people factors are the dominant influence in health care outcomes (and education outcomes, and economics...). Health access professional training needs people change focus far more and clinical intervention focus far less. The reality of true health reform awaits discovery. True health reform must have health professionals with people and people factor focus. The preparation and training and payment designs fail to support the cognitive or person to person interactions that can best change health outcomes. Health access professionals should understand the people that they serve. This seems obvious, but what is not obvious is substantial movement away from people understanding. Health access pro...