Basic Health Access

When you spend a decade or more preparing and training for a career as a physician or as a nurse practitioner, you expect that you life will improve with your new employment. This is no longer a reliable expectation. Decades of overproduction of NP, PA, DO, and MD graduates will have consequences for graduates as well as for our nation. High debt from tuition, higher cost of living, the challenges of becoming a young health professional, and the difficulties dealing with employers that hold all the cards - will collaborate for worsening outcomes. The burnout, turnover, productivity, and suicide issues will intensify. Slowing Population Growth Magnifies Overproduction The new census figures indicate a slowing of population growth. This translates to a glut of health care workforce even worse than previously projected. Previous calculations of expansions used 0.72% as the annual growth rate from older census data. The newer figures are 0.62%. The decline will continue to 0.6% or ...

We should send a clear message to the "experts" and the media and associations and health professional training institutions: Please stop the insanity of doing the same thing over and over again expecting a different result.  New innovative types of workforce have failed to resolve workforce deficits despite massive expansions More new types and more expansions have failed. More new types and more expansions are proposed. It is the financial foundation of the system that is broken. No training intervention is more powerful than the financial design which prevents shortages from being addressed. It Is Not the Initials or the Expansion, It is the Financial Design It is not about who is a better health professional or the type of training. Expansions are not the solution for any domination or perceived domination of health care. Texas has another new medical school planned but a family physician dean will not be able to keep the promise of more doctors where nee...

Calculations reveal just how much micromanagement is costing primary care practices where they are most needed. The costs involve other specialties that are also basic, smaller, less organized, and most needed. With reflection, the epidemic of measurement has had even greater spread. Micromanagement costs and consequences devastate education in these same lowest concentration counties. Primary Care in 2621 Lowest Workforce Concentration Counties  The calculations reveal at least 8 billion dollars less remaining to invest in primary care in 2621 counties lowest in concentrations of primary care, health care workforce, and physicians. The same financial designs that impact primary care also impact nurse practitioners, physician assistants, and physicians. Women's health and basic surgical services are impacted. Measurement focus in health care has attempted to improve costs and quality But costs have been increased by digitalization, innovation, certification, and regulatio...

Today as more big corporations capture national attention as they enter the fray to "fix" health care, you will see more promotions by a wide range of corporations. Many of them brand spanking new and financed by those who already profit most, including their health care investments. These consultants, corporations, and "experts" are complicating not only the work of those who deliver the care, but also their lives. Micromanagement of costs and of quality are still considered to be "good" even though the evidence base indicates no improvements in cost saving or in outcomes. Micromanagment of health care steals the dollars needed to support those who deliver the care and also steals time from their relationships with patients, team members, and family members. The same is true with micromanagement and measurement focus in education. Together these dollar diversions of tens of billions result in better for the few in higher concentr...

Most Veterans are located in counties distant from Veterans facilities. Veterans facilities are concentrated in major metro areas where highest concentrations of physicians are found. As a visual representation these are mostly Blue Counties. Most Veterans find it too expensive to live in places with highest concentrations of physicians as the housing is highest cost to buy or rent. Veterans clinic locations have extended to other sites, but the widespread distribution of veterans makes this a ridiculous and costly choice. The design for Veterans health care is a poor fit for health access for most Veterans. Triple Threat Hurts Access to Veterans More Veterans are most likely to arise from families, counties, and communities that are average to lower in concentrations. They are most often from lowest concentration counties and they tend to return, and they are joined by Veterans not from these counties. This has to do with housing. Affordable housing is lacking in ...

More articles indicate more closures of small hospitals. These articles have been appearing for over 30 years. Washington designers have implement a lethal combination of cost cutting to shrink revenue plus ever higher cost of delivery as shaped by regulation. The margins are low to negative and hope for the future of many hospitals is vanishing. All it takes is lost hope to die. Small practices face much the same decline by design as seen in small hospitals - and for the same reasons. It is hard to tell who to blame – Republicans, Democrats, the media that profits from controversy, or the designers that are so out of touch with basic health care needs for most Americans. The one thing that unifies all who are against small health care is the lack of awareness regarding the situations facing more and more Americans - soon to be half of Americans behind by design. It was quite interesting to see the HRSA impression regarding these closures. In many ways, HRSA was bla...

A popular video on social media lists 20 areas of improvement around the planet. It lists a 50% decrease in homeless veteran numbers. The rapid declines in Veteran homeless counts in metro areas are not necessarily a positive result. The media has a hard time understanding demographics and this makes it difficult when attempting to report on positive and negative areas. Another popular poster notes that homeless veterans need attention before refugees. The fact of the matter is that many Americans are treated like refugees - as those who do well plan ways to do even better. Their designs continue to leave most Americans behind. The relevant areas to consider for Veteran situations are not immigrants. The relevant areas are declines of veteran benefits, deteriorations involving lower income, disabled, fixed income, and less healthy populations of which Veterans are part. Most important is the consideration of available and affordable housing. Factors Regarding Veteran Homeles...