Basic Health Access

Family practice is needed more than ever.  Only family practice positions filled are specific to the locations in need of workforce and are specific to the populations in need of care - for elderly, for veterans, and for counties and zip codes with lowest concentrations of clinicians Family medicine is the only 90% family practice position result for a career - less than a permanent family practice result shapes less primary care and less distribution where needed Family medicine is a choice prevented by designs for medical education and designs for payment Family medicine has the right ending in terms of outcomes and residency training, but preparation and medical school designs are not specific to family practice. Family medicine needs a new beginning A new beginning is required when the old beginning prevents family medicine choice. A beginning, a middle, and an ending specific to family practice results in multiple times more primary care result and multiple time...

Wisconsin family physicians intended a summit meeting focused upon workforce. Numerous connections were made. There have been improvements in primary care training support, but is Wisconsin closer to a specific solution for inadequate health access? Sticking with a specific intent is very important, as are state and local organized  efforts to resolve health access.  The continued summit efforts in Wisconsin have resulted in grants for family medicine residencies and generic funding for primary care training. Whether these are targeted specifically for Wisconsin (with obligations), for permanent primary care where needed (family medicine or legislated family practice arising from NP and PA), or for optimal health access focus of training remains to be seen.  In a nation where generic primary care training only result in 20 – 30% primary care, most of the so-called primary care funding goes to create non-primary care clinicians. States have funded more fami...

Getting to rural practice is often about a calling and a response, as it was in my case. Sometimes the career is thrust upon us. Taking a cue from Shakespeare, Some are born rural, some achieve ruralness, and some have rural thrust upon them. Regardless of the route to rural practice, the journey is often neglected. The need for a journey or path has long been marginalized as in paths to rural practice, to primary care, or to care where needed. The emails awaiting me this morning back to back were about rural training and apprenticeship -  coincidence? "People who commit themselves for a cause have a right to expect training in the job for which they have been selected. In some of the trades, this is called “apprenticeship.” In medicine, it is known as “internship.” In the military, it is referred to as “basic training.” In scripture, it is referred to as “discipleship.” However, in our modern day, training is often by-passed due to the pressures of time, need and a low...

Academics love innovation, new grants, and change. A weakness of academic focus is doing what works -  practical and relevant. Academics often have to be forced to do the practical and relevant. Such is the case with RPAP. The Rural Physician Associates Program has been practical and relevant for 40 years and has facilitated increased primary care and rural services where needed since the first 3rd year medical student began. RPAP is well known to the people at HRSA. During this past two years at least three times I have reminded them about RPAP as a very inexpensive way to increase health services for those in most need - in rural underserved areas. Given the serious problem facing HRSA with designs that would increase primary care demand in the face of failing primary care supply, worse in underserved areas, one would think HRSA would do more. HRSA has been busy elsewhere on reports and programs that are not SMART - specific, measurable, achievable, realistic, and timely...