Basic Health Access

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...

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 ...

Year after year various primary care associations get excited to find out the results of the match or residency choices of medical students. It is quite interesting to see how so little change is promoted so much. Even a small increase of a few dozen graduates is celebrated. Such celebrations hide the tragedy shaped by primary care payment design. This is best seen in family medicine, by far the best remaining source of primary care. Changes over time indicate the likely result of increased family medicine graduates. The increase from 2900 to 3200 seems significant at 10% growth. But over the same time period family medicine residency graduates have been choosing other career paths involving emergency care, hospitalist careers, urgent care, and other specialties. The specialty once 90% retained in primary care is down to below 70%. The impact of the actual primary care result is shown below: Annual Graduates Increase in Graduates Active in FM Positions...

A commenting family physician indicates the need for some restraint for FM leaders jumping to the defense of international graduates via the immigration limitations. Restraint is indeed a good idea. AAFP should not play the shortage card lightly, since no other specialty has the 2 to 4 times multiplier of distribution where needed.  Basic Health Access Passes 100,000 Mark - Thanks! If access was indeed a top priority, where was AMA, AAMC, and AAFP when the Fifth Pathway was terminated - one of the major sources of Spanish speaking US physicians and a major source of access? As usual, organized medicine focuses on its own interests and finds a way to capture headlines - without really supporting the changes that would resolve access woes. What Actually Fails Access to Care is Not Insurance or Training 1. The financial design of primary care (revenue minus cost of delivery) is what fails overall US primary care in the nation and what fails having enough...

Physicians and other clinicians have been moving steadily away from primary care. Specific measuring tools can indicate sources better and worse in the production of primary care. Unlike "wait and see" or projections based on annual graduates, the Standard Primary Care Year (SPCYR) is a more specific measuring tool. The SPCYR estimates the future primary care delivery at the time of graduation. Data regarding years in a career, clinical activity, and adjustments for differences in volume between primary care sources are already known.  Career Years x Primary Care Retention x Clinician Activity x Volume Adjust  =  SPCYR The career years times how that career was spent with adjustments for activity and volume differences yields the Standard Primary Career Year estimate. The most recent primary care retention figures can be inserted or the steady declines of recent decades of class years can be projected. Recent primary care retention was used rather than projec...