Basic Health Access

The United States has 30 states in need of clinicians, needs primary care, and needs clinicians to locate practice where 40 - 50% of Americans are most in need of care. These same locations also are increasing most in population and have higher shares of populations growing faster in demand for primary care and basic services. All true reform for graduate medical education leads to family medicine specific expansions of GME positions.  Primary Care Trained Graduates for Primary Care Result for a Career Only family medicine training leads to 90% primary care result for a career. Declines down below 15% primary care result for IM training and less than 40% for pediatric training represent failure for primary care.  Less than 50% for primary care for nurse practitioners and less than 30% for physician assistant graduates is also failure for primary care Clinician Workforce Where Needed Only family physicians have population based distribution across their caree...

Few studies critique primary care workforce sources - especially the popular sources promoted as primary care solutions. The public receives information via the media that is even more distorted and promotional in nature. One area to consider is experience in primary care delivery. Readers are cautioned that experience in primary care may not translate to quality for any number of reasons, but experience may be important to certain populations, workforce designers, and those in need of the most complex primary care delivery. Those most experienced in primary care contribute substantially to primary care continuity teams.  It is difficult to see how continuity is aided by primary care sources with the least experience in primary care and with the least retention within specific primary care practices.  Consistency in Primary Care Experience Patients visiting family physicians are likely to visit sources with the most primary care experience. Family medicine is ...

Uncle Sam says "I want you" to serve in rural locations. Uncle Sam's design says "I don't want you" to serve in rural locations. Dozens of special programs can no longer hide the fact of an aberrant basic design that fails rural Americans. The last major contribution that has remained specific to rural locations is family medicine. Family medicine during the decade from creation until the 3000 annual graduate level in 1980 has been the only consistent contribution for rural workforce increase. Other sources old and new have steadily departed primary care, family practice, and more general types of careers. These are all departures away from rural locations and toward top concentrations of existing workforce - according to Uncle Sam's design for health spending and health workforce. . From 2010 to 2020 the nation can expect declines in primary care retention and lower proportions in rural locations. No projections of rural workforce from 2010 to...

All primary care sources have declined in primary care per graduate and in rural primary care delivery per graduate. The rural Standard Primary Care Year contributions over the class years illustrate the declines in rural primary care delivery. The Standard Primary Care Year is multiplied by the proportion of the primary care component found in rural areas. Declines in Rural Primary Care Delivery per Primary Care Graduate Family Medicine has declined also, but other sources have had greater decreases due to substantial departures from primary care. Estimated Rural Primary Care Year per Graduate Changes By Class Year   PA NP FM IM PD MPD Average 1965 3.07 1.77 7.08 2.27 2.72 4.84 3.14 1980 3.18 1.77 6.92 1.86 2.36 3.90 3.22 1995 2.55 1.63 5.86 1.38 1.70 2.88 2.52 2010 1.21 1.03 5.12 0.39 0.90 1.63 1.31 2025 0.94 0.82 4.49 0.28 0.68 1.22 1.03 2040 0.86 0.75 4.28 0...