Basic Health Access

Current medical students are investing much more in a decision for family medicine now. They need to know that family medicine leaders are doing everything possible so that they have a better future. Most importantly, a better future for those choosing family medicine is a better future for those in the nation that most need care. Breaking News - Pay for Performance Emphasis Documented as Wasted Effort by FM lacking in evidence basis to go with penalties most likely for those delivering care where needed - family physicians, rural and small practices as well as rural and small hospitals. Medical students choosing FM should have assurance of revenue increasing to family practices at or above the cost of delivery increases. This is the true route to financially viable practices, more and better team members, increased productivity, and increases in the higher primary care functions. It is also the route to more family physicians, higher retention of graduates in family medicine and...

The United States remains 23 rd of 26 developed nations in generalists and less than 50 th where most Americans reside. A substantial portion of what exists where care is most needed is a testament to the family medicine leadership that built the original FM design and the graduates that were shaped by this design. Compromises since 1980 that have impacted the entire last generation of health care workforce have been the result of failures in political, health, and family medicine leadership. Backward is Compromise of Broadest Generalists The United States continues to require broadest generalists that remain broadest generalists over their careers after training. FM residency grads have been stellar in this role as were the family practice general practice generalists before them.  No others distribute reliably.  No others have resisted the payment design for decades as only family medicine has been retained in primary care across the decades after grad...

Family medicine leadership supports a coalition that claims that it can cut costs and improve quality by a movement to value based payment. This coalition wants to convince the incoming government to continue to support continued innovations and transitions to value based payments. This would be a continuation of the last decade of experimentation. "While not fully scaled, the new payment models have made great progress in promoting transparency, reducing cost and improving quality," said the letter. "Many organizations are nearing the tipping point for realizing permanent change."  As has been common in these experimentations, the efforts have involved more concentrated organizations, practices, businesses, and locations - those least associationed with family physicians and basic health access needs. In the 34 years since Prospective Payment and DRGs the dominant focus has been on cost cutting. This period, The Era of Cost Cutting, continues to dominate thin...

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...