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...

The recent Beyond Flexner postings and social mission articles have revived interest in Academic Medicine's Season of Accountability and Social Responsibility  by William T. Butler, M.D. Dr. Butler gave this address to AAMC in 1990 and expected a response - one that never came. The following are predominantly Dr. Butler's words with an update regarding the lack of progress regarding his calls to action. Public Concerns About the Overall Health Care System Dr. Butler declared that academic medicine had entered a new and stormy "season" of accountability and social responsibility, due to public concerns about the overall health care system. His recommendations are followed by comments regarding academic medicine addressing these concerns or not. Public concerns have continued. There has been no progress in this area. The political arena has been a distraction, but the concerns continue. The same types of headlines listed not only are seen in the media headl...

Data is often collected, processed, and promoted for dramatic impact. Dialing for dollars is very lucrative when it comes to health care. The controversies dominate our attention  as health care eats its way through our budgets, our employer budgets, our state budgets, and the federal budget. Physician salary data is a popular attraction. This data is often used to claim that physicians seek careers associated with higher salaries. The payment design shapes much more than physician salaries and in turn shapes those in our nation that win and those that lose - by national design. Data from Medscape The payment design has long favored procedural-technical services over office-based/cognitive/basic services. The highest paid physicians perform procedures that are paid at highest rates. Other highest paid physicians are those that perform higher volumes of higher paid procedures. These highest rates have been determined by academic, hospital, and physician association representat...

A complete revision of payment in favor of basic services is required for any hope of more general surgeons, general orthopedists, and other general surgical workforce. Any hope of getting surgical residents to bypass prestigious fellowships in favor of direct practice entry is entirely about the financial design. A fellowship results in a career with services that are reimbursed at much higher levels. Narrowing the differential between basic and highly specialized is required for restoration of all generalist and general specialty careers. Summary General surgeons are shrinking along with other general surgical specialties. Production is too low to replace attrition. This has actually been going on for some time - General surgery has taken at least a 15% decline since 2005 and more likely close to 20%. The oldest general surgeons are in locations with lowest concentrations of physicians - making shortages worse. These are also the places increasing...

A story out of Boston (or New York, or...) brings attention to a long term dream of academic family medicine - having a family medicine department in every medical school. Not surprisingly the latest article or blog is soon promoted and passed around by FM associations. For decades the Family Medicine journal has listed family medicine results once a year and has categorized by department - keeping this focus alive. The question remains... Are new departments helpful for family medicine or not?  Payment Design = Workforce, Regardless of Training Can departments of family medicine boost family medicine? Apparently not since the most rapid increase in family medicine residency growth from 1970 to 1980 was the period of fewest family medicine departments. What really fueled the rapid growth of family medicine was substantially more payment going to increase primary care. Since family medicine is the most dependent upon primary care payment (cognitive, office, ba...