Basic Health Access

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 ...

Hospitalist physicians have continued to increase and hospitalist related costs paid by American hospitals have risen to 11 billion dollars a year. Academic hospitals appear to benefit most and this is where studies have mostly been done. Not all full service hospitals benefit from this design, but full service hospitals are pretty much forced to hire hospitalists. Too few hospitalists per inpatient can negate the savings to a hospital. Hospitalists arise from primary care training - a design that has resulted in rapid additional primary care decline  as a consequence of rapid hospitalist growth. The rise of hospitalist workforce was also dictated by cost cutting designs such as Diagnosis Related Groups that were implemented in 1983. Hospitalists are a primary example of the consequences of design changes - consequences that are typically not anticipated and can cause disruptions in important areas inside or outside of health care. Hospitalists have again reached the headlines. I...

Primary care workforce is substantially less than annual graduate numbers depict due to departures from primary care during primary care training, at graduation, and each year after graduation. The Health Resources and Services Administration projection of 2020 physician primary care was last posted in 2010. This document indicates increases in primary care that are impossible for internal medicine and family practice. To properly guide the nation, HRSA must not wait for new data or studies. It should remove the erroneous projections. This major document represents much good work tainted by the primary care projections. Family Medicine Internal Medicine Pediatrics Annual Graduates since 1980 3000 and steady for zero growth for 30 yrs About 1% annual growth to 7200 About 2% annual growth to 3200 % Primary Care Entry 85% - surveys, office based retention, COGME 91% 20 - 25% for senior resident surveys and COGME 44% for senior resident surveys and CO...