Basic Health Access

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...

More retail clinics in more chains with more store sites are inevitable. Changes to observe: MegaRetail versus MegaInsurance Deny, Delay, etc. Success or Failure with Loss Leader Marketing Epidemic Victims Crowding in with MegaRetail Customers Will Highest Turnover Clinicians (13%) reach 20% or More?  Least Experienced Clinician Care  Protection of protected health information? Further shrinkage of primary care workforce Best retail avoids sites where health services are most needed Who Wins in Insurance Versus MegaRetail? What if insurance companies attempt the usual delay or deny tactics? As with all who supply goods or services for MegaRetail, resistance is futile. Insurance companies would lose if they chose to fight this battle, which they won’t. But do not shed tears over this situation, after all insurance companies are powerful in their own right. Their losses dealing with MegaRetail will just be passed on to the rest of us...

As noted previously, all primary care RN, MD, DO, NP, and PA are greatly needed. But the probability of actually being in primary care over a career of contribution is small for new graduates in RN (10%), MD (20%), DO (30%), NP (25%), and PA (25%). Steady departures from primary care are seen for all except the small part of MD and DO that is family physicians. Family physicians are the only remaining primary care result that is relatively permanent but are only 7 – 8% of US MD and Non-Citizen IMG choose FM along with about 16 – 18% of DO and 25% of Caribbean US Origin. The NP and PA primary care effort has stagnated because fewer have remained in primary care. The case can be made that unless more health spending is injected into primary care, the NP, PA, IM, and PD contributions will actually shrink. Family medicine is stagnated by 30 years of no increase in annual graduates from the 1980 level of 3000 per year. One would think that common sense observations would reveal the myt...

The Standard Primary Care Year is a common sense measuring tool. Graduates must meet all of 4 criteria to deliver primary care - train in primary care, remain in primary care, serve long careers, and deliver signficant volume. It is not enough just to graduate primary care - especially with US policies that drive primary care graduates away from primary care before training, during training, and each year after graduation. The Standard Primary Care Year estimate = Average Career Years X % remaining in PC for a career X % active for a career X % volume. Update for 2014 Class Year Clinician Activity Over a Career Primary Care Retention Volume per FTE Career Years Standard Primary Care Years Office Primary Care Product Duluth 80.0% 43.8% 99.4% 34.0 11.85 35.1% Top Osteopathic 80.0% 33.2% 98.7% 34.0 8.92 26.6% Caribbean MD 80.0% 30.5% 97.4% 34.0 8.08 24....