Basic Health Access

Just in from Annals of Family Medicine (Miller, Rubenstein, Howard, Crabtree) Shifting Implementation Science Theory to Empower Primary Care Practices Hope for primary care, generalists, rural health, and care where needed requires a very different perspective after decades of failed designs. Not surprisingly this will need to come from inside of these practices and places. Not surprisingly policies and practices dictated from outside have been not only a poor fit - but have been abusive to the populations most in need of care and the practices that serve them. There is hope from the primary care research community. The perspective must be inside of practice looking out - instead of outsiders forcing changes. Qualitative research explores and discovers and reflects as Ben, Will, and others taught me along with the various rural family physicians interviewed and researched in the 1990s in Nebraska. The current focus on quantitative research has demonstrated little to ...

Once again a most important area of primary care is being ignored. The primary care workforce has moved from the most experienced workforce to the least experienced - without so much as a warning. The focus for primary care has been elsewhere other than significant changes in the workforce in areas such as consumer focus, convenience, quality, metrics, or lower costs. But there has not been much about changes in the primary care workforce itself. No, this is not about the movement from physicians to non-physicians, although this change is a big factor in the changing of primary care experience. All of the primary care workforce is impacted - MD DO NP and PA. Fewer enter and even fewer remain. Because they depart and take their primary care experience with them, the remaining workforce is more and more likely to be inexperienced. Not even researchers are asking many of the important questions with regard to primary care.  How is the primary care workforce changing and ...

Every day there are articles, blogs, and speeches proposing a fix for primary care. The latest to cross my desk comes from Health Affairs. Another value based plan is proposed to address the needs of patients with dementia. We can agree that individuals with dementia do have complex health care needs and their caregivers are often overwhelmed. We can agree that primary care is the most appropriate care venue for such patients. But I would argue that primary care is currently not capable of the challenge. Before additional proposals are considered such as those involving innovation, digitalization, reorganization, regulation, integration, coordination, or outreach  – the financial design must be addressed. How Does Innovation Hurt Where Practices, Towns, Health Facilities and Resources are Small Innovation Is a Distraction from Real Primary Care Solutions Innovation Focus Forced on Team Members Contributes to Overload Innovation Is More Likely Where Primary Care...

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...

It is a time of great change and challenge in health care. The challenges are best seen in those who deliver the health care. Marginalization of nursing has been present for decades. Financial designs have long resulted in pressures for fewer nurses doing more as patient care gets more complex. Now this is seen in physicians and across those in health care.  The chronic provocations of the broken-down  healthcare "delivery system"  relegates physicians into a chronic  and unsustainable fight-or-flight mode. (Hood) It is indeed a cruel irony that we are all alone – together. (RCB) Innovation and disruption discussions have been converted into policies, regulation, and the push for digitalization. This rapid change focus is fixed on fixing health care. Instead the relentless bandwagon of disruptive innovation has rolled over those who deliver health care.  Rapid regressive changes are taking the humanity out of health care. They are takin...

With additional decades, with time away from academic influences, with time away from conferences, and with more interactions with practice and practicing physicians - it is possible to see with a different perspective. The leaders and staff shaped by the above may be quite limited in their critical abilities. The newest and most innovative approaches are given free reign. Meanwhile back in the real world of practice, there are consequences. Conferences to address burnout - this is the nominee for the first Focus on Fixing the Financial post. Conferences on burnout appear to be a good thing For associations to appear that they are addressing member needs, especially those failing to address the financial design or the innovations, regulations, and digitalizations that make practice worse For association leaders to raise up their flags to also appear to focus on important areas For association finances For advertisers associated with association conferences For advert...

Please reconsider your plans to devote major resources to expand family medicine graduates. We must work together for FM, but we must be effective. Effective efforts must be specificity to address the problem. The problem in primary care cannot be solved by training. More reports, conferences, staff resources, and association resources would waste time, effort, and energy. It is meaningless to attempt to expand any primary care, generalist, or general specialty workforce without the dollars specific to support more delivery team members. Only a major improvement of the financial design can support more team members in more locations - especially where most Americans have the least by design. The lack of effectiveness of more graduates is obvious and has been for decades. New sources of primary care and massive expansions of four sources have not resolved deficits of primary care or workforce where needed. The glut of workforce created will make matters worse. The finan...