Basic Health Access

Getting to rural practice is often about a calling and a response, as it was in my case. Sometimes the career is thrust upon us. Taking a cue from Shakespeare, Some are born rural, some achieve ruralness, and some have rural thrust upon them. Regardless of the route to rural practice, the journey is often neglected. The need for a journey or path has long been marginalized as in paths to rural practice, to primary care, or to care where needed. The emails awaiting me this morning back to back were about rural training and apprenticeship -  coincidence? "People who commit themselves for a cause have a right to expect training in the job for which they have been selected. In some of the trades, this is called “apprenticeship.” In medicine, it is known as “internship.” In the military, it is referred to as “basic training.” In scripture, it is referred to as “discipleship.” However, in our modern day, training is often by-passed due to the pressures of time, need and a low...

The intent of resident work hours limitations was to improve the quality of care received in the nation’s teaching hospitals. There have been numerous consequences of the limitations - upon primary care, medical education value, and surgical training. The quality of care has not improved. Primary Care Impacts Based on lost resident workforce, over 30,000 nurse practitioner and physician assistant graduates have been hired to become teaching hospital workforce. Losses in resident workforce may have been a reason for the rapid movement toward hospitalist design. Studies of the benefits of hospitalist workforce (half day stay saved) have 11 of 17 been done in academic centers. These studies have encouraged widespread adoption of hospitalist workforce. It is interesting that hospitalists may have limited overall benefit in lower volume and other facilities.  Hospitalist focus has resulted in a second 30,000 loss of primary care trained physicians to become hospitalists wit...

Most Recent Posts All True GME Reforms Point to Family Medicine Family Medicine Needs a New Beginning - Current Preparation, Admission, and Medical School Plus Health Policy Interact To Prevent Family Medicine Choice - and Health Access Result Too Many and the Wrong Clinicians  for graphic - Additional consequences result from designs not specific to primary care or care where needed.    What Veterans Need Is Family Practice - No Other Type of Clinician Comes Close to the Location or the Scope Best Beginnings for Health Access Clinicians - Shared Origins and Optimal Health Access Focus During Trainings  - Those least likely to gain admission are the most likely to choose family medicine, the most likely to be found in primary care, and the most likely to distribute to counties in most need of care. Why does our national design so distort physicians away from health access recovery. How To Resolve Health Access for 40 States Behind By Design ...

A secondary title would be the problem of poor support for mental health and primary care where substantial portions of Americans reside. Primary care is not improved when "my form" is supported and "other primary care" is not. Numerous interventions are being attempted in health care. Various media and foundation postings appear to promote "jump on the bandwagon." Sometimes in their haste to promote PCMH or integration or their own intervention, there is damage done to primary care in areas such as reputation. A recent post at the Robert Wood Johnson site discussed Improving Primary Care, One Patient at a Time . It was hard to follow this or understand how this related to primary care. The major point highlighted was negative about primary care in the mental health area - noting how depression was under-recognized. As with many such clips, the point of view of resourced health care was advanced (often supplemented by special funds or grants) and the...

Population Based Care is a beginning for I OM . How about Basic Health Access for Most Americans? The Institutes of Medicine plays a key role as a designer of health care. Up and coming health care designers and those established as designers are a part of the infrastructure of IOM. Designers move around between associations, corporations, institutions, and foundations to gain credentials to reach the IOM and other positions of influence. Is the reality of designs and designers gone awry finally taking hold at IOM? Can IOM move from academic focus to a population based focus with more academics focused upon population health? IOM has just now established a Roundtable on Population Health This is decades after some understanding of the impact of smoking cessation upon population health - an impact greater than cancer research regarding evaluation and treatment until about 15 years ago. Until that time, population health mattered more than all of the research and development, th...

--> Highlights of the Sanders' Primary Care Report are Number ed and ar e fo llowed by Critique Senator Sanders and Fi tzhugh Mullan MD are respected individuals. Their reports about health access make great contributions. The re are errors in their assumptions about primary care workforce. Strong solutions can help recover primary care. Dilute primary care training solutions resulting in low proportions of graduates found in primary care workforce will not recover primary care. For primary care rec overy the United States must focus upon  M o st primary care delivery per primary care graduate Mo st primary care where needed More primary care spending, and  More spending where health care spending is multiple times per person lower.  National experts that truly want to recover primary care and basic health access must support these princ iples. Interventions must be consi stent with these principles and m ust not result in the opposi...