Basic Health Access

Another AAFP media piece asserts that small practices can prosper. The article needs clarification and correction.  We need to end disparity by design, not make excuses for it. First, the South East Rural Physician Alliance is the correct title (not association).  SERPA + Blue River Valley = Rural Comprehensive Care Network would be a fitting media piece about small and rural practices – but not when used for some other agenda. Second, our nation needs to hear from family physicians that situations in primary care and especially in small primary care and in rural health care are not prospering - as I did 3 years ago in an AFP Blog. FM leaders may well be surrounding themselves with the wrong influences since family physicians from rural areas or who served in rural areas are all around.  It has been 20 years since my AFP article - Continuing FM’s Unique Contributions to Rural Health Care. It was a call for family medicine to keep rural heal...

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...

What patients value most from physicians is our time and attention focused upon them and their needs. The time together has become shorter and what time remains is impaired by technology and data collection. The past 20 years of innovation and modernization have distracted us from what patients value most. Reflecting Upon the Ashes Physicians should reflect upon the declining ability of primary care to deliver the basics, made worse with the new demands added each year plus the limitations of employed practice. Employers are less likely to know you (the employed physician), your team, your patients, or the needs of your community.  Reflect upon movements away from the solo and small practices, the practices that are most closely associated with patients and communities, the practices noted to be best at preventing preventable hospitalizations (Casalino), the practices that are disappearing at a rapid rate, the practices most likely to involve family physicians. Not su...

Yet another media article appears indicating the problem of medical error. At least this article notes that patients should be engaged. It's Not Physicians Who Shape Outcomes - It Is the Patient and Patient Factors Patients should indeed be engaged, educated, and changed in behaviors, situations, environments, and supports because this is 60 - 70% of health outcomes. The failure to influence patients, families, homes, communities, resources, social determinants, and child well being will continue to shape lesser outcomes in health, health status, and health outcomes. These most important areas are currently outside of our current design for health care spending.  Reformers and innovators hoped to influence improved patient outcomes by changing physician behavior. The most consistent finding in the efforts to improve quality - is no change. The outcomes have not been changing because people are not changed or being changed. Their behaviors, environments, situations, r...