Medicine
Major Journals Fail Primary Care Once Again
- Medicare And Medicaid At 50 And Beyond
When did M and M design change from support for health access to against health access and why? Government and Foundations are currently celebrating the accomplishments of Medicare at Age 50 - but which Medicare? Claims of improving the cost of care are...
- Will Small Health Make The News Long Enough To Matter?
It is about time that Small Health Care received some attention as the small hospitals and small practices, but will this continue. Off and on over past decades, primary care has received much attention, but the attention has not resulted in changes in...
- More Reasons For Lesser Performance For Small Health
America is aging. With increases in age, Americans become more dependent and have more care needs in areas such as health, activities of daily living, finances, and more. Aging in America is not equitably distributed. States like Alaska and many of the...
- Damn The Reality Of Small Practices - Full Speed Ahead
The Graham Center has released a study indicating that 45% of primary care physicians are found in small practices with 5 or fewer physicians. Studies by county and by zip code indicate substantial portions of the American population dependent upon small...
- Perverse Health Payment Dividing Us
Numerous examples exist of perverse payment designs that pay less or that are more likely to penalize hospitals and practices in counties where lower to lowest concentrations of clinicians are found.The same service by an outpatient hospital compared...
Medicine
Health Access Blogs in Order of Viewing
Most Recent Posts
How Bad Health Design Has Been Sweeping the Nation - Designs must focus on care delivery, not compromise
Getting to Rural Practice and Do They Get Rural Practice - Getting to Rural Practice is more of a challenge than ever often becauses our designers duo not understand rural practice, rural people, the specialties needed, or the funding needed.
Have Resident Work Hours Limitations Helped? We now know that quality has not changed and we are seeing the consequences including compromise of health access.
Top Rated Posts
Too Many Clinicians in the United States - Three Dimensions of Non-Primary Care vs Zero Growth in Primary Care 1980 - 2010 – Too much is the rule for US health care costs with three dimensions of rapid growth of non-primary care – the care that cannot be regulated except through limitations of workforce.
Failure of Primary Care Is About Failure to Design Training and Payment Specific to Primary Care - Meeting Primary Care Needs in the Last Half of the 21st Century - A SMART plan actually indicates how the US can meet primary care needs. All that is required is a focus upon specific primary care result rather than primary care that is 70% not primary care in result.
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
Preventing Rural Workforce By Design
Open Season Upon Small Health Care
- Continue on to Open Season on Small Health By Big Media
- Summary of Small Health Complexities
Starting to Solve Societal Inequities - Support for a SMART Start from the Very Beginning of Life
Perverse Health Payment Dividing US - More for Fewer and Less for More, and Penalties for Those Caring for Those Most in Need
And the Next Victims of Cost Cutting: Dual Eligibles - Those Most Vulnerable and Least Able to Defend Themselves Are Next
Information Technology Cannot Heal - Time to Get Out of the Way of Healing and Those Who Can Help Remove Barriers to Healing
Hotspotting Has Many Spots To Consider - Simple Interpretations Are Inaccurate, Many Different Characteristics Shape the Outcomes, Not Just Geographic Location
Retail Clinic Recoil - Many Side Effects Can Be Anticipated, And More to Come
Global Fails Local But Local Focus Succeeds Globally
Domino Decline By Design - as ERs Close, Those Nearby Face Challenges, as Small or Rural Hospitals Close or Practices Where Needed...
Declines in Health Care Delivery Despite Increases in Health Spending - If We Keep Accelerating Non-Delivery Costs, We Can Continue to Remain Behind Health Care Demand
Health Care Delivery Is No Laughing Matter - Political Cartoons are Nice, but...
Overcoming Barriers to Health Access Including ACA - Exposing the Myth of Coverage Equals Care
Will Teaching CHC Sites Deliver on the Promise of Health Access - More than good intentions are required as sites must train family physicians and be located in states and counties in need of workforce for maximum result
How Bad Health Design Has Been Sweeping the Nation - Designs must focus on care delivery, not compromise
Getting to Rural Practice and Do They Get Rural Practice - Getting to Rural Practice is more of a challenge than ever often becauses our designers duo not understand rural practice, rural people, the specialties needed, or the funding needed.
Have Resident Work Hours Limitations Helped? We now know that quality has not changed and we are seeing the consequences including compromise of health access.
Top Rated Posts
Too Many Clinicians in the United States - Three Dimensions of Non-Primary Care vs Zero Growth in Primary Care 1980 - 2010 – Too much is the rule for US health care costs with three dimensions of rapid growth of non-primary care – the care that cannot be regulated except through limitations of workforce.
Failure of Primary Care Is About Failure to Design Training and Payment Specific to Primary Care - Meeting Primary Care Needs in the Last Half of the 21st Century - A SMART plan actually indicates how the US can meet primary care needs. All that is required is a focus upon specific primary care result rather than primary care that is 70% not primary care in result.
To Follow the Money, Follow the Workforce:
Workforce distribution, or lack thereof, is about health spending. Where the US fails most of its population in spending, it fails most of its population in workforce
Workforce distribution, or lack thereof, is about health spending. Where the US fails most of its population in spending, it fails most of its population in workforce
The Rural Physician Associates Program: Continuity Longitudinal Integrated Curricula continues to set the bar for rural training and top quality medical education for four decades.
One Million Hearts Saved or 160 Million Lives Improved - Disease Focus Has Consequences.With so few helped at such high cost, so many are left behind.
What can a zip code 10032 study indicate about nurse practitioner versus physicians
Finance-me-cratic Constants in the Bureaucratic Universe
What is Killing US is Not Four Diseases Focus - The Myth for the Cure and others in the Disease Focused Crowd Are Now Selling Four Diseases to the United States and to the World Health Organization.
Does Primary Care Experience Matter in the US where Primary Care Workforce Will Soon Be the Least Experienced in the Nation's History?
Accelerating Cycles of Primary Care Decline
Why are 2008 HRSA Projections of Primary Care Workforce indicating substantial increases when the reality is decreases in primary care?
Failing Primary Care Explained By Policy Failure – Failures in primary care spending include low spending, spending far lower than non-primary care, poor support, rapid increases in cost of delivery, and funding squandered in numerous areas other than support of clinicians and team members to deliver care.
Why Do Primary Care Myths and Misinformations Persist?
Fifty Years of Failed Primary Care Workforce Innovation
Cost of Training per Unit of Primary Care Delivery
What is Killing US is Not Four Diseases Focus - The Myth for the Cure and others in the Disease Focused Crowd Are Now Selling Four Diseases to the United States and to the World Health Organization.
Does Primary Care Experience Matter in the US where Primary Care Workforce Will Soon Be the Least Experienced in the Nation's History?
Accelerating Cycles of Primary Care Decline
Pounding Poverty Providers with Pay for Performance
Disease Focused Disorder Mentality or Sentimentality
Disease Focused Disorder Mentality or Sentimentality
What Do Medical Home Studies Indicate? Those positive about the medical home are promotions that indicate the value of the continuity medical home when the real determinants of better health care are social determinants. The fact is that health care access, cost, and quality are fixed in place by designs. To understand what works, it is important to understand the designs and the designers.
The Black Hole of US Subspecialization spells Workforce Concentration, continued higher costs for health care, and Lack of Access for Most Americans
Comparing Family Practice Sources - The few, the proud, and the distributed arising from the nation’s MD, DO, NP, and PA graduates
Rural Rearrangements of the Deck Chairs - The fact is that rural programming has not been able to overcome overall changes in the US health design.
Failing Primary Care Explained By Policy Failure – Koch’s postulates are satisfied – US Health Policy can rebuild or destroy primary care as illustrated a number of policy periods across 1960 – 2010.
Generic Expansions Are Not SMART – Generic expansions of annual graduates absolutely fail for the purpose of health access. Too few enter and too few remain, even when the training program is a primary care program.
Rural Primary Care: Stark Realities
SMART Primary Care : Family Practice Contributions
The Squeeze Play that Fails - Medicare is supposed to be a design that facilitates health care for the elderly. But...
Still the Health Access Solution for Most Americans - Health access workforce solutions have always been and will always be the broadest scope generalists.
Myth for the Cure: Essential for Disease Focus - Do no harm is difficult when the focus is eliminating disease.
Myth for the Cure: Essential for Disease Focus - Do no harm is difficult when the focus is eliminating disease.
How the Disease Focused Abuse Health Access
Deifying Disease By Design
Who Really Benefits? Claims of benefit to health access have been pointed out as promotions and promises, impractical, deceptive, or insignificant. Over and over the design deficits do not allow health access recovery. To understand primary care failure, one must understand who benefits from designs that fail for primary care result.
Can We Have Our Billions Back Please? Why would an advocate for basic health access keep hammering on disease focus? The answer is simple. For decades we have more different researchers and subspecialists creating more reasons to spend dollars anywhere but on basic health care services, especially services needed by over half of Americans.
Standard Primary Care Year Estimates – Only primary care training that results in graduates that enter and stay in primary care and have the longest careers and have the most activity as direct care clinicians and have the top volume delivery and remain where needed at highest levels can help with primary care recovery. Lowest retention, shortest career, lowest volume, and fewest active requires far too many graduates to even maintain primary care levels, much less address primary care for 200 million left behind.
Rural Pipelines Versus Long Term Obligations – Rural pipelines in the US are a failure and have been for the last 30 years because of US health policy.
Uncovering Cover Ups Involving the Front Lines – A British report in WWII indicated the horrific failures of the early years regarding bombing runs. The US needs an objective approach to deal with the failed front lines of primary care.
To Be SMART or Not to Have Health Access – Specific, Measurable, Achievable, Realistic, and Timely is what is required to recover health access. Generic, primary care training not primary care in result, assumption, promotion, delay, and other priorities higher than primary care (even in primary care training) are not going to recover health access.
Rural Workforce 2000 to 2010 - Uncle Sam says "I want you" to serve in rural locations. Uncle Sam's design says "I don't want you" to serve in rural locations
Critique of Commonwealth Fund Report on Ensuring Equity
Revisiting Physician Distribution by Concentration - lack of distribution that is
Rearranging the Deck Chairs: Death Displacement– A focus on deaths prevented or lives saved is only possible with distorted thinking. We all will die. Our overall quality of life is about how our lives are impacted by our efforts and by our national designs
Choices for Higher Priority Areas That Could Make a Difference
Blogs indicate that primary care can be recovered and should be recovered, but it will take 30 consistent class years of improvement for actual recovery. We have to have at least one to begin.
Dr. Bowman is the North American Co-Editor of Rural and Remote Health. He was the founding chair of the Rural Medical Educators Group of the National Rural Health Association and the long term chair of the STFM Group on Rural Health.
Robert C. Bowman, M.D. [email protected]
Basic Health Access Web Basic Health Access Blog World of Rural Medical Education
Basic Health Access Web Basic Health Access Blog World of Rural Medical Education
Dr. Bowman is the North American Co-Editor of Rural and Remote Health. He was the founding chair of the Rural Medical Educators Group of the National Rural Health Association and the long term chair of the STFM Group on Rural Health.
- Medicare And Medicaid At 50 And Beyond
When did M and M design change from support for health access to against health access and why? Government and Foundations are currently celebrating the accomplishments of Medicare at Age 50 - but which Medicare? Claims of improving the cost of care are...
- Will Small Health Make The News Long Enough To Matter?
It is about time that Small Health Care received some attention as the small hospitals and small practices, but will this continue. Off and on over past decades, primary care has received much attention, but the attention has not resulted in changes in...
- More Reasons For Lesser Performance For Small Health
America is aging. With increases in age, Americans become more dependent and have more care needs in areas such as health, activities of daily living, finances, and more. Aging in America is not equitably distributed. States like Alaska and many of the...
- Damn The Reality Of Small Practices - Full Speed Ahead
The Graham Center has released a study indicating that 45% of primary care physicians are found in small practices with 5 or fewer physicians. Studies by county and by zip code indicate substantial portions of the American population dependent upon small...
- Perverse Health Payment Dividing Us
Numerous examples exist of perverse payment designs that pay less or that are more likely to penalize hospitals and practices in counties where lower to lowest concentrations of clinicians are found.The same service by an outpatient hospital compared...