Medicine
Rural primary care is estimated by the rural percentage times the SPCYr. Top primary care delivery goes to those with the longest careers, most primary care retention, most activity, and most volume. Family medicine with only 10% of annual primary care graduates will contribute 36% of the primary care delivery result for 2012 and higher proportions of rural or underserved result for the nation.
Basic health access workforce calculations are not complex to understand. A nation that desires primary care workforce, rural workforce, workforce for underserved areas, and workforce for 65% of the population (outside of current concentrations) places a priority upon permanent broad generalists in designs for training and designs for practice support. As graduates depart primary care and family practice, they depart most needed careers and locations.
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Solutions for health access primary care workforceEnter primary care practices at highest proportions after trainingStay in primary care practice at highest proportions in the years after graduationHave the longest health professional career lengthsRemain...
- Cost Of Training Per Unit Of Primary Care Delivery
The cost of primary care training can be compared to primary care delivery over a career. The Basic Calculations of the Standard Primary Care Year % Primary CareYears in Career% Remain Active% VolumeSPCYR Per GradNP not FNP15%2470%70%1.76FNP...
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All primary care sources have declined in primary care per graduate and in rural primary care delivery per graduate. The rural Standard Primary Care Year contributions over the class years illustrate the declines in rural primary care delivery. The Standard...
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Achievable primary care is one of the weakest areas in the workforce literature. Enough annual graduate expansion of any primary care source will increase primary care, but steady declines in the proportion remaining in primary care in the years after...
Medicine
Standard Primary Care Year Estimates 2012 Class Year
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
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 | 24.4% |
| Physician Assistants | 75.0% | 42.4% | 75.0% | 31.0 | 7.39 | 31.8% |
| US DO | 80.0% | 22.3% | 95.0% | 34.0 | 5.77 | 17.9% |
| International NonCit MD | 80.0% | 19.7% | 94.5% | 34.0 | 5.05 | 15.7% |
| NP Masters | 60.0% | 50.0% | 70.0% | 23.0 | 4.83 | 30.0% |
| US MD | 80.0% | 17.0% | 95.8% | 34.0 | 4.43 | 13.6% |
| NP Doctoral | 60.0% | 50.0% | 70.0% | 21.0 | 4.41 | 30.0% |
| US MD Top 20 PC USNews | 80.0% | 16.6% | 96.5% | 34.0 | 4.37 | 13.3% |
| US MD Top MCAT | 80.0% | 11.7% | 94.5% | 34.0 | 3.01 | 9.4% |
| Designed FM | 80.0% | 95.0% | 100.0% | 36.0 | 27.36 | 76.0% |
| 100% FM School | 80.0% | 92.0% | 100.0% | 34.0 | 25.02 | 73.6% |
| 100% FP in PA | 75.0% | 92.0% | 75.0% | 31.0 | 16.04 | 69.0% |
| 100% FP Masters NP | 60.0% | 92.0% | 70.0% | 24.0 | 9.27 | 55.2% |
| 100% FP Doctoral NP | 60.0% | 92.0% | 70.0% | 22.0 | 8.50 | 55.2% |
Rural primary care is estimated by the rural percentage times the SPCYr. Top primary care delivery goes to those with the longest careers, most primary care retention, most activity, and most volume. Family medicine with only 10% of annual primary care graduates will contribute 36% of the primary care delivery result for 2012 and higher proportions of rural or underserved result for the nation.
2012 Class Year Estimates for Primary Care Delivery Using the Standard Primary Care Year
NP not FNP | FNP Trained | PA not FP Start | PA with FP Start | FM Trained | IM Trained | PD Trained | MPD Trained | |
% Primary Care | 15% | 54% | 10% | 50% | 91% | 15% | 39% | 43% |
Years in Career | 24 | 24 | 33 | 33 | 33 | 32 | 33 | 32 |
% Remaining Active | 70% | 70% | 75% | 75% | 84% | 82% | 82% | 82% |
Volume Relative to FM | 70% | 75% | 75% | 80% | 100% | 86% | 95% | 95% |
SPC Years Per Graduate | 1.76 | 6.30 | 1.86 | 9.90 | 25.23 | 3.38 | 10.03 | 10.72 |
Rural SPC Years/Grad | 0.176 | 1.764 | 0.186 | 2.970 | 5.550 | 0.338 | 0.802 | 1.715 |
Underserved SPCYrs/Grad | 0.212 | 0.945 | 0.223 | 1.782 | 3.784 | 0.305 | 0.902 | 1.286 |
Outside SPCYrs/Grad | 0.670 | 3.465 | 0.613 | 5.445 | 13.369 | 0.948 | 2.807 | 4.288 |
Proportions of Primary Care | ||||||||
Rural % for Career | 10% | 28% | 10% | 30% | 22% | 10% | 8% | 16% |
Underserved % for a Career | 12% | 15% | 12% | 18% | 15% | 9% | 9% | 12% |
Outside of Concentrations % | 38% | 55% | 33% | 55% | 53% | 28% | 28% | 40% |
Primary Care Grads at 28,340 | 4,000 | 4,000 | 5,500 | 1,300 | 2,800 | 7,300 | 3,000 | 440 |
Proportion of Grads | 14.1% | 14.1% | 19.4% | 4.6% | 9.9% | 25.8% | 10.6% | 1.6% |
Total SPCYrs for 2012 at 185,470 | 7,056 | 25,200 | 10,209 | 12,870 | 70,631 | 24,710 | 30,077 | 4,716 |
Proportion of SPCYrs (Class Yr) | 3.8% | 13.59% | 5.5% | 6.94% | 38.08% | 13.32% | 16.22% | 2.54% |
All NP | All PA | All FM | All IM | All PD | All MPD | |||
2012 Average of 6.89 SPCYrs per Grad | 4.03 | 3.39 | 25.23 | 3.38 | 10.03 | 10.72 |
Lowest primary care delivery goes to those with the shortest careers, lowest primary care retention, lowest activity, and lowest volume. United States primary care delivery has decreased from 18.6 SPCYrs per graduate in 1980 to less than 7. Annual primary care graduates have increased from 14,000 to 28,000 since 1980. Decreases from 260,000 to 195,000 indicate a 25% decline in primary care delivery capacity for the class of 2012 compared to the class of 1980.
Steady declines in primary care retention for NP, PA, IM, PD, and MPD have resulted in less primary care delivery per graduate. The doubling of NP and PA annual graduates each 6 to 12 years since 1980 has made this less apparent. SMART analysis specific to primary care delivery is required to understand career contributions - not training type or the first years in a career.
Basic health access workforce calculations are not complex to understand. A nation that desires primary care workforce, rural workforce, workforce for underserved areas, and workforce for 65% of the population (outside of current concentrations) places a priority upon permanent broad generalists in designs for training and designs for practice support. As graduates depart primary care and family practice, they depart most needed careers and locations.
With zero growth in annual graduates for family medicine over the past 30 years, the nation has avoided the choice of the most specific solution. Similarly steady departures from family practice for NP and PA across the class years and across the years after graduation have limited the health access result.
The dedicated family practice component is critically important and yet remains virtually unrecognized for this stellar health access contribution.
Perhaps the upcoming Primary Care Week will decide to recognize this retention where most needed, the only positive area in a dismal year for primary care with more dismal times to come as revenue declines and costs of delivering primary care mount.
Departures from primary care have negated primary care delivery result for 5 out of 6 primary care sources. The US designs have shaped annual graduate expansions emphasizing those most generic and least specific to family practice and primary care. The result has been minimal primary care, rural, and underserved result - least health access by design.
The result of the US primary care design
has been maximal result for non-primary care
and for zip codes that already have top concentrations of workforce.
Basic Health Access Contributions in Primary Care for the Class of 2012
Rural (RUCA) Location | NP not FNP | FNP Trained | PA not FP Start | PA with FP Start | FM Trained | IM Trained | PD Trained | MPD Trained |
Rural SPC Years/Grad | 0.176 | 1.905 | 0.278 | 3.564 | 5.550 | 0.338 | 0.802 | 1.715 |
Location % for Career | 10% | 28% | 10% | 30% | 22% | 10% | 8% | 16% |
35,661 | 706 | 7620 | 1531 | 4633 | 15539 | 2471 | 2406 | 755 |
Proportion By Source | 2.0% | 21.4% | 4.3% | 13.0% | 43.6% | 6.9% | 6.7% | 2.1% |
Underserved (Shortage High Poverty Zip Code) | ||||||||
Underserved SPCYrs/Grad | 0.212 | 1.021 | 0.334 | 2.138 | 3.784 | 0.305 | 0.902 | 1.286 |
Location % for Career | 12% | 15% | 12% | 18% | 15% | 9% | 9% | 12% |
25,638 | 847 | 4082 | 1838 | 2780 | 10595 | 2224 | 2707 | 566 |
Proportion By Source | 3.3% | 15.9% | 7.2% | 10.8% | 41.3% | 8.7% | 10.6% | 2.2% |
Outside of Concentrations (30,000 Zip Codes, 65% of the US Pop, 200 million) | ||||||||
Outside SPCYrs/Grad | 0.617 | 3.742 | 0.975 | 6.534 | 13.369 | 0.948 | 2.807 | 4.288 |
Location % for Career | 35% | 55% | 35% | 55% | 53% | 28% | 28% | 40% |
85,954 | 2470 | 14969 | 5360 | 8494 | 37434 | 6919 | 8422 | 1887 |
Outside PC Proportion | 2.9% | 17.4% | 6.2% | 9.9% | 43.6% | 8.0% | 9.8% | 2.2% |
SMART focus upon primary care results in improved basic health access result. When small proportions of the annual graduates deliver multiple times the needed health access result, designs should favor what works best rather than what ends up as non-primary care or in top concentrations of existing workforce. Designs that fail for basic health access fail most Americans.
The United States needs more primary care, rural primary care, underserved primary care, and primary care outside of existing workforce concentrations. SMART requires a focus upon what works - not generic expansions or technology or innovation - but people to deliver primary care where needed.
More details on The Standard Primary Care Year for 2012 including comparative results for types of medical schools and programs
Thanks to all 12,000 who have visited Basic Health Access in 2011.
Robert C. Bowman, M.D. Basic Health Access Web Basic Health Access Blog
SMART Basic Health Access World of Rural Medical Education
Basic Health Access Blogspot 2011 - Summaries and Links for 2011
Dr. Bowman is the North American Co-Editor of Rural and Remote Health and a Professor in Family Medicine at A T Still University School of Osteopathic Medicine. He was the founding chair of the Rural Medical Educators Group of the National Rural Health Association, he was the long term chair of the STFM Group on Rural Health, he is the founding director of Priority Infrastructure at http://www.infrastructureamerica.org/ and he is the author of the World of Rural Medical Education, and Physician Workforce Studies
Meeting Primary Care Needs in the Last Half of the 21st Century - Really!.
Clinician Specific Medical Education
SMART – Specific, Measurable, Achievable, Realistic, Timely
- Flexible Fails And Permanent Primary Care Prevented
The United States has a health policy construct that actually prevents recovery of primary care. Primary care revenue support is insufficient to keep up with the increasing cost of delivering primary care. New types of costs burden primary care practices...
- Number One Two Three In Health Access
Solutions for health access primary care workforceEnter primary care practices at highest proportions after trainingStay in primary care practice at highest proportions in the years after graduationHave the longest health professional career lengthsRemain...
- Cost Of Training Per Unit Of Primary Care Delivery
The cost of primary care training can be compared to primary care delivery over a career. The Basic Calculations of the Standard Primary Care Year % Primary CareYears in Career% Remain Active% VolumeSPCYR Per GradNP not FNP15%2470%70%1.76FNP...
- Rural Primary Care: Stark Realities
All primary care sources have declined in primary care per graduate and in rural primary care delivery per graduate. The rural Standard Primary Care Year contributions over the class years illustrate the declines in rural primary care delivery. The Standard...
- Meeting Primary Care Needs In The Last Half Of The 21st Century
Achievable primary care is one of the weakest areas in the workforce literature. Enough annual graduate expansion of any primary care source will increase primary care, but steady declines in the proportion remaining in primary care in the years after...