Medicine
- 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...
- 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...
- 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. Dozens of special programs can no longer hide the fact of an aberrant basic design that fails rural Americans. The...
- 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...
Medicine
Number One Two Three in Health Access
Solutions for health access primary care workforce
- Enter primary care practices at highest proportions after training
- Stay in primary care practice at highest proportions in the years after graduation
- Have the longest health professional career lengths
- Remain active in practice during a career at the highest percentages
- Deliver the highest volume of primary care when active in primary care delivery.
- Are most likely to be found in 30,000 zip codes with 200 million Americans and only 25% of total workforce (Practice Locations Outside of Concentrations) and
- Are least likely to be found in 1000 zip codes with only 11% of the population and 50% of the workforce (Super Center Concentrations).
Only family medicine residency graduates meet all of these criteria for graduates past, present, and future. Only family medicine residents have not been increased beyond the 3000 annual graduates first reached in 1980. The US primary care design has also not changed for primary care numbers since 1980 while the non-primary care design has doubled each 15 years since 1965.
Only a broadest generalist primary care source can best meet the needs of over 65% of elderly, poor, near poor, rural, underserved, lower income, middle income, disadvantaged, children in need of health care workforce, and shortage area populations.
Number 1 is United States Origin Family Medicine from a US Medical School | 25 Standard Primary Care Years | Estimated Range of 23 – 30 Standard Primary Care Years depending upon age at workforce entry, gender, retention in primary care |
Number 2 is United States Origin Family Medicine from a non-US Medical School | 22 - 25 Standard Primary Care Years | A slight delay in entry to practice is likely to result in the potential for lesser workforce, but there may be no difference |
Number 3 is non-US Origin Family Medicine from a non-US Medical School | 20 – 22 Standard Primary Care Years (but broad range) | Medical education in other nations commonly results in younger age but those working toward US training and practice face delays that result in older age entry to US workforce |
Standard Primary Care Years Estimates for 2012
First career and practice location choices are simply insufficient to assess primary care sources. The Standard Primary Care Year is an important estimate of future primary care delivery assigned to the class year of graduation.
Nurse practitioner and physician assistant contributions to rural or underserved locations in need of workforce are multiple times greater when employed in family practice as compared to NP and PA not family practice employed. NP and PA graduates not employed in family practice remain below average in needed practice locations. About 25% of NP and PA workforce are found active as family practice clinicians although declines could result in fewer.
First career and practice location choices are simply insufficient to assess primary care sources. The Standard Primary Care Year is an important estimate of future primary care delivery assigned to the class year of graduation.
Pediatric and Medicine Pediatrics | 10 – 14 SPCYrs | Less than half and likely less than 40% will remain in primary care. |
Physician Assistant Beginning Family Practice | 12 SPCYrs | Steady departures over the years after graduation limit outcomes. |
Nurse Practitioners Trained as Family Nurse Practitioners | 6 – 8 SPCYrs | Half will be active as direct care clinicians in family practice employ. Fewest years and lowest volume result in substantially fewer SPCYrs. |
Internal Medicine | 3 – 5 SPCYrs | Few enter primary care and departures continue after graduation. |
Physician Assistant not Starting in Family Practice | 1 - 3 SPCYrs | Family practice is the predominant PA primary care vehicle |
Nurse Practitioners not FNP trained | 1 – 2 SPCYrs | Family nurse practitioners are the predominant NP primary care vehicle |
Nurse practitioner and physician assistant contributions to rural or underserved locations in need of workforce are multiple times greater when employed in family practice as compared to NP and PA not family practice employed. NP and PA graduates not employed in family practice remain below average in needed practice locations. About 25% of NP and PA workforce are found active as family practice clinicians although declines could result in fewer.
Comments by any number of “workforce experts” about family medicine from any US origin or non-citizen source should be supportive about expansion, about selection specific to family practice, and about training specific to family practice. This entire blog was posted because non-citizen family medicine has received comments and even testimony to Congress that has not been flattering. What matters is health access delivery where needed. Even if only 7% of non-citizens average family medicine choice, this choice is an important one for 200 million Americans left behind and about to have even more difficulty.
Generic expansions of health professional training not specific to permanent family practice (MD, DO, NP, and PA) should be understood as solutions for non-primary care and practice locations that already have top concentrations. Flexible designs fail for primary care and for 200 million Americans. Flexible designs are represented by NP, PA, and IM training that can result in any number of non-primary care careers. For nurse practitioner or physician assistant training to be SMART Basic Health Access Solutions, they would have to find a way to permanent family practice by a permanent design change. Generic and flexible is failed health access.
Specific family practice is the SMART solution for health access for 200 million Americans left behind and falling further behind by design.
Physician Distribution By Concentration Zip Code Practice Locations Inside and Outside of Concentrations
More about the Standard Primary Care Year
Three Dimensions of Non-Primary Care Expansion and Zero Growth in Primary Care Design
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
- 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...
- 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...
- 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. Dozens of special programs can no longer hide the fact of an aberrant basic design that fails rural Americans. The...
- 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...