Basic Health Access Primary Care Workforce 

Robert C. Bowman, M.D.    rcbowman@atsu.edu    

Primary Care Decline: Declining Retention and Primary Care Failure Despite Expansions of Primary Care Graduates    The US design for primary care fails as 22,000 of 28,000 Annual Primary Care Graduates are Flexible and Leave Primary Care.

The Standard Primary Care Year Atlas        The Standard Primary Care Year  Primary Care in the United States must be understood in terms of actual delivery of primary care, not claims of primary care. Maximal primary care is 35 years of a career spent 90% in primary care with 90% active for a career with top volume. Minimal primary care is 27 years, 10 - 30% remaining in primary care, 60% active, and lowest volume of primary care.

Comparative Anatomy of Future Primary Care Contributions for Nurse Practitioners, Physician Assistants, and Individual US Medical School Match 2009 Estimates

Ranking Instate Office Primary Care Contributions by Individual US Medical Schools

Exclusivity Index Table Illustrating the Exclusive Career Choices, Exclusive Origins, and Exclusive Training That Fail in Basic Health Access Workforce

Standard Primary Care Years By Medical School and MCAT Scores  Once again the theme of most exclusive with lowest primary care delivery is confirmed.

Resolving Primary Care and Basic Health Access Shortages Is there a solution for most needed health access remaining at a time when so few remain in primary care and serve those left behind?

Producing Doctors for Seniors: Brave Legislators Needed to Support Health Care That Will Meet the Needs of Senior Citizens The studies are conclusive. The United States fails to produce doctors that will locate practices in locations where older Americans are found. About 70% of seniors are found in zip codes with only 20 - 25% of physicians. While health care legislation is often controversial. Without a change, seniors will not have the types of health care most needed. Most needed changes are often compromised before, during, and after the legislative process. Experts in the language of legislation must meet up with experts in the language of health access to establish basic health access as a real foundation for efficient and effective health care.

The Health Access Medical School: The Only Solution for Health Access at the Current Time

Resolving Primary Care and Basic Health Access Shortages

Permanent Primary Care May Not Be a Top US Medical Student Choice Given US Health Policy, But it is the Remaining Choice for Most Needed Health Access in the United States

Older Age Graduates Consistently Contribute More to Most Needed Health Access: Confirmation of the Theme of Those with Lower Probability of Admission that Contribute the Most in all of the most needed workforce areas

More Failures of Reagan Policies and Since: Basic Health Access

Too Many Specialists Once Again As Designers Fail to Plan 35 Years or One Generation of Physicians Into the Future

Beyond Rhetoric to Reality in Health Access Many consider themselves as contributors to health access, but few actually deliver health access, even in primary care training. Primary care graduates actually fail to remain with a majority in primary care for 3 if not 4 of the sources of primary care. Claims of primary care and basic health access remain steady for family practice MD, DO, NP, and PA forms but NP and PA forms are leaving the family practice broad generalist mode that is the only mode associated with practice location in zip codes containing the 65% of the population left behind, especially rural populations and underserved populations.

Nebraska: A Practical Application of Experiential Place and Workforce  With changes in admission, in training, and in career choice, where is Nebraska heading. Can the state produce and retain the necessary physicians when other states have higher concentrations of physicians that attract physicians from all lesser concentrations, including states with lesser concentrations. What happens when family physicians, the bulk of health access for Nebaskans, are produced at half the levels of a decade ago, no longer drift in from others states, and no longer have the greater salaries and value of broadly trained family physicians? Then consider most of the states in the United States similar to Nebraska or with large regions of population similar to Nebraska.

Primary Care Past, Present, and Future Using the Most Important Criteria for Primary Care - Actually Remaining in Primary Care and Delivering Primary Care Make the comparison between 15,000 more flexible forms with 5000 more IM, 5000 more NP, and 5000 more PA graduates as compared to 5000 more family medicine residency graduates. Flexible training forms fail to address massive and growing primary care deficits while the family medicine intervention moves the nation toward most needed health access. Graphics illustrate the changes.  

Summary - Why 5000 More Family Medicine Graduates Is the Remaining Solution for Recovery of Basic Health Access in the United States Maximal primary care, maximal distribution to all populations in need, maximal retention in primary care, 6 - 10 times more primary care per graduate, and far less decline in primary care contributions compared to other primary care forms are all logical, common sense reasons to increase family medicine residency graduates to 8000 per year by 2020.

Missing Persons: Eliminations of Primary Care in the 1980s and 2000s  Compare the graphics demonstrating production of primary care to identify the decades with decreased production and retention of primary care. Also remember the insufficient health access production extending for decades prior to the 1970s. Then consider the deficits being built now, for the next decade, and potentially beyond.

Why Nurse Practitioners Are Not Primary Care Shortage Solutions The NP primary care training form demonstrates the fewest years in a career (27 not 35), the lowest volume of primary care delivered (60% not 100%), the lowest % remaining active at 60%, a steadily lower rate of primary care retention for over 30 years, four times more found in administrative careers, and the fewest graduates actually counted. In addition the NP movement is toward internal medicine subspecialties and away from the family practice broad generalist mode in pratice (not just training). These all defeat primary care, rural primary care, underserved primary care. Nurse practitioners are much better choices for the hospital and specialty careers that they are more and more likely to pursue. Benefits are seen for NP (salaries, support, benefits) as well as employer (lowest cost of workforce and higher revenue generation) for maximal cost to productivity ratios. Why do others claim future primary care contributions? They only see the small percentage of active primary care NPs and they cling to NP contributions decades ago long departed.

Physician Distribution by Concentration Atlas   Physician Distribution by Concentration Coding 

pdc The Health Access Medical School: The Only Solution for Health Access at the Current Time

pdc Rural Distribution Times Seven - Medical Schools Were Divided into Seven Groups to Examine the Characteristics of Schools that Contribute Rural Workforce and Those that Do Not

pdc Older Age Graduates Consistently Contribute More to Most Needed Health Access: Confirmation of the Theme of Those with Lower Probability of Admission that Contribute the Most in all of the most needed workforce areas

pdc Producing Doctors for Seniors: Brave Legislators Needed to Support Health Care That Will Meet the Needs of Senior Citizens The studies are conclusive. The United States fails to produce doctors that will locate practices in locations where older Americans are found. About 70% of seniors are found in zip codes with only 20 - 25% of physicians. While health care legislation is often controversial. Without a change, seniors will not have the types of health care most needed. Most needed changes are often compromised before, during, and after the legislative process. Experts in the language of legislation must meet up with experts in the language of health access to establish basic health access as a real foundation for efficient and effective health care.

PDC Beyond Rhetoric to Reality in Health Access Many consider themselves as contributors to health access, but few actually deliver health access, even in primary care training. Primary care graduates actually fail to remain with a majority in primary care for 3 if not 4 of the sources of primary care. Claims of primary care and basic health access remain steady for family practice MD, DO, NP, and PA forms but NP and PA forms are leaving the family practice broad generalist mode that is the only mode associated with practice location in zip codes containing the 65% of the population left behind, especially rural populations and underserved populations.

pdc Most Needed Health Access: Rural Workforce Rural workforce involves the same principles of health access - origins outside of concentrations, older graduates, family practice career choice, and more normal (less exclusive training). Logistic regression equations demonstrate these factors.

pdc Presentation Illustrating Physician Distribution by Concentration Coding for 5 types of specialties considering birth origins associated with concentrations and practice locations associated with concentrations Toggle the slides to gain better understanding.

pdc Shorter presentation comparing 5 Specialty Types from origins to practice locations 

PDCNew Perspective: Health Access Recovery Requires Understanding Inside and Outside of Concentrations - Once the Process that Concentrates Is Understood, Primary Care and Health Access Recovery Is Possible. Quite Simply Health Access Recovery Requires a Health Access Perspective. Our Current Lack of Perspective Has Prevented and Destroyed Primary Care and Basic Access to Health

pdc Changes in Origins, Training, and Career Choice Defeat Rural Workforce Before It Starts

pdc Exclusivity Index Table Illustrating the Exclusive Career Choices, Exclusive Origins, and Exclusive Training That Fail in Basic Health Access Workforce

pdc Exclusive and Normal Career Choices by Type of Medical School - Who Produces Health Access and Who Produces Top Board Score Subspecialties?

pdc Rural Concentrations of Physicians - About One-Third of Rural Physicians Are Found in Top Concentrations Not Different from Super Centers and Major Centers in Urban Settings. A Few Concepts Discussed Include the Failure of Geographic Coding for these Locations, Loss of Local Influence Over Health Care, and Public Attention Given to Models that Fail Regarding Real Rural Workforce Needs

Principles of Health Access Summary Points     Steps to Health Access     Basic Health Access Concepts To Review 

Foundation of Basic Health Access Primary Care

www.basichealthaccess.org

www.physicianworkforcestudies.org

www.ruralmedicaleducation.org