Health Access Recovery Atlas

The models that actually deliver most needed health access, decade after decade, are illustrated. When origins, training, career choice, state policy, and federal policies are all combined, the result is optimal health access.

Tragically many of the health access models, including those illustrated, have been terminated or compromised. A nation that supports health access primary care at lowest levels also compromises the training models that focus on what the nation needs most. 

Return to Basic Health Access Atlas

Duluth: Optimal Rural Health Access Outcomes  Duluth is an ideal model with optimal admission and training for rural primary care and the graduates have made substantial basic health access contributions where most needed. Schools such as Duluth and West Virginia School of Osteopathic Medicine exhibit all aspects of admission, training, and family medicine choice. Such schools graduate physicians that deliver 50 - 100 times the rural primary care compared to the schools with least rural primary care - the graduates of the 20 medical schools with the top MCAT scores. While selection of the most exclusive in origins and scores has advantages in other areas, the consequence is least permanent primary care, fewest remaining in primary care despite primary care training, fewest found in rural locations, and least delivery of rural primary care. Limitations also include underserved primary care as well.

RecoveryTwoInterventions1p2.GIF  Recovery of health access and primary care is illustrated using two interventions. One intervention involves expansions of flexible primary care (IM, NP, and PA) by 30,000 more annual graduates to 1.2 million or more in the workforce, the requirement for sufficient primary care. The second intervention is 8000 family physician graduates a year (5000 more) for 300,000 workforce for more dependable health access.  

RecoveryTwoInterventions600k.GIF is a close up slide illustrating the impossible task of graduating enough flexible primary care forms to meet US primary care needs as compared to an achievable and dependable primary care result from permanent primary care.

Accelerated Family Medicine was the lowest cost medical education with optimal most needed health access with 4 times the average rural contribution and 3 times the underserved contribution. The accelerated model is yet another top health access model terminated by the United States despite top distribution to rural and underserved locations. Accelerated FM Graduates were also not selected or trained for rural or for underserved locations. They were older graduates who committed to family medicine a year earlier.   The model worked well in female graduates, urban origin graduates, and US citizens new to the United States. These are the three directions of US medical school admissions where the most increases have been found in the past 20 years. In this graphic the percentage found in each practice location is compared to the national average to generate a ratio. Accelerated graduates have higher ratios in practice locations representing most needed health access. Indeed tracking of over 140 accelerated graduates in 11 different locations revealed over 40% rural location or 4 times the national average for physicians and three times the underserved location rate of physicians. Too few medical students entering family medicine resulted in envious program directors in community based programs that were rising to power and challenging the academic department based residency programs. Also despite promises of studies of the accelerated model by family medicine leaders, the studies failed to reveal the superior health access contributions of the model. Accelerated models were a fulfillment of the promise of the discipline of family medicine. Lack of awareness of the outstanding success of the model and failure of the United States to graduate enough family physicians resulted in termination. With 50% of graduates that were 4 years or more older, the additional contributions were also stellar. Instate retention was the highest for this model as well. Failure of states to invest in a model that most retained instate primary care is also a serious indictment. The instate frontier and rural location rates reached over 70% for two of the accelerated models.

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