Basic Health Access     Robert C. Bowman, M.D.        


The Standard Primary Care Year Primary Care Delivery For the Class of 2012 

New Blog: Basic Health Access

One Million Hearts Focus or 160 Million Lives ImprovedMajor Journals Fail Primary Care Once Again , Does Primary Care Experience Matter? , Comparing Family Practice Sources , Rural Workforce 2000 to 2010 , Countdown to the 2012 Primary Care Armageddon Jan 1, 2012 , Rural Primary Care: Stark Realities , To Follow the Money, Follow the Workforce  , Finance-me-cratic Constants in the Bureaucratic Universe  , Still the Health Access Solution for Most Americans: Family Practice  , Three Dimensions of Non-Primary Care Increase vs Zero Growth in Primary Care  , What can a study from Zip Code 10032 Teach America about Primary Care  , RPAP Is SMART and Has Been for Forty Years  , Meeting Primary Care Needs in the Last Half of the 21st Century (or Not)  , Rural Pipelines Versus Long Term Obligations  , Generic Expansions Are Not SMART and Do Not Work for Primary Care Either  , SMART Primary Care : Family Practice Contributions

Inequality and Medical Education - A Martin Luther King Jr. Tribute

Medical Student Career Choice 2010

Primary Care Workforce 1980 to 2040 - More of the Same Still Fails More

Why Medical Students Should Ask Congress to Vote No Regarding Last Minute Expansions of Residents Until Expansion Does Care for the Health Access Needs of the Nation, and For Them

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

Health Care: Dividing the Nation      Basic Health Access: Bringing a Divided Nation Back Together

Basic Table: Taxonomy, Themes, Theories Related to Experiential Place and the Principles of Health Access Probability of basic health access career and location choices can be demonstrated using logistic regression. Factors such as physician origins, career choices, and training can be compared to most needed health access locations. Exclusive origin, training, and career choice can be separated out and all are linked to exclusive practice locations. More normal in origin, in training, and in career choice is associated with inceasing health access contributions.

Experiential Place and Health Access Considerations The life experiences or experiential place influences of physicians represent a wide variation and different experiential place is associated with different career and location choices by physicians. More than just rural origin to rural location is involved. Physicians born, raised, educated, and trained in top concentrations are least likely to leave such locations and are least likely to choose most needed health access careers.

If You Can Answer These Questions, You Understand What Health Access and Health Access Recovery Are All About

Estimated 2009 Class Year Primary Care, Rural Primary Care, and Underserved Primary care Contributions by Individual Medical Schools with Comparisons to NP and PA 2009 Contributions

Foundation of Basic Health Access Primary Care

Atlas of Basic Health Access  

Featured Graphic    Past and Present Physician and Non-Physician Numbers with Future Estimated Primary Care and Non-Primary Care Graduates    - Thanks to people such as Beale, Ghelfi, Parker, Ricketts, and Hart that have worked lifetimes to translate the nation visually so that it might just learn to translate itself in the most important ways.

Health Access Report Card - Rating of the Five Primary Care Training Forms in Most Needed Primary Care Delivery

About Birth Origins Coding


Health Access Failure in Design: Flexible Primary Care Instead of Permanent


Facts Important in Basic Health Access


The Standard Primary Care Year - A Required Measuring Tool for Reasonable Comparisons of Primary Care Forms 


Documentation of Specialization in Physicians, Nurse Practitioners, Physician Assistants


The Physician Distribution By Concentration Coding System Health Access has a new coding system based on zip code and adjacent zip code concentrations of physicians that are inside of concentrations as well as zip codes with 65% of the population that are outside of concentrations of physicians. 

Theme Confirmation: Lower Probability of Admission Is Associated with Higher Probability of Most Needed Health Access Documentation is provided of the theme. Additional documentation is provided by reviews of those admitted at higher levels by type of school, by type of physician, by race or ethnicity, or by geographic origin.

The Partnership Between A T Still SOMA and NACHC - The School of Osteopathic Medicine Arizona and the National Association of Community Health Centers  Admission for access and training for access

Why Physician Workforce Needs New Tools (and a health access perspective)   The most basic reason is that health access is failing under current methods and perspectives. New perspectives, an understanding that health access has been accomplished, and new methods illustrate health access problems and solutions. 

The Counterproductive and Untrue Perspective of the Impossibility of Health Access  Health advances have required some level of unlearning so that learning and progress can occur. Political and medical leaders must unlearn so that they can focus on the types of health professional students, training choices, and career choices that actually result in health access. Multiple studies have demonstrate the science behind health access and the ability to accomplish health access. The major impediment to health access progress is an attitude of Impossibility of Health Access.

Missing Persons in health access - What Was, What Is, and What Could Be in Visible Graphics

Facts Important in Basic Health Access     

Medical School Type and Career Choice and Most Needed Health Access

What can we discern about future primary care from the 2009 Match and 2009 graduates of NP and PA programs? The answer is steadily declining primary care delivery. Match lists were used to generate future primary care contributions. Allopathic private and top ranking MCAT schools graduate the fewest that remain in primary care and past graduates consistently have the lowest primary care, family practice, rural, and underserved outcomes.

The Health Access Medical School: The Remaining Solution for Health Access

Slide Show Brief Clip - Most Needed Health Access Careers By Birth Origins - Decreased Probability of Admission is Associated with Increased Probability of Most Needed Health Access 

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

Admission Probability and Experiential Place: Admission Ratios and Physician Origins Consistently the physicians most closely associated with concentrations have highest probability of admission and lowest probability of being found in most needed health access careers and locations. Movements toward more exclusive in origins represent a problem for most of the US population in basic health access needs.

Real Diversity Extremes in Physician Workforce - Diverse admissions are often considered "different" but are actually more normal in origins, career choice, and in distribution where most needed. Extremely different children of the most concentrated origins are extremely exclusive and make exclusive career and location choices. Only a small fraction of the American population is as extreme as the physicians that enter the US workforce. And the nation's physicians are getting even more exclusive/diverse/different in origins.

Most needed health access seems to have many approaches but few solutions. Some have common sense. Some have data. Others have tools. Still others have persistence. Foresight is required (decades in advance) as is the proper perspective. All are required for Basic Health Access and for inclusion in this site. Common sense is more normal, not most exclusive in thought patterns. Data illustrating health access is about more normal careers and populations, not just the most exclusive. The tools illustrating health access are more normal, not more exclusive. Health access requires decades of persistence by leaders, coordinators, facilitators, nations, and states as well as the facilities, health care team members, and primary care practitioners that deliver basic health access. Mostly basic health access requires the American people to demand that all in the United States have basic access to health. The thought of most of the US population left out in the health care design should be repugnant to all Americans.

To be able to address Health Access Recovery, many if not most of the concepts illustrated at this site must be understood. Currently few of these even appear in the literature, much less are discussed or processed through to viable solutions.

There are no sad children's faces to use for poster children for those without access to health. When people die tragically of some rare disease, one of hundreds of forms of cancer, one of any of millions of genetic defects with dozens identified each year, there is no end to the consumption of health care away from basic access to health. There are Cattleman's fund raisers for cancer research, but none for health access for Cattlemen. Loved ones die and leave millions to associations devoted to addressing a wide range of diseases, but few donate to support basic health access. Meanwhile governments appear powerless while associations are Ducking the Responsibility of Basic Health Access.

Basic nursing and basic family practice are not flashy careers and often receive the least respect (except from the patients who matter most of all, which others delivering "health care" tend to forget), receive the lowest salaries, and receive the lowest support. However basic health access workforce is the essential foundation of real health care. After basic sanitation, after basic nutrition and nurturing and child development, basic health access is the most efficient and effective vehicle to reduce morbidity, mortality, and chaos. It is a solid design that works during routine time periods, during economic disasters, for all populations, for all ages, and during pandemics, disasters, and other health care nightmares. The current design fails in routine times, fails worse in economic downturns, and actually results in even worse outcomes during surge capacity events. As the United States concentrates more people together in more vulnerable locations, as the United States concentrates more and more health care resources into fewer zip codes concentrated together (often in vulnerable flood prone, earthquake prone, and transportation locked locations), American health care fails the most when Americans need health care most and can least afford to wait. 

Current distortions have progressed beyond belief. One faction wants to reduce access to health to computerized algorithms. Another faction wants to promote a continuity home as a place forgetting that basic health care is delivered person to person not place to person. How can their be continuity care without continuity in those staying in primary care for a lifetime and working with people for a lifetime, patients and health care team members, to optimize health.

People that know and trust those who care for them are in the best position when the worst is thrown at them. Care is delivered best when colleagues, team members, and those who lead health care implement health care for specific patients meeting their specific needs.

Basic health access is so poorly understood that it is not even missed, until stressed to the breaking point. In fact, when basic health access goes, many have difficulty identifying the lack of basic access to health as the real problem. As with any system breakdown, the problems are multiple and widespread, and diminish only when nations engage in a problem solving involving the most critical basic relationships - in this case the re-establishment of a basic relationships that return basic access to health.

Health access is not difficult to understand and can easily be addressed, but as with any most worthwhile commodity the effort takes decades to accomplish. As with the painful development of medicine into a science focus, there are superstitions, assumptions, and misperceptions to overcome. This is also the same with health access. What is required is to unlearn the cheap fixes, the distortions, the assumptions, or even the methods that once worked but have not worked in recent decades.

It is not hard to understand basic access to health. There is science, logic, reason, common sense, and practicality in basic health access not found to the same level in much of health care. When groups of people understand and implement the principles of health access patiently and as a top priority, basic health access is the result. When people ignore basic health access and tolerate a design that results in basic health access compromised by the infinite growth of "doing everything possible to prevent a death that is inevitable" then basic health access is compromised for more and more Americans.

When more and more funds are invested in health care, more and more Americans are deprived of the most important thing of all - the opportunity to rise above their "social programming" to be much more - in life, in career, in health, in communities, and as a nation.

Health Care: Dividing the Nation      Basic Health Access: Bringing a Divided Nation Back Together

Other Sites

Basic Health Access Denied for 56 million Americans - Graham Center and NACHC Study

A Model for Primary Care - 1992 Recommendation - Road Not Taken