Thought this would be of interest to all premed students, particularly those
interested in primary care careers. Rec'd this from a colleague.
1987 - 1998 class years, 2005 Masterfile database
Ranked for Three Different Areas Important in Health Access
1. Primary Care production in Standard Primary Care Years per medical school
graduate
2. % of physicians found in marginal and underserved areas outside of
concentrations (zip code less than 75 physicians),
locations with 65% of the US population but 23% of physicians
these are locations with 70% or more of the elderly population for those
of us aging
3. % found in the most underserved locations (over 19% poverty or
designation)
Each Factor Ranked 1 - 139 from best to worst, 3 rankings totaled, lowest
score or most top rankings is best
Measure of the top health access school
Top 25
1 Mercer
2 WV Coll Osteopathic
3 Kirksville Osteopathic
4 Morehouse
5 KC Osteopathic in MO
6 U N Tx St Osteopathic
7 Western U Coll Osteopathic
8 U MN Duluth
9 Ok St U Osteopathic
10 Oral Roberts
11 Des Moines U Osteopathic
12 Marshall
13 Nova Southeast Osteopathic
14 Southern Illinois
15 U of New England Osteopathic
16 Arkansas
17 South Alabama
18 U of South Dakota
19 East Carolina
20 U of North Dakota
21 East TN St
22 Wright State
23 Meharry
24 U of NM
25 Michigan St Allopathic
Osteopathic schools, newer schools created for primary care and family
practice (Lost Lesson of Government Support in the 1970s expansion), schools
with missions for the underserved, schools in states with higher poverty
These rankings resemble family practice rankings because
Family practice is the major contributor to primary care as family
physicians contribute an average of 29 years compared to 5 for internal
medicine and 17 for pediatric residents
Family physicians distribute and stay with 53% in marginal and underserved
locations compared to 70 - 92% of other specialties.
Family physicians are 2 - 3 times more likely to be found in the most
underserved locations.
The lineup will be changing, primarily because of changes in choice of
family medicine. Mercer dropped from 30% family medicine to 8%, WVSOM
tripled in size with changes in admission and training, Oral Roberts is
gone, Duluth will move up since it still manages 46% into family practice .
How much change will depend upon how much the above medical schools resemble
those with the least health access contributions in future years. Given
moves to higher income, most urban, children of concentration in the past
decade, it will be harder to pry physicians loose from 30 years of
concentrations in birth to admission, admission, training, and the current
policy environment
Bottom 10 - and likely to remain with unchanged admission, training, and US
policy (admissions of those least likely to distribute or do primary care,
training least likely, policy least likely in past 40 years)
U of Pennsylvania
Georgetown
Johns Hopkins
Cornell
Chicago Pritzker
Vanderbilt
Harvard
Columbia
New York U
Yale
Top primary care schools - 14 - 16 primary care years per medical
school graduate
Bottom primary care schools - 1 - 2 primary care years per medical
school graduate
Current US production from all 5 sources - 225,000 standard primary care
years from all 2008 graduates, estimated
Production at peak policy 1998 class year - 325,000 standard primary care
years from all 1998 graduates, estimated
Estimate of needed annual production at least 300,000 to 320,000 currently
(not including current deficit) and rising rapidly with elderly, rapid
growth of complex populations
US deficit in primary care from current production to need - an additional
deficit of 70,000 standard primary care years is added each year due to
insufficient production to keep up
Under current expansion (30%, doubling of osteopathic, PA to 10,000 per
year)and low primary care levels with lower expected, the US will return to
1998 primary care production levels by the year 2040.
The 70,000 primary care years needed to produce each year would take
PC Yrs Graduates needed
FP 29.3 2389 The US did manage 4000 grads a year so it
could manage this addition to the current 2500, and more who are commonly
turned away
IM 5.3 13208 nope
PD 17.6 3977 nope
PA 6 11667 possible, but still specializing more, will
take 6 PA for one FP soon
NP 3 23333 nope
Bob Bowman
[log in to unmask]
So
Why do we have access problems? Because primary care does not remain
primary care and also because saturations of primary care in some areas
(concentrations) leave other areas behind
What is the solution? More primary care that remains primary care and
that distributes at the highest levels to the 65% left behind and outside of
current saturations of primary care. Physicians selected and trained in
medical schools with 15 years of instate family practice obligation in
exchange for medical school costs - not underserved, just primary care
outside of concentrations - 100% primary care, 100% outside of
concentrations, increases to rural and underserved areas above the 8%
national and 15% family practice average, actually more like 32 years of
primary care per graduate, especially with reasonable salary guarantees
Why must this happen before universal access or better health care coverage?
Because primary care deficits are so bad that pent up demand (60 million
Americans) and new access (47 million Americans) and better costs (untold
millions) would overwhelm primary care. Then those who did not want reform
would say - I told you so (like a decade ago), and another chance for a real
health access foundation would be lost. By the way, increased access would
greatly raise health care costs before they would come down for the same
reasons, as in 1965 - 1978 and in the early years of managed care.
Why should we fund 500 more family physician graduates each year for a
decade?
only efficient and effective way to address the primary care and access
deficit
cost of about $2 per citizen for a state like California to meet its
primary care production deficit
all states must participate, including the states that do not contribute
their fair share
15 years obligation for instate family practice - primary care that
stays primary care and stays in the state
Does this mean that family physicians are better at primary care? Nope,
only the most likely to stay, unless someone starts paying them more to
specialize and concentrate as in the other forms
What else might work? 15 year obligations for physician assistants to
work with family physicians, but this might be tough to get takers
FP PAs have 30% rural location, 50% inside and outside of concentrations,
100% primary care - but are leaving FP, PC, and rural at 1 - 2 percentage
points each year for over a decade, according to PA data.
Why won't nurse practitioners solve the problem? Falling graduate numbers,
worsening nurse shortages that can also impact primary care nursing and
health access, 8 years fewer in their career due to late entry, only 62%
active, most are specialists now, lowest primary care volume (50% of FP),
movements to concentrations with each class year 6% are in cardiology
already - AANP
Why won't internal medicine work? less than 20% in primary care at
residency graduation and departures each year after, increasing departures
due to hospitalist movement
Why won't internal medicine international medical graduates work?
Delays in entry of 8 years, only 58% active in US after graduation (over 20%
depart, 8% unemployed), only 20% remain in primary care, lower primary care
volume, movements to specialize with each year after graduation
Why don't studies demonstrate this?
studies are not national in scale
studies involve the best models, but few of these exist
studies show early results, not long term retention
primary care studies fail to include the primary care graduates that are
missing, no longer active, not licensed, or no longer practice as NP, PA, or
primary care
studies do not compensate for years in a career, activity in practice,
primary care volume, specialization rates
because those who are inside of concentrations fail to understand the
needs of health access and those outside of concentrations
because workforce studies are very poorly supported, especially in
health access
because those in health access schools are busy doing health access
while research comes from schools not doing health access
journal space is very limited in the top journals
some of the best workforce articles are not polished, must as the
medical students most likely to distribute are not polished
email if you would like your ranking or to know a ranking
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