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 <<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> If you wish to unsubscribe from the PREMEDINFO-L List, please send an E-mail to:"[log in to unmask]". 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