My previous post has generated a bit of interest among folks smarter and more knowledgeable than I about the health care workforce. I refer you to the post for the full comments. I thought Bob Bowman’s comments were important (and long) enough to warrant a separate post which follows. The one thing I think everyone agrees on is that quality is as important as access and we need to find a delivery system that delivers both:

To understand this situation, one must understand that for near poor, poor, lower income, middle income, rural, underserved, less educated, CHC, lowest health literacy, elderly, oldest of the elderly, and all populations in most need of basic health access that are most complex in evaluation and treatment…(Ferrer, Mold, Rosenblatt, Bowman) Are most likely to see family practice physicians

And are seen in locations with the least health spending, resources, support staff, facilities A few years back the Hartford Currant, the oldest newspaper in the US, singled out doctors from certain medical schools as lower quality using questionable measures. Not surprisingly these were front line doctors serving the most challenging populations that other US docs were less likely to care for.Social determinants shape most outcomes for lower and middle income Americans – decisions by patients, access to care, response to treatment, etc. This is also why pay for performance is a bad idea.Osteopathic information and my own research helped me in this area. In the 1960s the AMA became alarmed about the osteopathic patient care influence much higher than osteopathic numbers. The reason was that over 70% were in family practice or general practice with the longest medical careers (over 35 yrs), the most active, the most volume, and the highest primary care retention (over 90%). This resulted in the most patients seen in the least time. With osteopathic down to 35% FPGP by the 1990s and 18% now, this impact has diminished and the truth is that this was a family practice impact all along

So  there will always be stories, good and bad, myths and truths, about family practice docs. Since there are clearly groups with an agenda to focus on the negative about family practice to make themselves look to be solutions (even with substantially lower and declining primary care retention and lowest volume and fewest years in a career and lowest activity), there will be many more media exposures.

As with so many groups, shouting the most and the loudest seems to be noticed by Americans and information much closer to the truth is ignored, especially when people want to belief something else. In the case of health workforce leaders, believing less than the truth has resulted in this mess in health access and primary care that will last another 30 years, just as it took 30 years to develop – year after year of failed decisions to support primary care, rural populations, and underserved populations and even other lower and middle income populations, which have grown to most Americans left behind.

For the next 30 years a major recovery solution is a primary care source that stays permanently in primary care with top volume, activity, years, and activity. FM is the current best choice although frankly the US needs even better with 37 years in a career (not 34), over 85% active, 110% of the volume of a family physician (not 100%), and 95% primary care retention (not 80 – 85% for FM, 45% for PD grads, and 20 – 40% for IM, PA, and NP.So if you want a more cushy health career, family practice is not your choice.

But if you want to serve where needed and help lead a team that is as dedicated as you are, and will make some mistakes, but will succeed where all others have failed, for many decades,

Family practice stays