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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

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