Health Access Report Card
Robert C. Bowman, M.D.
Forms of primary care can be given grades in the major factors resulting in primary care delivery (or not). The percentage contribution compared to 100% is noted. A 100% rating would be 35 years of a career, 100% active, 100% remaining in primary care, and 100% of the volume of a family physician, the top volume primary care form.
|
|
Primary Care Retention |
Years Compare to 35 |
Active in Practice (not part time or inactive) |
Volume |
|
Rural |
Under-served |
Outside of Concentrations Zip Codes with 65% of the US Pop (70% of Elderly) |
|
FM |
B+/A- |
A |
B |
A+ |
FM |
20% |
15% |
53% |
|
PD |
D- |
A |
B- |
A |
PD |
8% |
8% |
22% |
|
PA |
F |
A to B |
C- |
C- |
PA in FP |
30% |
15% |
55-60% |
|
|
|
|
|
|
PA Not FP |
10% |
7% |
20-40% |
|
NP |
F |
C+ |
D- |
D- |
NP in FP |
20-30% |
10-20% |
50-60% |
|
|
|
|
|
|
Not FP |
10-15% |
8-12% |
20-40% |
|
US IM |
F |
A |
B |
B |
US IM |
8% |
8% |
20% |
|
FIMG IM |
F |
C+ |
D- |
B- |
FIMG IM |
8% |
10% |
25% |
|
All US Doc |
F |
B |
B |
B |
All |
9�10% |
7-8% |
23% |
|
US not PC |
- |
B- |
B |
B- |
US not PC |
3-6% |
2-6% |
10-20% |
Scoring based on national populations and association data
Stable grades are found except in primary care retention where decreases of 2 � 3 percentage points have been the average annual primary care decline for IM, NP, and PA for decades.
To have stable health access, the primary care choice for a foundation must have an A or B in all areas. A lesser grade in each area yields far less primary care delivery, insufficient for health access recovery that will take over 35 years from the point in time when 12,000 primary care graduates are produced that have A or B rating in all areas.
Distribution best for family practice forms at only 40 � 50% found in 4% of the land area in top concentrations, then internal medicine and pediatrics remaining generalist in primary care (fewer and fewer), then general specialties (surgery, ob-gyn, orthopedics, urology), then hospital support (pathology, radiology, anesthesiology), then subspecialties 80 � 92% at the most concentrated in 4% of the land area.
Health Care: Dividing the Nation Basic Health Access: Bringing a Divided Nation Back Together