True Recovery in the United States - The Plan is not as important as the result. When the United States improves family structure, nurturing, child development, and the first years of education for lower and middle income children, recovery has truly begun.

Lower and middle income children become the human infrastructure of the nation. When lower and middle income children deteriorate, the United States deteriorates. When US lower and middle income children improve only a tiny bit each year or each decade or each generation, the United States is a more secure, more productive, more competitive, more efficient, and more effective nation.

How Do You Measure True Recovery in the United States - steady, consistent, year to year, decade to decade...

Top Sites for Data and Info regarding relationships between education and health, societal efficiency, outcomes, distributions [email protected]

Review at Hart and Risley, Meaningful Differences in the Everyday Lives of American Children detailed studies of 42 families linked to education and child development literature. After age 8, interventions are far more costly and less effective. This study links together many of the findings of the major works in child development interventions.

Poverty Crawls Higher Up the Ladder from lower to lower middle.....Working parents with high school degrees in the Midwest have children with rates of poverty that will make this one of the most disadvantaged populations. In this report on The New Poor using census data, the nation is adding new populations of disadvantage instead of removing some (and this was 2000 data long before the declines, maldistributions of economics, and recession).

The Funding Gap 2004 Carey - state and local financing of education - lower and middle property value school districts, lower income states, and states with inequitable distributions defeat education. Also brain drains make matters even worse. Physicians follow concentrations and take state investments with them as they concentrated in a few zip codes in other states.

Jay Greene, High School Graduation Rates in the United States - not a pretty picture - be wary of education data to be sure that all children are counted, not just seniors completing high school, not just 9th graders completing high school, but studies of all children that should have completed high school and did not from birth to age 20. School districts (Austin TX) have been deceptive in this shell game. Get real data. In cities such as Cleveland and Cincinnati birth to high school situations are so bad that few graduate. Los Angeles HS graduation rates hover at 50%. This county has the wealth and economic power that should allow it to supply itself, other counties in the state, and other states with teachers, nurses, public servants, and other serving occupations. Instead Los Angeles must take what it needs from all other states and nations.

ETS Study Warns of Growing Inequality in Income, Skills by Lynn Olson Education Week, February 7, 2007 Irwin S. Kirsch, Senior Research for the Educational Testing Service (ACT folks), is quoted "We can either sit back... or we can choose to make investments in policies that would try to return us to a period of more shared prosperity." "I'm not naive enough to think that schools are the only thing that need to improve, but given all the changes that are on the horizon in terms of the economy, I don't see how people are going to have a real opportunity unless we find ways of improving the overall skill levels of the population and narrowing the gaps." America's Perfect Storm by ETS These words are not the words of a prophet. They are the words of educators immersed in data and translating the situation for all to see. And the situation has become worse in the past few years with state budget cuts and with health care forcing even greater cuts in personnel for schools, child development, and other front line serving infrastructure.

ETS studies based on the ACT indicate that only 5 - 8% of Native American and African American children do well enough to have a 50% probability of making an A or B on their first science or math course in college. Without that A or B, they will be advised to consider another care not in medicine.

Gatekeeper effects in high school counselors work to funnel lower and middle income children (that tend to have more normal scores) away from college or higher ranking colleges. In the college gatekeeper effect, once again lower and middle income children are turned away with slighly lower scores and grades as they adjust to the rigors of college. This is one reason why so many lower and middle income, rural origin, and minority graduates enter medical school late. It takes them more years to get prepared and to overcome bad advice, missing advice, or the lack of a college educated or professional parent to guide the way.

College advisors also can have a vested interest in suppressing applications from student that they think might not get admitted. There are admission ratios that are tracked. These ratios are used to attract children of most educated parents. When admission to medical school or law school is lower, this can mean problems for a school. Admission ratios are often deceptive and inaccurate, but the entire prestige ranking process erects barriers for the lower and middle income children that are most likely to serve the populations in most need.

In recent years, funding has been increased for higher status children to lure them to college with lower and middle income children facing limitations in grants and funding. Some relief in Pell grants did result, but there are still barriers that are not equitable.

One Fifth of America's Children in Poverty are in Rural Areas - with some of the greatest barriers America in decades past did not tolerate such poverty. The character of America is being tested. This also translates to higher education and medical education and health access. Lower and middle income males are being impacted the most, and can cause the most difficulties for America, but can also provide the needed services. What happens to lower and middle income males determines the course of the nation. African American males are admitted at half of the rate of females, as are rural males compared to rural females. Basically all populations that are predominantly lower and middle income are impacted with males impacted more. For Hispanic popuations, the opportunities are so low that males and females have great barriers and lowest probability of admission.

Carnevale and Rose in Kahlenberg, Left Behind, New Century Foundation, page 9 74% of top income quartile students attend the top 146 colleges compared to 3% for lowest income quartile. The top 146 colleges more and more are an important step to medical school admission. Fewer colleges supplying US medical school graduates and fewer lower and middle income children gaining admission are a problem for most needed health access careers. Already 50% of the physicians entering the physician workforce in the United States arise from families not in American before 1980. Lower and middle income Americans in the United States for generations are nosed out by the most urban, highest income, children of professionals and physicians from US origins, foreign origins, and those only in the United states one or two generations. All points to neglect in US education for the past 30 years. If not for the 1960s and 1970s reaction to Sputnik, matters would have been much worse.

The massive quadrupling of primary care from 1970 to 1980 was a perfect storm with more children prepared for college, more education degrees than ever before, health policy optimal for primary care, a doubling of medical school annual graudates at just the right time, family medicine increasing to record levels, and primary care remaining in primary care at top levels. The birth to admission process made it possible to expand physicians in ways that helped lower and middle income Americans most. The nation has deserted such a response for 30 years in education and in health.

National Center for Children in Poverty - midwest children poverty up 29% (43% of the increase in child poverty in the nation), greatest rise in families without college education http://www.nccp.org/media/npr06_text.pdf

The battle for better physicians involves admissions of a much wider variety of students, particularly lower income students from both rural and urban areas. US medical schools are admitting more and more students who are less and less likely to serve or understand those with the most challenging situations. Changes must begin in education and move throughout all levels to medical school and medical practice.

Physician Distribution means Health Policy, Education Policy, Admissions Policy, all focusing on Breadth, not Depth!

Next Generations Result

Better Education

Physicians who are Accessible, Health Care That Is Affordable and High Quality

Less Need for Health Care, Savings in Other Costly Societal Components, Improved Economics, Services, etc. in Underserved Areas

Cutting back on education always costs more in future years - health, legal, prison, social, insurance, security, etc.
Medical schools must meet national needs and priorities first, in education and in health care
Who gets in, compare US medical school admissions. Rural, older, and instate students tend to have lower status and are also admitted in lower numbers

Rural Medical Education

Rural Workforce and Health Policy in the United States

Models of Rural Medical Education

The World of Rural Medical Education

The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little." Franklin Delano Roosevelt - from John Gazewood MD

Physician Workforce Studies

Propositions - a variety of amendments have been proposed to limit government. Limiting government care prevent government from acting when it is most needed.

Step 1. Education: the top priority

Health care must not erode educational investment by states

Education equity, reform of property tax-based education that penalizes those from underserved areas where there is less to tax and more challenges and costs

Comprehensive efforts in inner city, and rural education Strong community colleges,

Breadth => depth of Education, More than just gifted

Step 2. Pre-K Elementary

Continue and expand quality continuity health care for all children

Early reading by parents, access to Pre-K school, emphasis on reading by parent and school,

Science and math teachers

Health care orientation

Step 4. College

Stellar College Health advisors in all colleges

Greater variety of higher education experiences so that students can have a better fit and better performance

Summer jobs, shadowing, service-oriented on a par with current research and academic experiences, including role models exhibited

Step 6. Admissions Partnerships

Involves increased admissions of students with lower admissions ratios

Partnerships with community colleges, small colleges, sites where students have different education, background

Older students, rural, low income, from underserved populations, job experience that would add value to medical education and medicine

Step 3. Secondary

Career advising including health careers, academic excellence

Special materials and programs for science, math and other teachers and schools, specific for school and student needs

Summer jobs and shadowing

Academic partnerships with underserved, AHEC

Bridging Tracks to Admissions

Step 5. Education Partnership

Replicate existing successful examples widely

Partnerships working with states and schools and teachers to develop materials, assist with experiences

Remove obstacles in minds such as cost, grades, attitudes, lack of role models in underserved areas

Driven by school, student, and community needs

Step 7. Admissions Policies

Evidence-based admissions

Strong desire for students of character, overcomers, systems-oriented

Broad criteria, service orientation, Older, rural, low income, educational background

MCAT Not used as ranking for interview or admit

MCAT and Family Medicine

"Not to know is bad. Not to wish to know is worse." African proverb Sometimes we make decisions as a nation that make it less and less likely to be aware.

More and more I have been drawn to K-12 Education as the source of maldistribution of education, health care, health providers, and poverty. My heroes have shifted from the likes of physicians to teachers and teachers assistants in alternative, middle, and elementary schools as well as volunteer mentors who make a tremendous difference in the lives of those most at risk.

A recent review of Nebraska's finest students reviewed what the past decade's grads had done and where they were located. Few were of any consequence to Nebraska or Omaha. However those who are not in the top 1% do a great deal for the state. I am especially proud of those who have graduated from the medical school. The real work in education is not in the gifted, however. They usually take care of themselves.

The key work that can and should be done is in the early years with the at risk kids. The challenge is great - education, parenting, fatherlessness, discrimination, resentment, mental health, legal issues, etc. The rewards include lives not wasted, other lives not damaged by criminal acts or violence or theft, dollars saved in legal, education, and prison costs with future tax savings.

I have come to the conclusion that we have mortgaged our future to the hilt by not paying better attention to those in most need today. RCB 7/2003

Medical school admissions in Nebraska is an interesting discussion point. When considering students born in the state in rural as compared to urban areas for the past 5 classes admitted to UNMC, there is a similar probability for rural as compared to urban students. However in studying national data on those born in Nebraska, the admissions to out of state schools is limited for those from rural areas. This may be the impact of rural origins, lower income, lower scores, etc.

Any school in any location can manage to get a kid who is gifted with speeded intellect into medical school. It takes a state and local partnership administered through quality teachers to get the less "speedy' kids admitted to medical school. These students who have broader focus and different background are the ones that depend upon quality education. This is not an easy task because it appears that the nation is heading toward less experienced teachers in the most challenging urban and rural areas, worsening distribution of funding, lack of accountability (or accountability with no funding), and a complete disregard of the value of education.

Parents of Asian students (US born or schooled), those likely Mormon (born in Utah), foreign born students, and those from upper midwest states seem to value education much more than most in this nation.

Students from the higher income and professional groups are increasing in numbers and percentages admitted to medical school. Students born in the US are decreasing in percentage from every county type from the most rural to the most urban. Short of major improvements in respect for education, this will continue for decades. This should be a wakeup call for US education, but so far we continue to sleep and await a "Sputnik" or a full realization that the global war against terrorism will only be won by a global emphasis on education and health, when young men realize that investing in education is viable, realistic, and necessary.

For those at risk, for those in poverty, and for the young professionals we must have in our nation

Step 1. Education: the top priority

Can disadvantaged children learn? The states with the best investments and the least obstacles to teaching rank highly in their students gaining access to medical school. Several of the highest rated states (by Adjusted School Efficiency) are increasing sources of US medical students, such as Utah, Idaho, North Carolina, Kansas, and Wyoming. States lowest on this scale such as New York (37th), Michigan (45th), New Jersey (46th), Pennsylvania (43rd) and Illinois (36th) have declining admissions of medical students born within these states. There is a .31 correlation between Adjusted School Efficiency in a state (Teachability Readiness Economics Community Health Race Family) and increases in medical students born in the state. States doing better in education are able to get more of the students born there admitted to medical school.

Understanding Higher Education and Income

Step 2. Pre-K Elementary

Step 3. Secondary

Special materials and programs for science, math and other teachers and schools, specific for school and student needs

AIDS Devastation in Africa Impacts Young Professionals - leaving little chance of restoring countries in poverty and lacking in education and health services.