Distributional Analysis Policy Center (DAPC)

A few workforce researchers are gathering into a Distributional Analysis Policy Center or DAPC, for information, contact [email protected]  Recent contacts include the province of Alberta regarding recruitment and retention support, assistance given to the state of Iowa in workforce planning, collaborative works with other researchers at the Rural WONCA meetings in Seattle in 2006, Accelerated Family Medicine Programs in Osteopathic Schools, recruitment efforts in the state of Nebraska, and continued advice regarding the early path to admissions involving education, college health advisors, medical students, and admissions committees.

The Physician Workforce Studies web page is the main collection for new works. Searching on Google for Physician Workforce will turn up this site as a top choice. About the Site and Author 

Head to Head: Physician Assistants in 2000 Compared to Family Physicians in State and National Location

Legislative and Health Policy

Distributional Choices and Health Policy

Rural Recruitment and Retention Factoids

Distributional Research Series

Distribution: Index Concentrations of Physician Distribution - compare and contrast the various types that distribute to rural underserved and urban underserved locations. How do international medical graduate internal medicine physicians compare to family physicians? What does birth origin have to do with practice location?

Primary Care Years: New Measures of Total Workforce Contribution

Head to Head: Physician Assistants in 2000 Compared to Family Physicians in State and National Locations studies

Five Periods of Health Policy and Physician Career Choice - health policy has been the primary influence upon career choice and upon physician distribution. Career choice decisions are tracked by class year for the past 40 years. The nation can distribute physicians but is making other choices.

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Distribution involves

• Students with origins outside of major medical centers
• Collaborative efforts of partnerships with those preparing such students
• Admissions of students with outside origins including usual age and older age students
• Training that emphasizes primary care, people skills, care in multiple dimensions beyond just technology or major medical center health care
• Minimizing losses of primary care and distribution throughout all levels
• Health policy that assures lower, middle income, rural, inner city, and other populations outside of major medical centers of the support needed to deliver quality health care. Enough to encourage students to choose primary care careers to help retain them in primary care careers and in rural and underserved areas.

This is no easy task since the nation has changes in admissions,  changes in training,  and changes in health policy that concentrate physicians within major medical centers.

Distribution also cannot compromise on quality by sending the most inexperienced practitioners to the most complex populations with the lowest levels of understanding possible. In many ways rural and underserved clinics and hospitals are smaller and can teach the nation about quality, distribution, efficiency, and effectiveness.

The nation's leaders would have the public believe that medical education is unable to distribute physicians (Cohen - Why Doctor's Don't Go Where They Are Needed). A less vocal group in the United States has pleaded for a better distributional effort (Butler - Academic Medicine's Season of Accountability and Social Responsibility) It is revealing that the last rural conference for the AAMC was in 1990 (Rural America: A Challenge for Medical Education, AAMC Conference 1990 in San Antonio)

The evidence does not support the assertion that physicians will not go to rural or to underserved areas. When the nation admits the physicians suggested by the same medical experts (Cohen Encourages Admissions to Look Beyond MCAT), the nation distributes physicians (Distributional Medical Schools). Successful efforts to distribute physicians include programs, admissions tracks, medical schools, entire states, and entire nations, including the United States in recent years. The principles involved in distribution are clear and the programs that have adopted these principles have consistently distributed, however convincing others to replicate models, fund models, or adapt accreditation is difficult. Some of the best models have been hybrids, caught between various accrediting bodies and eventually terminated, even with some of the best distribution outcomes in the nation. (Accelerated Family Medicine Training Programs).

The major area of need for distribution involves better support for primary care outside of major medical centers. This support is critical to supporting the decisions of those who distribute (family physicians) and keeping current primary care providers retained within primary care (Primary Care Retention). Currently the nation loses thousands each year away from distribution and back to major medical centers for additional training or jobs in emergency rooms, hospital positions, surgery, teaching, and support positions. Current health policy will not retain primary care and will not increase primary care to keep up with population growth and growth of uninsured, underinsured, and underserved populations.

With fixed budget categories, the only way to increase primary care support outside of major medical centers is to shift funds from  inside of major medical centers to outside of major medical centers. Critical Access Hospital funding managed to accomplish this and restored rural hospitals and gave them a future with a small percentage of funding. Much the same is needed for those outside of major medical centers with only a few percent of funds, a few percent of primary care providers, and efforts to graduate a few % more family physicians.

Successful Distribution - Only a few examples

Duluth Plus RPAP, Rural Health Opportunities Program, Jefferson Physician Shortage Area Program by Rabinowitz,
Best Models Admissions or Complete Rural School

Distributional Medical Schools

Distributional Medical Schools: The Lost Lesson of Specific Forms of Government Support: Osteopathic Public Schools

Statewide Distributional Efforts

Managed Care Comparison and Managed Care Comparison Table

Physician Workforce Studies

www.ruralmedicaleducation.org