A Pittance Can Change Health Care

[imgbelt img=oliver-twist-gruel530.jpg]What’s the cheapest route to health care reform? Staffing “continuity
care homes” in places now medically underserved, writes Dr. Robert


U.S. Rural Physician Workforce: Analysis of Medical School Graduates from 1988-1997

Most MDs, doctors of osteopathy (DOs) and International
Medical Graduates (IMGs) go to work in urban settings. This chart,
prepared by scholars at University of Washington, charts where
physicians who graduated between 1988 and 1997 have gone into

To deliver primary care, graduates must stay in primary care and not depart during training, at graduation, or after graduation.

    •    The 600 family physicians are just 2% of the physicians entering the US workforce. Yet among the class of 2020, this 2% will deliver 10% of the primary care.
    •    This 2% will meet 25% of the primary care needs the United States population that’s now left behind with deficient primary care, due to the current health policy design. This is the 65% of the population with only 23% of physicians.
    •    This 2% of entering physicians will supply 35% of the primary care for underserved populations,  half serving urban underserved and half serving rural underserved populations.


The system is stacked against financing and staffing community health clinics, and 65% of Americans who now lack sufficient health care.
Under this system there would be equitable care for rural populations, for underserved populations — the poor, near poor, and minorities,  as continually documented by studies of family physician. Rural areas would benefit, with family physicians three times more likely to be found in rural locations and increasing to greater levels for the most isolated and underserved settings.

One would think that a good deal for the elderly rural population, and for the nearly 65% of Americans left behind, would be something our country would embrace. It is a good deal for Alaska’s clinics attempting to care for those most left behind, as savings with continuity home family physicians have been substantial compared to locums (substitute physicians) or temporary obligation physicians. About 20 family physicians a year in Alaska save about $10 million a year in locums, recruitment, retention, state, and federal costs over the current situation, as the nation graduates the fewest doctors for rural, underserved, and family medicine careers.

If instituted, continuity health clinics could be one of few economic recovery vehicles that has a chance of serving the 65% of Americans now left behind in health, economic development, jobs, and other benefits. “Please Sir, may I have some more….?”  so we can all do more with less in the future.