TRAINING INTERVENTIONS DO NOT WORK TO RESOLVE DEFICITS OF GENERALISTS AND GENERAL SPECIALISTS FOR HALF OF THE US POPULATION

Another article seems to demonstrate better distribution to underserved areas with the Teaching Community Health Center Intervention. Please stop this nonsense. Learn what it took me 20 years of rural pipeline efforts - THEY DO NOT WORK.

Look at the evidence in the financial design

Do our designers value primary care any more - NO

Did our designers increasing primary care spending to support more workforce and delivery team members - NO

Does it help to expand the worst quality health insurance plans that often pay less than cost of delivery? _ NO This is especially true for Community Health Centers since Medicaid pays less than cost of delivery and is the majority of their patients.

• Take home point - There is nothing that the Health Resource and Service Administration (HRSA) can do that CMS (Medicare and Medicaid) has not already defeated. This includes training grants and CHCs and NHSC and loan repayments.

Look at the Evidence in Workforce Innovations and Interventions

1. More types of graduates have failed as in FM PA and NP
2. Massive expansions of NP and PA and DO and MD have not resolved half enough generalists and general specialists where half of the US population has half enough of each.
3. Special training and pipelines do not work

Learn About Maximal Primary Care Capacity Set in Concrete by 250 Billion for Primary Care

• Primary care is filled to the capacity allowed by 250 billion - minus the increasing costs of inflation, technology, and micromanagement. Stagnant revenue makes this worse.
• Increasing costs of delivery makes this worse.
• New added costs of delivery make this worse from innovation, regulation, certification, micromanagement, value based, performance based, medical homes, digitalization, HITECH, new technology, maintenance, security, updates
• The financial design shapes more volume via primary care as an escape, making it worse.
• The financial design shapes fewer and lesser delivery team members which is a move in the absolute opposite direction needed for higher functioning primary care, patient centered primary care, integration, outreach, and better outcomes.

Learn that ALL Training Interventions Will Fail

The Teaching CHC program looks good. My studies of rural focused FM residencies also looked good. The results of the Accelerated Family Medicine Program were better - the one the American Board of Family Medicine terminated (now they promote Teaching CHC?)

Optimal instate instate primary care where needed result was also achieved by family medicine residents who attended medical school and residency in the same location - regardless of accelerated or not.

These results indicate a substantial self selection as origins, medical school, residency, and family medicine residency all line up for optimal instate, primary care, where needed.

It is important to remember that only the family practice positions filled by NP PA DO and MD graduates have 36% distribution to the 40% of the nation most behind in workforce in 2621 counties. These counties have always had half enough primary care or less. Only 1965 to 1978 did they receive more funding for primary care and since the 1980s all policies by CMS and payers have made this worse. https://www.dhirubhai.net/pulse/why-most-americans-must-organize-sue-cms-centers-medicare-bowman/

Pipelines do not work either.

Nebraska and Kansas both achieved outstanding highest proportions of instate county of need practice locations. The indicator was family medicine choice - a successful pipeline outcome. Both had over 10 times greater practice location rates such as location in 70 Nebraska counties with at half enough primary care or less. But examination over a 20 year period (and likely before and after) indicated no change in the concentrations of primary care.

Health Insurance Plan Quality Defeats All Workforce Interventions

Indeed there can be no increase in primary care where concentrations of elderly, poor, lower income, disabled, Veterans, and worst employers are found - because of their worst quality health insurance plans. How can you have patient centered or higher functioning primary care when most Americans have half enough?

Now you know that academics are doing what is best for academics - and not best for most Americans (more tuition dollars, more slave labor, more subspecialists...).

Now you know that no health care reform can help most Americans or basic health access until the designers value these - which they have not done for 40 years of designs. https://www.dhirubhai.net/pulse/brief-summary-discriminations-against-most-americans-behind-bowman/

Now you know that big health, academic health, and big associations are the reason for deficits of workforce and access for most Americans. They vehemently oppose revisions of the designs that are best for them with multiple lines of revenue and the top payments in each line. They will oppose any shift of their good fortune to help most Americans most behind or basic health access. https://www.dhirubhai.net/pulse/why-most-americans-should-trust-health-care-leaders-robert-bowman/

American health care leaders are not mindful, selfless, or compassionate - so they will fail US. https://www.dhirubhai.net/pulse/mindful-selfless-compassionate-health-care-leaders-missing-bowman/

What is best for academics is not what is best for most Americans https://www.dhirubhai.net/pulse/whats-best-academics-most-americans-robert-bowman/

I was there at Teaching CHC organizational meetings and I noted that the model would be nice, but ineffective.

Each of the 62 Teaching CHC sites was coded by county and by state location and by training specialty.

• Top Rated - 11 sites were top rated due to the triple combination of FM training, training in a state in greatest need, and training in a county lower to lowest in clinician concentrations.
• Higher Rated - 7 sites were higher rated with 2 out of 3 of a mix of FM training, county need, and state location need.
• Marginal - 29 sites were marginal with the main factor being FM training as the county and state locations did not reflect greater need.
• Lowest Rated - 18 sites were lowest rated as they were missing all 3. The sites were without FM training, without training in a state in greater need, and without training in a county of greatest need.

What works for basic health access for most Americans is not what we are doing now or past or future. https://www.dhirubhai.net/pulse/what-works-move-most-americans-basic-health-access-we-robert-bowman/

There is nothing that training interventions can do to address basic health access for most Americans most Behind with half enough primary care and mental health and women's health and basic surgical workforce - Because of the Financial Design for each, period, end of story.