Primary Medical Care in the United States: Present Status and Future Prospects

1972 ◽  
Vol 2 (2) ◽  
pp. 195-206 ◽  
Author(s):  
R. R. Huntley
Keyword(s):  
United States ◽  
Medical Care ◽  
Minority Group ◽  
Health Maintenance Organization ◽  
The United States ◽  
Future Prospects ◽  
Rural People ◽  
Health Maintenance ◽  
Primary Medical Care ◽  
Primary Physicians

The steady decline in primary physicians in the United States is documented. The increasingly severe maldistribution of physicians is examined in relation to the effect this has on primary care. The effect on the poor, rural people, and minority group people is particularly serious. Four approaches to the solution of this problem are identified and discussed in some detail: an increase in the output of physicians, an increase in the supply and use of ancillary support personnel, reform in the organization of medical care, and the creation of a new specialty of family practice. Special attention is devoted to the likely contribution of the Neighborhood Health Center and Health Maintenance Organization movements to solution of current problems in primary medical care.

Career Plans of New Pediatricians: Results from a Survey of Residency Program Directors

PEDIATRICS ◽  
1991 ◽  
Vol 88 (4) ◽  
pp. 861-866
Author(s):  
Sarah E. Brotherton
Keyword(s):  
United States ◽  
Academic Staff ◽  
Health Maintenance Organization ◽  
Program Directors ◽  
The United States ◽  
Subspecialty Training ◽  
Pediatric Practice ◽  
Health Maintenance ◽  
Pediatric Residency ◽  
Residency Program Directors

Directors of pediatric residency programs in the United States, Puerto Rico, and Canada were surveyed regarding plans of graduating residents to determine whether new pediatricians experienced problems finding employment in light of a decreasing growth rate in the child population. Nearly 90% of directors responded, providing information on 1915 residents. Of the 1782 nonmilitary residents in the United States, 815 were entering general pediatric practice and one third (596) were entering subspecialty training. Nearly one half (379) of residents entering general pediatric practice were joining a small group practice, almost one fourth (184) were joining a larger group, 6% (48) were becoming solo practitioners, 7% (57) were joining a health maintenance organization, and nearly 8% (62) were joining a hospital or academic staff. Most residents in the United States experienced no difficulty finding a position and received multiple offers for jobs. Canadian residents were similar to residents in the United States, whereas the postresidency situations of graduates of military and Puerto Rican programs were very different. Despite manpower predictions to the contrary, comments by program directors indicated a demand for general pediatricians. This paper presents only the viewpoint of program directors; whether this perceived need illustrates an avid market for young general pediatricians merits further study.

A Model to Determine Workforce Needs for Endocrinologists in the United States Until 20201

2003 ◽  
Vol 88 (5) ◽  
pp. 1979-1987 ◽  
Author(s):  
Robert A. Rizza ◽  
Robert A. Vigersky ◽  
Helena W. Rodbard ◽  
Paul W. Ladenson ◽  
William F. Young Jr. ◽  
...  
Keyword(s):  
United States ◽  
Supply And Demand ◽  
Health Maintenance Organization ◽  
The United States ◽  
Endocrine Disorders ◽  
Office Visits ◽  
Health Maintenance ◽  
Age Related ◽  
Wide Range ◽  
Workforce Needs

The objective of this study was to define the workforce needs for the specialty of endocrinology, diabetes, and metabolism in the United States between 1999 and 2020. An interactive model of factors likely to influence the balance between the supply and demand of endocrinologists during the next 20 yr was constructed. The model used data from a wide range of sources and was developed under the guidance of a panel of experts derived from sponsoring organizations of endocrinologists. We determined current and projected numbers and demographics of endocrinologists in the United States workforce and the anticipated balance between supply and demand from 1999 to 2020. There were 3,623 adult endocrinologists in the workforce in 1999, of which 2,389 (66%) were in office-based practice. Their median age was 49 yr. Both total office visits and services performed by endocrinologists (particularly for diabetes) increased substantially during the 1990s. Waiting time for an initial appointment is presently longer for endocrinologists than for other physicians. Compared with a balanced, largely closed-staff health maintenance organization, the current national supply of endocrinologists is estimated to be 12% lower than demand. The number of endocrinologists entering the market has continuously fallen over the previous 5 yr, from 200 in 1995 to 171 in 1999. Even if this downward trend were abruptly stopped, the model predicts that demand will exceed supply from now until 2020. Whereas this gap narrows from 2000 to 2008 due to projected growth of managed care, it widens thereafter due to the aging of both the population and the endocrine workforce. Inclusion of other factors such as projected real income growth and increased prevalence of age-related endocrine disorders (e.g. diabetes and osteoporosis) further accentuates the deficit. If the number of endocrinologists entering the workforce remains at 1999 levels, demand will continue to exceed supply from now through 2020 for adult endocrinologists, and the gap will widen progressively from 2010 onward. The present analysis indicates that the number of endocrinologists entering the workforce will not be sufficient to meet future demand. These data suggest that steps should be taken to stop the ongoing decline in the number of endocrinologists in training and consideration should be given to actions designed to increase the number of endocrinologists in practice in the years ahead.

A Comparison of Ambulatory Care and Selected Procedure Rates in the Health Care Systems of the Province of Manitoba, Canada; Kaiser Permanente Health Maintenance Organization; and the United States

1997 ◽  
Vol 10 (4) ◽  
pp. 26-34 ◽  
Author(s):  
Carolyn A. DeCoster ◽  
Marvin Smoller ◽  
Noralou P. Roos ◽  
Edward Thomas
Keyword(s):  
United States ◽  
Primary Care ◽  
Health Care ◽  
Health Care Systems ◽  
Health Maintenance Organization ◽  
The United States ◽  
Kaiser Permanente ◽  
Financial Barriers ◽  
Health Maintenance ◽  
Care Systems

To determine if there are differences in physician services in different health care systems, we compared ambulatory visit rates and procedure rates for three surgical procedures in the province of Manitoba, Canada; Kaiser Permanente Health Maintenance Organization; and the United States. The KP system, with its single payer and low financial barriers, is not unlike the Canadian system. But, for most of the United States, the primary payment mechanism is fee-for-service, with the patient paying a significant amount, thereby militating against preventive and early primary care. Manitoba and KP data were extracted from computerized administrative records. U.S. data were obtained from publicly available reports, Manitoba provides 1.8 times and KP 1.2 times (1.4 when allied health visits are included) as many primary care physician visits as the United States. For the surgical procedures studied, U.S. rates were higher than those in either the KP HMO or in Manitoba. We conclude that (1) the U.S. system leads to more surgical intervention, and (2) removal of financial barriers leads to higher use of primary care services where more preventive and ameliorative care can occur.

The Special Perils of Being Old and Sick in Prison

2020 ◽  
Vol 32 (5) ◽  
pp. 276-284
Author(s):  
William J. Jefferson
Keyword(s):  
United States ◽  
Health Care ◽  
Medical Care ◽  
Health Care Providers ◽  
The United States ◽  
United States Constitution ◽  
Care Providers ◽  
Medical Practitioners ◽  
Medical Needs ◽  
Access To Medical Care

The United States Supreme Court declared in 1976 that deliberate indifference to the serious medical needs of prisoners constitutes the unnecessary and wanton infliction of pain…proscribed by the Eighth Amendment. It matters not whether the indifference is manifested by prison doctors in their response to the prisoner’s needs or by prison guards intentionally denying or delaying access to medical care or intentionally interfering with treatment once prescribed—adequate prisoner medical care is required by the United States Constitution. My incarceration for four years at the Oakdale Satellite Prison Camp, a chronic health care level camp, gives me the perspective to challenge the generally promoted claim of the Bureau of Federal Prisons that it provides decent medical care by competent and caring medical practitioners to chronically unhealthy elderly prisoners. The same observation, to a slightly lesser extent, could be made with respect to deficiencies in the delivery of health care to prisoners of all ages, as it is all significantly deficient in access, competencies, courtesies and treatments extended by prison health care providers at every level of care, without regard to age. However, the frailer the prisoner, the more dangerous these health care deficiencies are to his health and, therefore, I believe, warrant separate attention. This paper uses first-hand experiences of elderly prisoners to dismantle the tale that prisoner healthcare meets constitutional standards.

scholarly journals Understanding and Promoting Racial Diversity in Healthcare Settings to Address Disparities in Pandemic Crisis Management

2021 ◽  
Vol 12 ◽  
pp. 215013272110183
Author(s):  
Azza Sarfraz ◽  
Zouina Sarfraz ◽  
Alanna Barrios ◽  
Kuchalambal Agadi ◽  
Sindhu Thevuthasan ◽  
...  
Keyword(s):  
United States ◽  
Health Disparities ◽  
Racial Discrimination ◽  
Clinical Training ◽  
Minority Groups ◽  
Mental Health Problems ◽  
Minority Group ◽  
Healthcare Delivery ◽  
The United States ◽  
Majority Group

Background: Health disparities have become apparent since the beginning of the COVID-19 pandemic. When observing racial discrimination in healthcare, self-reported incidences, and perceptions among minority groups in the United States suggest that, the most socioeconomically underrepresented groups will suffer disproportionately in COVID-19 due to synergistic mechanisms. This study reports racially-stratified data regarding the experiences and impacts of different groups availing the healthcare system to identify disparities in outcomes of minority and majority groups in the United States. Methods: Studies were identified utilizing PubMed, Embase, CINAHL Plus, and PsycINFO search engines without date and language restrictions. The following keywords were used: Healthcare, raci*, ethnic*, discriminant, hosti*, harass*, insur*, education, income, psychiat*, COVID-19, incidence, mortality, mechanical ventilation. Statistical analysis was conducted in Review Manager (RevMan V.5.4). Unadjusted Odds Ratios, P-values, and 95% confidence intervals were presented. Results: Discrimination in the United States is evident among racial groups regarding medical care portraying mental risk behaviors as having serious outcomes in the health of minority groups. The perceived health inequity had a low association to the majority group as compared to the minority group (OR = 0.41; 95% CI = 0.22 to 0.78; P = .007), and the association of mental health problems to the Caucasian-American majority group was low (OR = 0.51; 95% CI = 0.45 to 0.58; P < .001). Conclusion: As the pandemic continues into its next stage, efforts should be taken to address the gaps in clinical training and education, and medical practice to avoid the recurring patterns of racial health disparities that become especially prominent in community health emergencies. A standardized tool to assess racial discrimination and inequity will potentially improve pandemic healthcare delivery.

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