Principles of Health Access

Robert C. Bowman, M.D.

Health Access in the United States is the result of the following:

         Health professional origins arising from populations in the 65% of Americans left behind as compared to most exclusive origins

         Older age admitted students that enter training with more life and health experience rather than directly from college

         Admissions with an exclusive focus on superior service orientation and people skills as compared to current admission with exclusive biomedical focus dominating admission

         Graduation of broad generalists as compared to most exclusive specialists

         Health access focus in training in locations delivering most needed health access with training by health access clinicians rather than training in the most exclusive locations with the most exclusive physicians, and top concentrations of health resources

         Sufficient policy support for basic health access primary care with funding design such that other types of health care cannot grow and eclipse basic health access funding

         Sufficient policy support for lower and middle income populations left behind in financial access to health care that are most dependent upon sufficient primary care

Failure of Health Access is the result of

         Most exclusive origin medical students that dominate admission and increasingly replace students from the 65% of the population left behind

         Admission rankings for interviews and admission based on most exclusive scores, most exclusive biomedical focus, and most exclusive colleges insuring lowest health access probability

         Emphasis on the most exclusive careers that increase and replace more general and generalist careers

         Younger graduates or graduates straight from college with the least life and health experience and maturity prior to training

         Narrowing biomedical focus to increase board scores also a means to facilitate exclusive career choice

         Most exclusive training in environments emphasizing top concentrations of physicians, specialists, hospitals, and health resources

         International medical graduates (US origin or foreign origin) entering US graduate medical education that have the most exclusive origins, the lowest probability of needed health access delivery, serve the fewest years of workforce, and have the highest probability of being found in top concentrations of physicians, people, income, and health resources

         And the sources of health access primary care that are promoted (foreign origin international medical graduates, nurse practitioners, physician assistants, internal medicine) deliver the least primary care and health access

         Top support, salaries, and benefits for hospital and specialty physicians and non-physicians

         Concentration of 90% of the funding related to physicians in 4% of the land area in 3400 zip codes with top concentrations of health care

         Grant funded health access programs that can also be accessed by those in top concentrations who also have top concentrations of social and political organization.

         Grant funded programs that distract states and nations from infrastructure investments in facilities, health care team members, and practitioners

         A health care design that moves populations down the scale from affordable to unaffordable health access, and from some health access to no access

         A health care design that funnels patients into large systems for optimal revenue generation regardless of local health access needs, culture or language considerations, local economic and young professional leadership needs, out of  pocket costs, and greater distances travelled to access health care

         Leadership that has been born, raised, and trained in top concentrations such that current and future leaders are no longer aware of the health care needs of lower and middle income populations left behind

         Leadership with failed awareness that can no longer design medical education or health care systems that address lower and middle income, rural, and other populations left behind


Optimal Health Access

         Begins with earliest age improvements in lower and middle income American children

         Continues with birth to admission focus on more normal and less exclusive medical students given opportunity at the earliest ages, prepared for higher education and health careers, and admitted to medical school

         Admission based on sufficient academic and biomedical abilities with final selection based on people skills characteristics most critical for physicians

         Preparation, admission, training, and career choice emphasis on the broad generalist  family practice mode

         Graduates with at least some years of life and health experience prior to admission that have overcome at least some obstacles to gain admission

         Training in health access settings with experienced health access practitioners as faculty with all participating as health care team members delivering health access workforce where most needed during training and afterward

         Sufficient support, support personnel, facilities, salaries, and benefits for generalist primary care careers

         Steady redistributions of health care funding related to physicians away from existing concentrations of physicians and health resources and toward populations in need of health access, from 90% of funding concentrated in 4% of the land area in 3400 zip codes to steadily lower concentrations with greater distributions to zip codes outside of concentrations with 65% of Americans and 70% of the age 65 and older population

         Separate funding of health access training that will train broad generalists and sufficient broad generalists for an entire nation that will stay in health access an entire career and will distribute to all populations in need of health access

         Separate support for health access facilities, health care team members, and practitioners that forms a foundation for the US health care system

         Local control of health access, not abuse of health access for profit or for funneling patients to specialty focused systems

         Minimal use of grant funded programs and maximal use of infrastructure funding mechanisms that sufficiently support health access facilities, health care team members, and practitioners

         Locally determined health care rather than a health care design that funnels patients into large systems for optimal revenue generation

         Movement away from exclusive students, exclusive parents, and exclusive schools that result in exclusive national leaders to greater awareness, greater interaction, and greater immersion experiences with lower and middle income populations and those serving lower and middle income populations such that those destined to become leaders can address the challenges of delivering the wide range of needed health services across the wide range of different populations for current and future generations

Steps to Health Access

Basic Health Access Concepts To Review

The Basic Table - Taxonomy, Themes, and Theories Related to Experiential Place and the Principles of Health Access


Experiential Place and Health Access Considerations


The Counterproductive and Untrue Perspective of the Impossibility of Health Access

   Nebraska: A Practical Application of Experiential Place and Workforce

A Health Access Medical School for the United States