Underserved Links and Literature

I continue to be haunted by the words of America Bracho, MD, MPH at the 1999 STFM Annual Spring Conference. Her life has been about service to underserved communities in Orange County California. During her talk, she challenged academic medical centers to get involved more with the underserved. She noted that neighborhoods facing challenging circumstances often surrounded most of our academic medical centers. She asked why these neighborhoods were not doing better despite decades of geographic contact. - America Bracho, MD, MPH 1999 A very good question! Where is the economic benefit claimed by academic medical centers when defending their budgets at the state level if these benefits do not include those most in need and closest to them?

National Center for Children in Poverty - midwest children poverty up 29% (43% of the increase in child poverty in the nation), greatest rise in families without college education

The US could adopt UK methods that were stolen from the US in previous eras

Child Poverty: Faces Not to Be Seen in Medical School

Organized - who gets what they want and how do we get what people need?

Poorer Health in the Process

Poverty Locations and Physicians

Understanding Higher Education and Income

Medical School Admissions and Social Status

Meeting the Needs of Underserved Rural and Inner City Areas with Accelerated Training

AAMC GQ 1995  Rural Interested Students 60 % interested in choosing underserved areas, but only admitted

Physician Discipline and Caring for the Underserved

Centralization and Regionalization

Poverty in Pakistan

Appeal to State Leaders Regarding Poor

Power, Maldistribution, Leadership, and Primary Care

Minorities, Admissions, and Underserved


Turning to Lawyers for a Cure

Teach For America

Katherine Flores, M.D.

Medicaid Prescription Copay & Restrictions

Medicaid Studies and Links

Education opens, closes doors


Medical Schools, Medical Education, and their role in Leadership & Restoration

Racial Disparities and Links to Study Site and Physician Orgs

Civil Rights, King, Rustin, and more

Heroes in Medicine

Letter that I almost didn't open essay

Richard is Gone Essay

Is Health a Right

Marcus Welby Lives

Teens: the Disappearing American Male

Rural Public Health

Mound Bayou, Delta, Model  in COPC and Health Prof Training for Underserved

Susan La Flesche Picotte - first native female physician, missionary, advocate, servant to all

Kennedy and Crisis - dealing with the underserved is the best foreign policy  in 1961 and today Not For the Faint of Heart - New York City's finest torched, not the first time, terrorists extinguished by restoration
Poorer Health in the Process - 14 patient cases demonstrating that our health system is keeping patients in poverty McLennan County FP Residency: a Model of Cooperation and Better Health

The Continued Centralization of Resources and the Impact on the Location of Young Professionals

Mother Theresa Servant to the Underserved

Assessing Community Orientation

Learning from Appalachia

Barriers To Serving the Underserved

Fixing Maldistribution

Chart over Years: Contribution of Family Medicine to Underserved Practices

Howard University and Underserved

CENSUS in Haiti by Stu Embury

Ivan Illich Challenges Institutions No More

Link To Analysis of a Family Practice program's impact on costs and public health by Tim Henderson

Challenges to Primary Care: Serving the Underserved

AAMC Site Programs for Uninsured http://www.aamc.org/uninsured/start.htm

Where physicians dare - Pathman American Family Physician  

Physicians Helping the Underserved, The Reach Out Program in JAMA, physician-initiated 

AAFP Special Resource Page for Underserved http://www.aafp.org/special/resource/

New Schools For the Underserved From Existing Models

AFMO Document on FP community contribution at http://www.uams.edu/afpa/vol16_4.pdf

Improving Rural Health at the Federal, State, Local level


Federal State Local folder

Avoiding Compromise in Primary Care

Hope the following is helpful regarding recent discussions on indigent care

LCME, the Underserved, and Florida State Medical School

Undergraduate Rural Medical Curricula

Determinants of the generalist career intentions of 1995 graduating medical students

Immersion in the Underserved

What Is the Risk If We Train Too Many To Serve the Underserved

Studies show that an increase in insurance costs of 0.5 % above inflation results in another 200,000 without health care insurance - Blue Cross Blue Shield exec

"We live in a country that tolerates enormous disparities in income, material possessions, and social privilege. That may be inevitable in a free-market economy. But those disparities should not extend to essential services like education, clean water and air and protection from crime, all of which we already acknowledge are public responsibilities. The same should be true for medical care -- particularly since we can well afford to provide it for everyone if we end the waste and profiteering of our market-based system."   The Forgotten Domestic Crisis, Marcia Angell, former editor in chief of the New England Journal of Medicine and senior lecturer in Social Medicine at Harvard Medical School      She also states that health care would be the number one priority in the US, except for the war drums. http://www.nytimes.com/2002/10/13/opinion/13ANGE.html  

The best way to keep people in poverty is to restrict education and health care. The train to freedom will always go through a narrow dangerous gorge before it gets to the promised land of milk and honey. You can delay the start of the train, but once started, it is most dangerous to try to derail it     RCB 2003

FEATURED STORY from CCPH site. WHERE DOES IT HURT, DOC? WHERE THEY CUT OUT THE TRAINING  Read the entire story at http://futurehealth.ucsf.edu/pdf_files/PM092002.pdf 

I forgot one most important concept that I have grown more aware of over the past weeks.

We are not called so much to stamp out darkness. We are called to witness to the light!

Jesus did not spend time wandering about fighting all of the injustice in the country. He did the Father's bidding, and so must we. Fighting injustice is a fine balance between doing what you are called by God to do and over-reacting to what Satan can stir up to distract you and involve you in the world. Injustice reminds us that God is in control, not us. It is a balance that I will never fully have, but awareness of this is a start.

Physicians, if they really desire to understand their patients, will become aware of many of these problems. Many physicians have forgotten that this is a real privilege of the profession. If used correctly, physicians caring for the underserved can do much to help others understand what is going on, particularly those who might have the ability to change such situations. Physicians caught up in their own lives or agendas or situations will not be of much help.

Mark Twain understood the importance of a Christian's responsibility as a citizen. He wrote, "A Christian's first duty is to God. It then follows, as a matter of course, that it is his duty to carry his Christian code to the polls and vote them... If Christians should vote their duty to God at the polls, they would carry every election, and do it with ease... it would bring about a moral revolution that would be incalculably beneficent. It would save the country."

Research Topics and Methods in Underserved

Admissions and Minorities in California

High Educational Debt and choice of underserved - Pathman  http://www.ahcpr.gov/research/dec00/1200ra.pdf

Research Methods and References in Underserved

The following are pages involving this critical area:

My first encounter with Dr. Fitzhugh Mullan's work was in 1971 when I read his editorial in the NYT in 1971( White Hands Clenched Fists). We had an opportunity to meet in Washington several years ago. Dr. Carmichael was there and I introduced them to each other. That conversation I will not long forget. For those who may not read the Washington Post here is the URL of his editorial. Bob, I thought you might be especially interested.  Lawrence Silverberg

Fitzhugh Mullan's Washington Post Article about AHEC cuts http://www.washingtonpost.com/wp-dyn/articles/A29293-2002Aug17.html

Bibliographies of Note

Literature on Retention

Braden, J, & Beauregard, K. (1994, February). Health status and access to care of rural and urban populations (AHCPR Pub. No. 94-0031). Rockville, MD: National Medical Expenditure Survey Research Findings 18, Agency for Health Care Policy and Research, Public Health Service.   Jill J. Braden and Karen Beauregard

Gessert, C., Blossom, J., Sommers, P., Canfield, M.D., and C. Jones. "Family Physicians for Underserved Areas: The Role of Residency Training." The Western Journal of Medicine. 150(2):226-230, February 1989.

National Association of Community Health Centers, National Rural Health Association. The National Health Service Corps: An Investment in Health Professionals for Underserved Communities, 2000.

Xu, G, et al. (1997). The relationship between the race/ethnicity of generalist physicians and their care for underserved populations. American Journal of Public Health, 87(5), 817-822.

Physician Workforce Studies




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