Primary Care Provider Shortage Proposal Assignment Paper

Primary Care
Name
Institutional Affiliation
Executive Summary
Doctors are obliged to deliver primary care to members of the public who may be sick. They are fundamental in the delivery of such services to the public depending on the policies that guide their authority over which situations they should handle. The primary care physicians are licensed to practice medicine in internal medicine, family medicine and pediatrics. All their tasks are considered to be of little emergency since they can be treated using simple procedures. Additional services to the pubic include vaccinations and routine care of their patients through frequent check-ups. Their major role is being the basic advocates for health care in any nation. They dictate the parameters in which the health care that the people receive should receive. Despite their important role in the health care sector, their number is gradually reducing and it is said that by 2020, the shortage will be greater than 90,000 doctors. A shortage of doctors in the country will bring about a huge problem in the health care system. Primary care, being the most fundamental form of health care to the citizens of a country, should be available at all times. The policies governing it should therefore be strong. This paper sets out to explain the different problems that affect the delivery of primary health care to the citizens of a country.
Organization Information
The AOA (American Osteopathic Association) is one of the largest primary care providers in the United States. It is responsible for training medical professionals who are later released to work in either the public or private sectors of the economy ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "The Osteopathic Practice Standards comprise both the Standard of Proficiency and the Code of Practice for osteopaths. This document presents all the standards of conduct and competence required of osteopaths to promote patients\u2019 health and wellbeing and to protect them from harm. The Osteopathic Practice Standards play a central role in the requirements for osteopathic training and the achievement and retention of registration with the General Osteopathic Council. The document outlines the safe, competent and ethical practice of osteopathy.", "author" : [ { "dropping-particle" : "", "family" : "General Osteopathic Council", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Osteopathic Practice Standards", "id" : "ITEM-1", "issue" : "September", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "1-32", "title" : "Osteopathic Practice Standards", "type" : "article-journal" }, "uris" : [ "/documents/?uuid=9db0903e-694b-4f28-803b-ceeeea4683d7" ] } ], "mendeley" : { "formattedCitation" : "(General Osteopathic Council, 2012)", "plainTextFormattedCitation" : "(General Osteopathic Council, 2012)", "previouslyFormattedCitation" : "(General Osteopathic Council, 2012)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }(General Osteopathic Council, 2012). Over 70,000 osteopathic physicians are trained every year to be later recruited in various hospitals. The trained physicians are specialized in up to 31 different fields. It also represents the trained physicians with certificates to perform their practice ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "The Osteopathic Practice Standards comprise both the Standard of Proficiency and the Code of Practice for osteopaths. This document presents all the standards of conduct and competence required of osteopaths to promote patients\u2019 health and wellbeing and to protect them from harm. The Osteopathic Practice Standards play a central role in the requirements for osteopathic training and the achievement and retention of registration with the General Osteopathic Council. The document outlines the safe, competent and ethical practice of osteopathy.", "author" : [ { "dropping-particle" : "", "family" : "General Osteopathic Council", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Osteopathic Practice Standards", "id" : "ITEM-1", "issue" : "September", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "1-32", "title" : "Osteopathic Practice Standards", "type" : "article-journal" }, "uris" : [ "/documents/?uuid=9db0903e-694b-4f28-803b-ceeeea4683d7" ] } ], "mendeley" : { "formattedCitation" : "(General Osteopathic Council, 2012)", "plainTextFormattedCitation" : "(General Osteopathic Council, 2012)", "previouslyFormattedCitation" : "(General Osteopathic Council, 2012)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }(General Osteopathic Council, 2012). Apart from issuing the physicians with certificates, it also runs programs which promote public health, accredits all the medical schools that train osteopathic physicians and researches on different medical specialties and subspecialties which may improve the delivery of health care to the patients.
Each osteopathic physician has an obligation to be a member of the AOA. They should also adhere to the rules set by the association and they should respect the oath that they take during their training. The oath is to respect all human life and prevent any harm that comes to it. The code of ethics used in the AOA is aimed at ensuring that the physicians do their work according to the policies and guidelines that have been developed and passed by the board ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.7556/jaoa.2010.110.11.653", "ISBN" : "1945-1997", "ISSN" : "1945-1997", "PMID" : "21135197", "abstract" : "Osteopathic manipulative treatment (OMT) is a distinctive modality commonly used by osteopathic physicians to complement conventional treatment of musculoskeletal disorders, including those that cause low back pain. Osteopathic manipulative treatment is defined in the Glossary of Osteopathic Terminology as: \"The therapeutic application of manually guided forces by an osteopathic physician (US Usage) to improve physiologic function and/or support homeostasis that has been altered by somatic dysfunction. OMT employs a variety of techniques.\" Somatic dysfunction is defined as: \"Impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial and myofascial structures, and their related vascular, lymphatic, and neural elements. Somatic dysfunction is treatable using osteopathic manipulative treatment.\" Previous published guidelines have been based on literature reviews and meta-analyses of spinal manipulation for low back pain. They have not specifically addressed OMT and generally have focused on spinal manipulation as an alternative to conventional treatment. The purpose of this study was to assess the efficacy of OMT for somatic dysfunction associated with low back pain by osteopathic physicians and osteopathic practitioners trained in osteopathic palpatory diagnosis and manipulative treatment.", "author" : [ { "dropping-particle" : "", "family" : "Seffinger", "given" : "Michael A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Licciardone", "given" : "John C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lipton", "given" : "James A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lynch", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Patterson", "given" : "Michael M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Snow", "given" : "Richard", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Troutman", "given" : "Monte E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Univer-", "given" : "Western", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Journal of the American Osteopathic Association", "id" : "ITEM-1", "issue" : "11", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "653-666", "title" : "American Osteopathic Association guidelines for osteopathic manipulative treatment for patients with low back pain.", "type" : "article-journal", "volume" : "110" }, "uris" : [ "/documents/?uuid=f304294d-3fd1-4698-97d5-2b3397391889" ] } ], "mendeley" : { "formattedCitation" : "(Seffinger et al., 2010)", "plainTextFormattedCitation" : "(Seffinger et al., 2010)", "previouslyFormattedCitation" : "(Seffinger et al., 2010)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }(Seffinger et al., 2010). One way in which they respect the ethics is by making sure that their patients receive the best care that they can be given. The patients should also access the medical care at an affordable rate. Addressing the major health issues that affect the society is also a valuable rule that governs the actions of all the osteopathic physicians under this body ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.7556/jaoa.2010.110.11.653", "ISBN" : "1945-1997", "ISSN" : "1945-1997", "PMID" : "21135197", "abstract" : "Osteopathic manipulative treatment (OMT) is a distinctive modality commonly used by osteopathic physicians to complement conventional treatment of musculoskeletal disorders, including those that cause low back pain. Osteopathic manipulative treatment is defined in the Glossary of Osteopathic Terminology as: \"The therapeutic application of manually guided forces by an osteopathic physician (US Usage) to improve physiologic function and/or support homeostasis that has been altered by somatic dysfunction. OMT employs a variety of techniques.\" Somatic dysfunction is defined as: \"Impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial and myofascial structures, and their related vascular, lymphatic, and neural elements. Somatic dysfunction is treatable using osteopathic manipulative treatment.\" Previous published guidelines have been based on literature reviews and meta-analyses of spinal manipulation for low back pain. They have not specifically addressed OMT and generally have focused on spinal manipulation as an alternative to conventional treatment. The purpose of this study was to assess the efficacy of OMT for somatic dysfunction associated with low back pain by osteopathic physicians and osteopathic practitioners trained in osteopathic palpatory diagnosis and manipulative treatment.", "author" : [ { "dropping-particle" : "", "family" : "Seffinger", "given" : "Michael A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Licciardone", "given" : "John C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lipton", "given" : "James A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lynch", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Patterson", "given" : "Michael M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Snow", "given" : "Richard", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Troutman", "given" : "Monte E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Univer-", "given" : "Western", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Journal of the American Osteopathic Association", "id" : "ITEM-1", "issue" : "11", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "653-666", "title" : "American Osteopathic Association guidelines for osteopathic manipulative treatment for patients with low back pain.", "type" : "article-journal", "volume" : "110" }, "uris" : [ "/documents/?uuid=f304294d-3fd1-4698-97d5-2b3397391889" ] } ], "mendeley" : { "formattedCitation" : "(Seffinger et al., 2010)", "plainTextFormattedCitation" : "(Seffinger et al., 2010)", "previouslyFormattedCitation" : "(Seffinger et al., 2010)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }(Seffinger et al., 2010). In addition to that, the physicians are also required to advance the field in which they operate by testing and approving different methods of service delivery to their patients. The quality of their service delivery hinges upon the satisfaction of the patients.
In as much as the health care service delivery has to be of good quality, the rights of the osteopathic physicians also have to be defended. The AOA makes sure that the physicians working under it are well rested after a hard day’s work. If overworked, the physicians may do a bad job. Therefore shifts are encouraged so that every patient can be attended to effectively at any time. To make sure that the code of ethics, policies and regulations of the association are respected, the number of physicians available for the job should be optimum at all times ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.7556/jaoa.2010.110.11.653", "ISBN" : "1945-1997", "ISSN" : "1945-1997", "PMID" : "21135197", "abstract" : "Osteopathic manipulative treatment (OMT) is a distinctive modality commonly used by osteopathic physicians to complement conventional treatment of musculoskeletal disorders, including those that cause low back pain. Osteopathic manipulative treatment is defined in the Glossary of Osteopathic Terminology as: \"The therapeutic application of manually guided forces by an osteopathic physician (US Usage) to improve physiologic function and/or support homeostasis that has been altered by somatic dysfunction. OMT employs a variety of techniques.\" Somatic dysfunction is defined as: \"Impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial and myofascial structures, and their related vascular, lymphatic, and neural elements. Somatic dysfunction is treatable using osteopathic manipulative treatment.\" Previous published guidelines have been based on literature reviews and meta-analyses of spinal manipulation for low back pain. They have not specifically addressed OMT and generally have focused on spinal manipulation as an alternative to conventional treatment. The purpose of this study was to assess the efficacy of OMT for somatic dysfunction associated with low back pain by osteopathic physicians and osteopathic practitioners trained in osteopathic palpatory diagnosis and manipulative treatment.", "author" : [ { "dropping-particle" : "", "family" : "Seffinger", "given" : "Michael A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Licciardone", "given" : "John C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lipton", "given" : "James A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lynch", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Patterson", "given" : "Michael M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Snow", "given" : "Richard", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Troutman", "given" : "Monte E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Univer-", "given" : "Western", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Journal of the American Osteopathic Association", "id" : "ITEM-1", "issue" : "11", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "653-666", "title" : "American Osteopathic Association guidelines for osteopathic manipulative treatment for patients with low back pain.", "type" : "article-journal", "volume" : "110" }, "uris" : [ "/documents/?uuid=f304294d-3fd1-4698-97d5-2b3397391889" ] } ], "mendeley" : { "formattedCitation" : "(Seffinger et al., 2010)", "plainTextFormattedCitation" : "(Seffinger et al., 2010)", "previouslyFormattedCitation" : "(Seffinger et al., 2010)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }(Seffinger et al., 2010). This maintains the efficiency of the service delivery as well as the physicians’ performance. If one factor in the structure of the association is tampered with, the whole system crumbles. Therefore, to avoid problems, the procedures should be followed strictly by the association’s board and its practicing physicians.
Background
In a world of evolving disease causing germs, there needs to be constant enhancement of human’s disabilities to handle these germs. Different sicknesses are becoming more lethal to the human immune system and it is becoming difficult to handle the diseases as the years go by. Research is done every year to create drugs that may be useful in the treating of such diseases. The AOA is a major contributor to the success of such programs because it produces the physicians that are needed I handling such matters ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1525-1497.2005.32127.x", "ISBN" : "1525-1497", "ISSN" : "08848734", "PMID" : "15836532", "abstract" : "OBJECTIVE: To determine the associations between managed care, physician job satisfaction, and the quality of primary care, and to determine whether physician job satisfaction is associated with health outcomes among primary care patients with pain and depressive symptoms. DESIGN: Prospective cohort study. SETTING: Offices of 261 primary physicians in private practice in Seattle. PATIENTS: We screened 17,187 patients in waiting rooms, yielding a sample of 1,514 patients with pain only, 575 patients with depressive symptoms only, and 761 patients with pain and depressive symptoms; 2,004 patients completed a 6-month follow-up survey. MEASUREMENTS AND RESULTS: For each patient, managed care was measured by the intensity of managed care controls in the patient's primary care office, physician financial incentives, and whether the physician read or used back pain and depression guidelines. Physician job satisfaction at baseline was measured through a 6-item scale. Quality of primary care at follow-up was measured by patient rating of care provided by the primary physician, patient trust and confidence in primary physician, quality-of-care index, and continuity of primary physician. Outcomes were pain interference and bothersomeness, Symptom Checklist for Depression, and restricted activity days. Pain and depression patients of physicians with greater job satisfaction had greater trust and confidence in their primary physicians. Pain patients of more satisfied physicians also were less likely to change physicians in the follow-up period. Depression patients of more satisfied physicians had higher ratings of the care provided by their physicians. These associations remained after controlling statistically for managed care. Physician job satisfaction was not associated with health outcomes. CONCLUSIONS: For primary care patients with pain or depressive symptoms, primary physician job satisfaction is associated with some measures of patient-rated quality of care but not health outcomes.", "author" : [ { "dropping-particle" : "", "family" : "Grembowski", "given" : "David", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Paschane", "given" : "David", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Diehr", "given" : "Paula", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Katon", "given" : "Wayne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Martin", "given" : "Diane", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Patrick", "given" : "Donald L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of General Internal Medicine", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2005" ] ] }, "page" : "271-277", "title" : "Managed care, physician job satisfaction, and the quality of primary care", "type" : "article-journal", "volume" : "20" }, "uris" : [ "/documents/?uuid=13c876f5-88de-4868-8f9a-467d29eb2376" ] } ], "mendeley" : { "formattedCitation" : "(Grembowski et al., 2005)", "plainTextFormattedCitation" : "(Grembowski et al., 2005)", "previouslyFormattedCitation" : "(Grembowski et al., 2005)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }(Grembowski et al., 2005). Their competence depends on their ability to grasp the knowledge they are taught in their classes and how they use it when in the health care setting. The more the world advances, the more the courses get advanced thus more training is required as well. Adequate training will enable the physicians to be to handle such situations with maturity and in effect saving a life in the process ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1097/SMJ.0b013e31826f5bc5", "ISBN" : "1541-8243 (Electronic)\\r0038-4348 (Linking)", "ISSN" : "1541-8243", "PMID" : "23128798", "abstract" : "P rimary care in the United States is in a deepening crisis as physician shortages and reduced patient access loom. The healthcare reformlawenacted by the US Congress in 2010 will improve the coverage for uninsured and underinsured people and will indirectly address some of the cost problems of the healthcare system, but it does not solve the primary care access conundrum, especially with 32 million people expected to be added to the ranks of the insured by 2019. Consequently, experts warn that \u2018\u2018if the primary care foundation of the healthcare system is not strengthened, true access and cost containment may be impossible.\u2019\u20191 Solutions may reside in recent disruptive innovations, striving to make health care more accessible and convenient by relying on nonphysician providers. This article reviews the evidence on primary care physicians shortages and reduced access, discusses the implications of healthcare reformonprimary care, andexplores several advances in convenient care that may play a role in larger institutional settings such as patient-centered medical homes.", "author" : [ { "dropping-particle" : "", "family" : "Kaissi", "given" : "Amer", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Southern medical journal", "id" : "ITEM-1", "issue" : "11", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "576-80", "title" : "Primary care physician shortage, healthcare reform, and convenient care: challenge meets opportunity?", "type" : "article-journal", "volume" : "105" }, "uris" : [ "/documents/?uuid=cb3569ca-4d42-4beb-a146-1c590cea46ac" ] } ], "mendeley" : { "formattedCitation" : "(Kaissi, 2012)", "plainTextFormattedCitation" : "(Kaissi, 2012)", "previouslyFormattedCitation" : "(Kaissi, 2012)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }(Kaissi, 2012). The sophistication of the courses is however one of the main causes of the reduction of the number of qualified doctors to provide primary health care to the general public. Such hindrances create back logs towards the association in delivering its duties to the public ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1377/hlthaff.2010.0026", "ISBN" : "1544-5208 (Electronic)\\r0278-2715 (Linking)", "ISSN" : "02782715", "PMID" : "20439864", "abstract" : "In 2005, approximately 400,000 people provided primary medical care in the United States. About 300,000 were physicians, and another 100,000 were nurse practitioners and physician assistants. Yet primary care faces a growing crisis, in part because increasing numbers of U.S. medical graduates are avoiding careers in adult primary care. Sixty-five million Americans live in what are officially deemed primary care shortage areas, and adults throughout the United States face difficulty obtaining prompt access to primary care. A variety of strategies are being tried to improve primary care access, even without a large increase in the primary care workforce.", "author" : [ { "dropping-particle" : "", "family" : "Bodenheimer", "given" : "Thomas", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pham", "given" : "Hoangmai H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Health Affairs", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "799-805", "title" : "Primary care: Current problems and proposed solutions", "type" : "article", "volume" : "29" }, "uris" : [ "/documents/?uuid=9b54d85f-f36e-484f-ad48-bf64c9e9b664" ] } ], "mendeley" : { "formattedCitation" : "(T. Bodenheimer & Pham, 2010a)", "plainTextFormattedCitation" : "(T. Bodenheimer & Pham, 2010a)", "previouslyFormattedCitation" : "(T. Bodenheimer & Pham, 2010a)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }(T. Bodenheimer & Pham, 2010a).
The primary care field of study is quite tasking and requires a lot of dedication from the students to understand it. The sophistication of the course has caused many students to veer away from it and choose other medical fields that would suit them. This happens in many medical institutions despite the fact that the demand for physicians specialized in primary care is growing at a fast rate in the United States ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1377/hlthaff.2010.0026", "ISBN" : "1544-5208 (Electronic)\\r0278-2715 (Linking)", "ISSN" : "1544-5208", "PMID" : "20439864", "abstract" : "In 2005, approximately 400,000 people provided primary medical care in the United States. About 300,000 were physicians, and another 100,000 were nurse practitioners and physician assistants. Yet primary care faces a growing crisis, in part because increasing numbers of U.S. medical graduates are avoiding careers in adult primary care. Sixty-five million Americans live in what are officially deemed primary care shortage areas, and adults throughout the United States face difficulty obtaining prompt access to primary care. A variety of strategies are being tried to improve primary care access, even without a large increase in the primary care workforce.", "author" : [ { "dropping-particle" : "", "family" : "Bodenheimer", "given" : "Thomas", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pham", "given" : "Hoangmai H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Health affairs (Project Hope)", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "799-805", "title" : "Primary care: current problems and proposed solutions.", "type" : "article-journal", "volume" : "29" }, "uris" : [ "/documents/?uuid=64685bfb-331d-4f5e-aeff-ba3dbb4f8f7d" ] } ], "mendeley" : { "formattedCitation" : "(T. Bodenheimer & Pham, 2010b)", "plainTextFormattedCitation" : "(T. Bodenheimer & Pham, 2010b)", "previouslyFormattedCitation" : "(T. Bodenheimer & Pham, 2010b)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }(T. Bodenheimer & Pham, 2010b). Apart from the complexity of the courses to be done by the osteopathic students, the debt incurred by the medical students during their tenure in school is also a major factor co...