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2014 | 2013 | 2012 | 2011 | 2010 | 2009 | 2008 | 2007 | 2006 | 2005 | 2004 | 2003 | 2002 | 2001 | 2000 | 1999 |
Articles -- Abstracts of manuscripts submitted to and published in peer-reviewed journals.
One-Pagers -- Research summaries pertinent to family practice advocacy.
Commentaries and Editorials -- References to editorials by Graham Center staff that have been published in peer-reviewed journals.
Monographs & Books -- Comprehensive studies, syntheses of evidence and compilations of conversations on the history and future of family medicine.
Presentations -- Given by Graham Center staff at various events.


Accounting for Complexity: Aligning Current Payment Models with the Breadth of Care by Different Specialties - December 2014
Family physicians provide care for a wider range of conditions than do most specialists, introducing a high level of complexity into their practice. Historic assump­tions associating complexity with the intensity, skill, and training required to aceommodatea single task fail to capture the complexity of identifying and managing many interacting conditions. Payers and policy makers should recognize this dimension of complexity in care and revisit payment criteria. (One-Pagers)

Aligning Expansion of Graduate Medical Education With Recent Recommendations for Reform - November 2014
Federal funds support graduate medical education positions, but expansion is needed in urban and rural areas that experience shortages in health professionals. This commentary discusses the need for existing funds to be used to expand primary care training programs and thus improve access to care in underserved areas. (Articles)

How Will We Know if Obamacare has “Worked”? - November 2014
(Commentaries and Editorials)

The Battle Between Big Tobacco and Vape Shops - September 2014
(Commentaries and Editorials)

Lessons From a Fallen Hero - August 2014
(Commentaries and Editorials)

The Impact of Debt Load on Physician Assistants - July 2014
The study analyzed results of a series of focus group discussions with second-year PA students and the 2011 American Academy of Physician Assistants (AAPA)–PAEA Graduating Student Survey on career choices, education debt, and demographic characteristics of PA students. (Articles)

Doctors Treating Their Families - June 2014
(Commentaries and Editorials)

GME Summit - June 2014
Andrew Bazemore, MD, MpH (Presentations)

The World's Deadliest Animal - May 2014
(Commentaries and Editorials)

Annual Leadership Forum (ALF) - May 2014
Kathleen Klink, MD, FAAFP (Presentations)

Annual Leadersip Forum (ALF) - May 2014
Kathleen Klink, MD, FAAFP; Claire Gibbons, MpH, PhD (Presentations)

The Changing Landscape of Primary Care HPSAs and the Influence on Practice Location - May 2014
Health professional shortage area (HPSA) designations were created to highlight areas of primary care shortage and direct incentives to physicians willing to practice in these areas. We demonstrate the volatility of these geographies by examining the HPSA status of primary care physicians whose practice locations were the same in 2008 and 2013. (One-Pagers)

Family Medicine Congressional Conference - April 2014
Andrew Bazemore, MD, MPH (Presentations)

Association of American Geographers Annual Meeting - April 2014
Sean Finnegan, MS (Presentations)

Rural Training Track Conclave - April 2014
Andrew Bazemore, MD, MPH (Presentations)

Rural Training Track Conclave - April 2014
Andrew Bazemore, MD, MpH (Presentations)

Association of American Geographers Annual Meeting - April 2014
Jennifer Rankin, MS, PHP, PhD (Presentations)

The Poisonous "Juice" in e-Cigarettes - April 2014
(Commentaries and Editorials)

Projected Impact of the Primary Care Residency Expansion Program Using Historical Trends in Graduate Placement - April 2014
The Primary Care Residency Expansion (PCRE) program was created by the Health Resources and Services Administration in 2010 to help address the shortage of primary care physicians. If historical graduate placement trends for funded programs remain stable, the PCRE program would have a potential impact of more than 600 new physicians working in primary care. (One-Pagers)

PAEA 2014 - March 2014
Miranda Moore, PhD (Presentations)

Trends in Family Physicians Performing Deliveries, 2003-2010 - March 2014
This observational study examined the proportion of family physicians continuing to perform deliveries from 2003–2010. (Articles)

The Impact of Insurance and a Usual Source of Care on Emergency Department Use in the United States - February 2014
Finding a usual source of care (USC) is difficult for certain populations. This analysis determines how insurance type and having a USC affect the settings in which patients seek care. Methods. In this cross-sectional study of the 2000–2011 Medical Expenditure Panel Surveys, we assessed the percentage of low-income persons with half or more of their ambulatory visits to the emergency department (ED). Respondents were stratified based on insurance type and presence of a USC. (Articles)

Ecology of Healthcare: The Need to Address Low Utilization in American Indians/ Alaska Natives - February 2014
Disparities in health and access to health care continue to persist among the American Indian/Alaska Native population, despite federal efforts to call attention to and address these disparities. (One-Pagers)

Patients With High-Cost Chronic Conditions Rely Heavily on Primary Care Physicians - January 2014
Today’s US physician workforce principally comprises specialists trained in the care of specific chronic conditions in the outpatient setting. However, a majority of patients seeking care for most of 14 high-cost chronic conditions, for example hypertension, were more likely to see a primary care physician than a specialist physician. (Articles)


Do Residents Who Train in Safety Net Settings Return for Practice? - December 2013
This study examines the relationship between training during residency in a federally qualified health center (FQHC), rural health clinic (RHC), or critical access hospital (CAH) and subsequent practice in these settings. (Articles)

Migration After Family Medicine Residency: 56% of Graduates Practice Within 100 Miles of Training - November 2013
Using the 2009 American Medical Association Physician Masterfile, this one-pager notes that 56% of family medicine residents stay within 100 miles of where they graduate from residency. (One-Pagers)

Blended Payment Models and Associated Care Management Fees - November 2013

Historic Growth Rates Vary Widely Across the Primary Care Physician Disciplines - October 2013
To better understand trends in the primary care physician workforce, we have examined the growth of family physicians, general pediatricians, and general internists providing direct patient care. (One-Pagers)

State Patterns in Medical School Expansion, 2000-2010: Variation, Discord, and Policy Priorities - October 2013
This study used established national health workforce and training site datasets to compare total medical school enrollment (2000-2010) with change in population, medical student retention in state (those returning to practice in the state where they graduated), and primary care supply. (Articles)

Toward Graduate Medical Education (GME) Accountability: Measuring the Outcomes of GME Institutions - September 2013
This study developed and tested candidate GME outcome measures related to physician workforce. The findings can inform educators and policy makers during a period of increased calls to align the GME system with national health needs. (Articles)

Toward Defining and Measuring Social Accountability in Graduate Medical Education: A Stakeholder Study - September 2013
Since 1965, Medicare has publically financed graduate medical education (GME) in the United States. Given public financing, various advisory groups have argued that GME should be more socially accountable. Several efforts are underway to develop accountability measures for GME that could be tied to Medicare payments, but it is not clear how to measure or even define social accountability. (Articles)

Relying on NPs and PAs Does Not Avoid the Need for Policy Solutions for Primary Care - August 2013
Physician assistants (PAs) and nurse practitioners (NPs) are often proposed as solutions to the looming shortage of primary care physicians. However, a large and growing number of PAs and NPs now work outside of primary care, which suggests that innovative policy solutions to increase access to primary care are still needed. (One-Pagers)

Addressing Challenges: Data, Tools and Primary Care - August 2013
Andrew Bazemore, MD, MPH. (Presentations)

North Carolina Health Information Portal - July 2013
Sean Finnegan, MS; Sarah Lesesne, MSPH; Mark Carrozza, MA; Michael Topmiller, MS et al. (Presentations)

Stepping into a Brave New World: What can we learn from each other? - July 2013
Claire Jackson, Director, University of Queensland Centres for Primary Care Reform Research Excellence. (Presentations)

Factors Influencing Family Physician Adoption of Electronic Health Records (EHRs) - July 2013
Physician and practice characteristics associated with family physician adoption of electronic health records (EHRs) remain largely unexplored but may be important for tailoring policies and interventions. Variation in EHR adoption is associated with physician and practice characteristics that may help guide intervention. (Articles)

A Needs-Based Method for Estimating the Behavioral Health Staff Needs of Community Health Centers - July 2013
Federally Qualified Health Centers are expanding to increase access for millions of more Americans with a goal of doubling capacity to serve 40 million people. Health centers provide a lot of behavioral health services but many have difficulty accessing mental health and substance use professionals for their patients. To meet the needs of the underserved and newly insured it is important to better estimate how many behavioral health professionals are needed. (Articles)

Unequal Distribution of the U.S. Primary Care Workforce - June 2013
The United States is facing a primary care physician shortage, but the most pressing problem is uneven distribution, particularly in poor and rural communities. Providing adequate access to care for the nearly 30 million uninsured people living in these communities will require potent incentives and policy. (One-Pagers)

Communities of Solution - May 2013
JABFM and the Folsom Group editing team have just released a special edition dedicated to Communities of Solution, featuring a number of primary care-led case studies and commentaries (Articles)

Trends in physician supply and population growth - April 2013
The physician workforce has steadily grown faster than the U.S. population over the past 30 years, context that is often absent in conversations anticipating physician scarcity. Policy makers addressing future physician shortages should also direct resources to ensure specialty and geographic distribution that best serves population health. (One-Pagers)

Trends in Physician Supply and Population Growth - April 2013
The physician workforce has steadily grown faster than the U.S. population over the past 30 years, context that is often absent in conversations anticipating physician scarcity. Policy makers addressing future physician shortages should also direct resources to ensure specialty and geographic distribution that best serves population health. (Articles)

The Association Between Global Health Training and Underserved Care: Early Findings From Two Longstanding Tracks - April 2013
Global health tracks (GHTs) improve knowledge and skills, but their impact on career plans is unclear. The objective of this analysis was to determine whether GHT participants are more likely to practice in underserved areas than nonparticipants. In this retrospective cohort study, using the 2009 American Medical Association Masterfile, we assessed the practice location of the 480 graduates from 1980--2008 of two family medicine residencies-Residency 1 and Residency 2. The outcomes of interest were the percentage of graduates in health professional shortage areas (HPSAs), medically underserved areas (MUAs), rural areas, areas of dense poverty, or any area of underservice. (Articles)

Family Physicians Are Essential for Mental Health Care Delivery - March 2013
As the largest and most widely distributed of primary care physicians, family physicians have an important role in providing mental health care, especially in rural and underserved areas. However, the proportion of family physicians who report providing mental health care is low. Policy barriers such as payment for mental health services should be explored to ensure access to mental health care for patients across the urban to rural continuum. (Articles)

The Primary Care Extension Program: A Catalyst for Change - March 2013
The Affordable Care Act authorized, but did not fund, the Primary Care Extension Program (PCEP). Much like the Cooperative Extension Program of the US Department of Agriculture sped the modernization of farming a century ago, the PCEP could speed the transformation of primary care. It could also help achieve other goals such as integrating primary care with public health and translating research into practice. The urgency of these goals and their importance to achieving the Triple Aim for health care should increase interest in rapidly building the PCEP, much as the need to feed the country did a century ago. (Articles)

Is NIH Research Funding to Medical Schools Associated With More Family Medicine? - February 2013
National Institutes of Health (NIH) funding to family medicine departments is very low and has an inverse association with the production of family physicians at these medical schools. Clinical and Translational Science Awards and other efforts to include primary care in NIH research priorities should be considered to increase the family medicine workforce. (One-Pagers)

A Small Percentage of Family Physicians Report Time Devoted to Research - January 2013
Despite calls by family medicine organizations to build research capacity within the discipline, few family physicians report research activity. Policy that supports efforts in family medicine research and increases awareness of opportunities for primary care research in the practice setting is essential for family medicine to expand its scholarly foundations. (Articles)

The Rise of Electronic Health Record Adoption Among Family Physicians - January 2013
Realizing the benefits of adopting electronic health records (EHRs) in large measure depends heavily on clinicians and providers' uptake and meaningful use of the technology. This study examines EHR adoption among family physicians using 2 different data sources, compares family physicians with other office-based medical specialists, assesses variation in EHR adoption among family physicians across states, and shows the possibility for data sharing among various medical boards and federal agencies in monitoring and guiding EHR adoption. (Articles)

The Redistribution of Graduate Medical Education Positions in 2005 Failed to Boost Primary Care or Rural Training - January 2013
Graduate medical education (GME), the system to train graduates of medical schools in their chosen specialties, costs the government nearly $13 billion annually, yet there is little accountability in the system for addressing critical physician shortages in specific specialties and geographic areas. Medicare provides the bulk of GME funds, and the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 redistributed nearly 3,000 residency positions among the nation's hospitals, largely in an effort to train more residents in primary care and in rural areas. (Articles)


Health Care Transition - December 2012
Youth with special health care needs who receive care within a patient-centered medical home (PCMH) are significantly more likely to receive services for transitioning to adult care. (One-Pagers)

Defining Service Areas for Federally Funded Community Health Centers in the United States - December 2012
Jennifer L. Rankin, PhD; Andrew Bazemore, MD, MPH; Robert L. Phillips, MD, MSPH; Sean C. Finnegan, MS; Benjamin Adler, BS (Presentations)

Engagement of family physicians in Maintenance of Certification remains high - December 2012
Maintenance of Certification for Family Physicians was created to enhance the quality of care delivered by family physicians but risked decreasing their engagement due to the increased burden of meeting additional requirements to remain board-certified. Participation by family physicians in Maintenance of Certification remains higher than predicted. (Articles)

Projecting US Primary Care Physician Workforce Needs: 2010-2025 - November 2012
Researchers project the United States will need 52,000 additional primary care physicians by 2025 — a 25 percent increase in the current workforce — to address the expected increases in demand due to population growth, aging, and insurance expansion following passage of the Affordable Care Act. Analyzing nationally representative data, the researchers conclude population growth will be the single greatest driver of increased primary care utilization, requiring approximately 33,000 additional primary care physicians by 2025, while 10,000 additional physicians will be needed to accommodate population aging. Insurance expansion, they estimate, will require approximately 8,000 additional primary care physicians, a 3 percent increase in the current workforce. (Articles)

Primary care in the ACO: The role of primary care in the future healthcare system - November 2012
Erica Brode, MD MPH; Andrew Bazemore, MD, MPH; Kevin Grumbach, MD. University of California, San Francisco & The Robert Graham Center. (Presentations)

Comparison of Primary Care Service Areas and Estimated Drive Times - October 2012
Sean Finnegan, MS; American Public Health Association 140th Annual Meeting (Presentations)

Integrating community health centers into organized delivery systems can improve access to subspecialty care - August 2012
The Affordable Care Act is funding the expansion of community health centers to increase access to primary care, but this approach will not ensure effective access to subspecialty services. To address this issue, we interviewed directors of twenty community health centers. Our analysis of their responses led us to identify six unique models of how community health centers access subspecialty care, which we called Tin Cup, Hospital Partnership, Buy Your Own Subspecialists, Telehealth, Teaching Community, and Integrated System. We determined that the Integrated System model appears to provide the most comprehensive and cohesive access to subspecialty care. Because Medicaid accountable care organizations encourage integrated delivery of care, they offer a promising policy solution to improve the integration of community health centers into “medical neighborhoods.” (Articles)

Improving America's Health Requires Community-Level Solutions: Folsom Revisited - August 2012
Amidst sweeping changes to health care in the 1960s, the broadly influential Folsom Commission report, “Health is a Community Affair,” never fully achieved its vision of galvanizing the creation of Communities of Solution, which were empowered to improve health at the local level. Passage of health care reform, and persistent concern over poor health outcomes despite runaway spending, contemporizes Folsom’s call for nationally supported and evaluated, but community-driven, solutions to the nation’s health care challenges. (One-Pagers)

Measures of social deprivation that predict health care access and need within a rational area of primary care service delivery - July 2012
The geographic index has utility for identifying areas in need of assistance and is timely for revision of 35-year-old provider shortage and geographic underservice designation criteria used to allocate federal resources. (Articles)

The percentage of family physicians attending to women's gender-specific health needs is declining - July 2012
As the largest and most widely distributed of primary care physicians, family physicians have an important role in providing women's health care, especially in rural and underserved areas. The proportion of family physicians who are attending to women is declining. Policy intervention may be needed to help family physicians maintain the comprehensiveness of care necessary to address the wide range of medical problems of women they encounter within their practices. (Articles)

A re-emerging political space for linking person and community through primary health care - June 2012
Current efforts to reform primary care are only intermediate steps toward a system with a greater focus on community and population health. Transformed and policy-enabled primary care is an essential link between personalized care and population health. (Articles)

Integrating Public Health and Primary Care - May 2012
Paul Wallace, MD; Sean P. David, MD; Washington Primary Care Forum #68 (Presentations)

Proportion of family physicians providing maternity care continues to decline - May 2012
Family physicians traditionally have played an integral role in delivering babies as a component of the comprehensive care they provide for women. The proportion of family physicians who report providing any maternity care continues to decrease. This trend is particularly concerning because family physicians are the most widely distributed specialty and are essential to health care access in rural areas. (Articles)

Communities of solution: The Folsom Report revisited - May 2012
The 21st century primary care physician must be a true public health professional, forming partnerships and assisting data sharing with community organizations to facilitate healthy changes. We propose an updated vision of the Folsom Report for integrated and effective services, incorporating the principles of community-oriented primary care. (Articles)

Medical school rural programs: A comparison with international medical graduates in addressing state-level rural family physician and primary care supply - April 2012
Despite their relatively small size, RPs had a significant impact on rural family physician and primary care supply compared with the much larger cohort of IMGs. Wider adoption of the RP model would substantially increase access to care in rural areas compared with increasing reliance on IMGs or unfocused expansion of traditional medical schools. (Articles)

Declining numbers of family physicians are caring for children - March 2012
Despite continued growth of the primary care workforce, profound maldistribution persists among providers available for the care of children. Family physicians (FPs) spend, on average, approximately 10% of their total practice time caring for children; however, given that, among physician specialties, FPs are geographically distributed most evenly across the US population, the self-reported decline in the share of FPs caring for children should be disturbing to policymakers, especially with the looming insurance expansion in 2014. (Articles)

The next phase of Title VII funding for training primary care physicians for America's health care needs - March 2012
Congress should act on the Council on Graduate Medical Education's recommendation to increase funding for Title VII, Section 747 roughly 14-fold to $560 million annually. This amount represents a small investment in light of the billions that Medicare currently spends to support graduate medical education, and both should be held to account for meeting physician workforce needs. Expansion of Title VII, Section 747 with the goal of improving access to primary care would be an important part of a needed, broader effort to counter the decline of primary care. Failure to launch such a national primary care workforce revitalization program will put the health and economic viability of our nation at risk. (Articles)

A Large Retrospective Multivariate Analysis of the Relationship Between Medical Student Debt and Primary Care Practice in the United States - January 2012
Julie Phillips, MD, MPH; Stephen Petterson, PhD; Andrew Bazemore, MD, MPH; Robert Phillips, MD, MSPH. NAPCRG, 2012. (Presentations)

Increasing Graduate Medical Education (GME) in Critical Access Hospitals (CAH) could enhance physician recruitment and retention in rural America - January 2012
Critical Access Hospitals (CAHs) are essential to a functioning health care safety net and are a potential partner of rural Graduate Medical Education (GME), which is associated with greater likelihood of service in rural and underserved areas. Currently, very little Medicare funding supports GME in the CAH setting, highlighting a missed opportunity to improve access to care in rural America. (Articles)

Refocusing Geriatricians’ Role in Training to Improve Care for Older Adults - January 2012
The current number of geriatricians cannot keep up with the health care needs of the growing number of older adults. To fill the gap, more geriatricians should focus on training primary care and other specialty physicians to care for older adults. (One-Pagers)


Comprehensive medical school rural programs produce rural family physicians - December 2011
Health insurance expansion expected from the Affordable Care Act is likely to exacerbate the long-standing and critical shortage of rural and primary care physicians over the next decade. Comprehensive medical school rural programs, from which most graduates ultimately enter primary care disciplines and serve rural areas, offer policy makers an interesting potential solution. (One-Pagers)

EHR implementation without meaningful use can lead to worse health outcomes - December 2011
Defying expectations, typical electronic health record (EHR) use in practices belonging to a primary care network has been associated with poorer diabetes care quality and outcomes. Current expansion of primary care EHR implementation must focus on use that improves care. (One-Pagers)

Research Productivity of Senior General Practice Academicians in Australia, Canada, England/Wales, New Zealand, Scotland, and the U.S. - November 2011
Susan Dovey, PhD; Andrew W. Bazemore, MD, MPH; Winston Liaw, MD, MPH; Robert L. Phillips, Jr., MD, MSPH; NAPCRG Annual Meeting (Presentations)

Where the United States Falls Down and How We Might Stand Up - November 2011
(Commentaries and Editorials)

Rewarding family medicine while penalizing comprehensiveness? Primary care payment incentives and health reform: the Patient Protection and Affordable Care Act (PPACA) - November 2011
Family physicians’ scope of work is exceptionally broad, particularly with increasing rurality. Provisions for Medicare bonus payment specified in the health care reform bill (the Patient Protection and Affordable Care Act) used a narrow definition of primary care that inadvertently offers family physicians disincentives to delivering comprehensive primary care. (Articles)

What services do family physicians provide in a time of primary care transition? - November 2011
The Future of Family Medicine Report envisioned a new model of practice “committed to providing the full basket of clinical services offered by Family Medicine.” In actuality, variation in that basket is considerable and may influence patients’ access to care as much as supply and distribution of physicians does in the wake of health care reform. (Articles)

Better integration of mental health care improves depression screening and treatment in primary care - November 2011
Improving screening and treatment for depression in primary care will require better mental health care integration. Depression is common in primary care, yet screening for the condition remains low. Enhanced, coordinated financial support for the integration of mental health care into primary care could improve identification and treatment of depression. (One-Pagers)

Calling all scholars to the Council of Academic Family Medicine Educational Research Alliance (CERA) - July 2011
The mission of CERA is to set within family medicine a standard for medical education research that is rigorous and generalizable, to provide mentoring and education to junior researchers, to facilitate collaboration between medical education researchers, and to guide the specialty by providing leadership and vision in the arena of medical education research. (Articles)

The importance of time in treating mental health in primary care - June 2011
Primary care plays a critical role in treating mental health conditions, but caring for patients with comorbid mental health and medical conditions increases visit length. Lack of appropriate reimbursement mechanisms and competing priorities make it difficult to integrate mental health into primary care. Caring for patients with mental health comorbidities requires time not now affordable in the primary care setting and demands a new payment policy to promote team-based, integrated care for mental and physical illness in a patient-centered medical home. (Articles)

An international health track is associated with care for underserved US populations in subsequent clinical practice - June 2011
Presence of an international health track (IHT) was associated with increased care of underserved populations. After the institution of an IHT track, this association was seen among IHT participants and nonparticipants and was not associated with increased long-term service abroad. (Articles)

Evidence and Tools for Advocacy from The Robert Graham Center - May 2011
Jennifer Rankin, PhD; AAFP Annual Leadership Forum (Presentations)

Innovations in primary care residency education - May 2011
Samuel M. Jones, MD; Warren Newton, MD, MPH; Washington Primary Care Forum #64 (Presentations)

Evidence About Your Value (and the return on investment) - May 2011
Robert L. Phillips, Jr., MD, MSPH; Family Medicine Congressional Conference (Presentations)

Evidence about the Role of the PCMH and ACOs in Improving Quality and Safety - May 2011
Robert L. Phillips, Jr., MD, MSPH; Georgetown University Department of Family Medicine Grand Rounds (Presentations)

Primary Care Physician Workforce and Outcomes - May 2011
(Commentaries and Editorials)

Accounting for Graduate Medical Education production of primary care physicians and general surgeons: Timing of measurement matters - May 2011
Residency expansion thresholds that do not account for production at least two to four years after completion of first residency overestimate eligibility. The overall primary care production rate from GME will not sustain the current physician workforce composition. (Articles)

Family physician participation in maintenance of certification - May 2011
Large numbers of family physicians are participating in MOC. The significant association between practicing in underserved areas and lapsed board certification, however, warrants more research examining causes of differential participation. The penetrance of MOC engagement shows that MOC has the potential to convey substantial practice-relevant medical information to physicians. Thus, it offers a potential channel through which to improve health care knowledge and medical practice. (Articles)

FPs lower hospital readmission rates and costs - May 2011
Hospital readmission after discharge is often a costly failing of the U.S. health care system to adequately manage patients who are ill. Increasing the number of family physicians (FPs) is associated with significant reductions in hospital readmissions and substantial cost savings. (One-Pagers)

Evidence about the role of the Patient-Centered Medical Home and Accountable Care Organizations in Improving Quality and Safety - April 2011
Robert L. Phillips, Jr., MD, MSPH; Ohio Hospital Association/Ohio Patient Safety Institute (Presentations)

I LIVE PC: International Learning on Increasing the Value and Effectiveness of Primary Care - April 2011
(Monographs & Books)

Primary Care Present and Future - April 2011
Robert L. Phillips, Jr., MD, MSPH; Paul Ambrose Spring Forum (Presentations)

Rural-urban distribution of the U.S. geriatrics physician workforce - April 2011
Small numbers of geriatricians combined with a growing elderly population poses a challenge and an opportunity. Healthcare systems and policy-makers will need to modify care models to better use the skill of geriatricians in concert with other providers to provide quality care for older rural and urban Americans. (Articles)

Seeking ethical approval for an international study in primary care patient safety - April 2011
Seeking ethics committee approval for research can be challenging even for relatively simple studies occurring in single settings. Complicating factors such as multicentre studies and/or contentious research issues can challenge review processes, and conducting such studies internationally adds a further layer of complexity. This paper draws on the experiences of the LINNAEUS Collaboration, an international group of primary care researchers, in obtaining ethics approval to conduct an international study investigating medical error in general practice in six countries. (Articles)

A new Journal of the American Board of Family Medicine feature: The American Board of Family Medicine–Robert Graham Center Policy Brief - March 2011
(Commentaries and Editorials)

Establishing a baseline: Health information technology adoption among family medicine diplomates - March 2011
A majority of board-certified family physicians in the United States now use EHRs. The most rural of family physicians lag slightly behind the national adoption frequency, but 4-year trends suggest similar rates of uptake. Though board-certified family physicians may differ from those who do not maintain certification, understanding uptake among this cohort is critical because Maintenance of Certification (MOC) and the adoption of health information technology both are essential elements of quality improvement in primary care. Although further monitoring of adoption trends is important, the mounting challenge will not be adoption but the sufficiency of EHRs to help family physicians take better care of their patients. (Articles)

Case study of a primary care-based accountable care system approach to medical home transformation - February 2011
Over 20 years, WellMed Inc. (San Antonio, Texas) implemented many patient-centered services, experimenting to find which belong within clinics and which operate best as system functions. The adjusted mortality rate is half that of the state for people older than 65 years. Hospitalization and readmission rates and emergency department visits have not changed over time, but preventive services have improved. Phased implementation across the network makes it difficult to link improvements to specific processes but they seem to have improved outcomes collectively. (Articles)

Tackling primary care workforce demands in light of health care reform - January 2011
James C. Puffer, MD; Robert Phillips, MD, MSPH; Eric S. Holmboe, MD; and James A. Stockman III, MD; Washington Primary Care Forum #63 (Presentations)

Comparison between U.S. Preventive Services Task Force recommendations and Medicare coverage - January 2011
Medicare coverage for preventive services needs to be reassessed, with special focus on preventive coordination. Continuing previous practices will likely promote both inadequate and excessive delivery of preventive services. The new health care reform law has the potential to improve the provision of preventive services to Medicare beneficiaries. (Articles)


Travel medicine and the Maryland family physician - October 2010
Providing recommendations for a safe and healthy sojourn, without unnecessarily alarming travelers or blunting their cultural interchange and travel adventure, is a balancing act. That balance, best informed by thorough assessment of patient- and itinerary-specific risk, as well as risk tolerance, is an assessment perfectly suited to the relationships available to the traveler in the patient-centered medical home. (Articles)

Use of measures of socioeconomic deprivation in planning primary health care workforce and defining health care need in Australia - October 2010
Using remoteness areas alone to prioritize workforce incentive programs and training requirements has significant limitations. Including measures of socioeconomic disadvantage and workforce supply would better target health inequities and improve resource allocation in Australia. (Articles)

Primary Care and Health Reform - September 2010
Kevin Burke and Andrew Bazemore; AAFP Scientific Assembly (Presentations)

Income disparities shape medical student specialty choice - September 2010
Currently, a gap of more than $135,000 separates the median annual subspecialist income from that of a primary care physician, yielding a $3.5 million difference in expected income over a lifetime. These income disparities dissuade medical students from selecting primary care and should be addressed to ensure sufficient patient access to primary care. (One-Pagers)

Illinois Health Connect and Your Healthcare Plus Case Statement - August 2010
(Monographs & Books)

Building the research culture of family medicine with fellowship training - August 2010
There are many fellowship and research training opportunities for family physicians. But in many programs, research training is tenuous, and support for researchers is low. We recommend expanding research advocacy efforts within family medicine, Congress, and funding institutions. (Articles)

Loss of primary care residency positions amidst growth in other specialties - July 2010
Since the 1997 Balanced Budget Act capped funding for graduate medical education (GME) programs, overall growth in GME has continued (+7.8 percent), but primary care specialties have experienced a substantial decline in their number of programs and residency positions. This decline will further exacerbate the current primary care shortage and severely affect future projections of primary care shortage. (One-Pagers)

The social mission of medical education: ranking the schools - June 2010
Medical schools vary substantially in their contribution to the social mission of medical education. School rankings based on the social mission score differ from those that use research funding and subjective assessments of school reputation. These findings suggest that initiatives at the medical school level could increase the proportion of physicians who practice primary care, work in underserved areas, and are underrepresented minorities. (Articles)

Primary care and why it matters for U.S. health system reform - May 2010
We discuss the evidence for primary care's important functions and international experiences with primary care. We also describe how and why the United States has deviated from this fuller realization of primary care, as well as the steps needed to achieve primary care and health outcomes on a par with those of other developed countries. (Articles)

Measuring primary care expenses - May 2010
It is feasible to systematically collect intervention-specific expenses in primary care using formal expenditure methods. However, most practices and researchers lack the knowledge, expertise, and resources to collect such data independently. Further assistance and education is necessary to obtain reliable information about the expenses to transform and improve primary care. (Articles)

Greater family medicine presence at NIH could improve research relevance and reach - May 2010
Advisory committees perform pivotal tasks at the National Institutes of Health (NIH), informing funding decisions, helping establish research priorities, and contributing to the vision for the nation's biomedical research agenda. Family medicine has not had a substantial role on these committees, but could, helping the NIH make research more patient centered and informing translational efforts to improve population health. (One-Pagers)

Greater NIH investment in Family Medicine would help both achieve their missions - March 2010
Family medicine is the predominant provider of primary health care in the United States, yet it receives relatively little research funding from the National Institutes of Health (NIH). Family medicine can help the NIH speed research discovery and improve research relevance; the NIH can help family medicine build its research capacity, and such mutual benefit could mean improvement in public health. (One-Pagers)

State tort reforms and hospital malpractice costs - March 2010
This study explored the relation between state medical liability reform measures, hospital malpractice costs, and hospital solvency. It suggests that state malpractice caps are desirable but not essential for improved hospital financial solvency or viability. (Articles)

Does graduate medical education also follow green? - February 2010
Our findings support the concern expressed by the COGME that instead of responding to policy aims to correct shortage in the primary care pipeline, hospitals are instead training to meet hospital goals. (Articles)

Avertable deaths associated with household income in Virginia - February 2010
If the mortality rates of the reference population had applied to the entire state, 24.3% of deaths in Virginia from 1990 through 2006 (range=21.8%–28.1%) would not have occurred. Further research must clarify the extent to which individual-level factors (e.g., earnings, education, race, health insurance) and community characteristics can improve health outcomes. (Articles)

The impact of a clinic move on vulnerable patients with chronic disease: A geographic information systems (GIS) analysis - January 2010
Maps created from practice management data revealed a shift in patients when a clinic moved. Geographic information systems tools are valuable aids in defining changing service areas of primary health care clinics. (Articles)

Harnessing Geographic Information Systems (GIS) to enable Community-Oriented Primary Care - January 2010
Analytic mapping was enthusiastically received and practically applied in the primary care setting, and was readily comprehended by clinic leaders for innovative purposes. This is a tool of particular relevance amid primary care safety-net expansion and increased funding of health information technology diffusion in these settings, particularly if the hurdles of cost and technological expertise are overcome by harnessing new advances in web-based mapping technology. (Articles)

American Board of Family Medicine (ABFM) Maintenance of Certification: Variations in Self-Assessment Modules uptake within the 2006 cohort - January 2010
More than two-thirds of eligible, certified family physicians completed stage-one MC-FP requirements. Concerns that technical aspects of the new MC-FP paradigm would leave parts of a widely distributed, poorly resourced primary care workforce disadvantaged may hold true for providers in some underserved areas, but differential completion among rural and remote physicians was not found. Understanding barriers to uptake is essential if the specialty boards are to meet their obligations to the public to promote quality of care through Maintenance of Certification for all physicians. (Articles)

Title VII is critical to the community health center and National Health Service Corps workforce - January 2010
Community health centers (CHCs) and the National Health Service Corps (NHSC) are essential to a functioning health care safety net, but they struggle to recruit physicians. Compared with physicians trained in residency programs without Title VII funding, those trained in Title VII-funded programs are more likely to work in CHCs and the NHSC. Title VII funding cuts threaten efforts to improve access to care for the underserved. (One-Pagers)


Improving the delivery of preventive services to Medicare beneficiaries - December 2009
(Commentaries and Editorials)

A comparison of chronic illness care quality in US and UK family medicine practices prior to pay-for-performance initiatives - December 2009
Following National Health Service (NHS) investment in primary care preparedness, but prior to the QOF, UK practices provided more standardized care but did not achieve better intermediate outcomes than a sample of typical US practices. US policymakers should focus on reducing variation in care documentation to ensure the effectiveness of P4P efforts while the NHS should focus on moving from process documentation to better patient outcomes. (Articles)

Global choices: international health and medical student residency preferences - November 2009
(Commentaries and Editorials)

Family physicians' present and future role in caring for the elderly - November 2009
The population of patients older than 65 years is projected to increase substantially in the coming years, particularly in rural areas. Family physicians are essential providers of geriatric care, especially in rural areas, but need payment reform to improve their capacity to meet the needs of older patients. (One-Pagers)

Title VII's decline: Shrinking investment in the primary care training pipeline - October 2009
Title VII, Section 747 is a source of federal funding intended to strengthen the primary care workforce. Despite evidence that Title VII has been successful, its funding has declined over the past three decades, threatening the production of primary care physicians. (One-Pagers)

Estimated effects of Sec. 1721 of draft bill HR 3200 on physician gross revenue - September 2009
(Monographs & Books)

Decreasing self-perceived health status despite rising health expenditures - September 2009
Despite steady increases in U.S. health care spending, the population's self-perceived health status has been in a long-term decline. Increased support for public health, prevention, and primary care could reduce growth in spending and improve actual and perceived health. (One-Pagers)

Are Medicare GME policies adequate to meet the rising need for primary care physicians? - August 2009
Bob Phillips, MD, MSPH; HRSA Workforce Summitt (Presentations)

Race and ethnicity and rural mental health treatment - August 2009
Findings suggest that characteristics of the rural environment may disadvantage all residents with respect to mental health treatment. In more populated areas where mental health services are more plentiful, complex racial and service system factors may play a greater role in evident ethnic/racial treatment disparities. (Articles)

Health care reform depends on family medicine: Walk softly but keep the stick close - June 2009
Bob Phillips, MD, MSPH; Tulane University Visiting Professorship (Presentations)

How states will solve the healthcare workforce crisis: What to ask for from the Feds - June 2009
Bob Phillips, MD, MSPH; Louisiana Department of Health of Hospitals (Presentations)

The effect of facilitation in fostering practice change - June 2009
Working with facilitation agents measurably improves the ability of motivated primary care practices to move towards improved models of care. Widespread primary care practice transformation will likely require facilitation capacity in most communities. (One-Pagers)

Effects of proposed primary care incentive payments on average physician Medicare revenue and total Medicare allowed charges - May 2009
(Monographs & Books)

Ensuring access to a modern, Medical Home: The role for a primary care extension program in health reform - April 2009
Kevin Grumbach, MD; Primary Care Roundtable Dialogue Series (Presentations)

Medical school expansion, primary care, and policy: Engaging primary care educators in evidence-based advocacy - April 2009
Andrew Bazemore, Julie Phillips, Amy McGaha, Hope Wittenberg; STFM Annual Spring Conference (Presentations)

Is Colorado ready for a primary care-based health care system? - April 2009
Bob Phillips, MD MSPH and Andrew Bazemore, MD MPH; University of Colorado Levitt Distinguished Speaker Series (Presentations)

What influences medical student and resident choices? - April 2009
Bridget Teevan, MS; National AHEC Organization Spring Policy Days (Presentations)

Specialty and geographic distribution of the physician workforce: What influences medical student & resident choices? - March 2009
(Monographs & Books)

Universal Primary Care -- Shovel Ready Health Care Reform - March 2009
Michael Fine, MD and Shannon Brownlee, MS; Primary Care Roundtable Dialogue Series (Presentations)

The Robert Graham Center Update - March 2009
A compendium of slides for public use that includes original and adapted analyses and commentary from the staff of the Robert Graham Center (Presentations)

Usual source of care: An important source of variation in health care spending - March 2009
Based on analyses of data from the 2001–2004 Medical Expenditure Panel Surveys, we found significant differences in annual spending, especially for adults. Use of and spending for subspecialists were similar to those for general internists, and both were significantly higher than those for family physicians. Variation in spending might be the result of training differences among primary care specialties. (Articles)

Family medicine, the NIH, and the medical-research roadmap: Perspectives from inside the NIH - March 2009
NIH key informants generally appreciated family medicine clinically but viewed family medicine research as underdeveloped. Some identified opportunities for family medicine to lead, particularly CTSAs. Greater self-advocacy, research training,and developing areas of expertise may improve family medicine’s engagement with NIH. (Articles)

How can primary care cross the quality chasm? - March 2009
The chasm between knowledge and practice decried by the Institute of Medicine (IOM) is the result of other chasms that have not been addressed. If we are to facilitate the production and use of the knowledge needed for primary care to cross IOM’s chasm, major changes are needed. (Articles)

Primary care's ecologic impact on obesity - March 2009
With a costly obesity epidemic, policy makers must recognize factors that may influence obesity not only for each person, but also across communities. Increased primary care physician density on the county level is associated with decreased obesity rates. As we move to restructure the primary care workforce and engage our patients and communities in behavior change, the implications of this association merit closer investigation. (One-Pagers)

Arranging generalism in the 2020 primary care team - February 2009
(Monographs & Books)

Social determinants of health: Their influence on personal choice, environmental exposures, and health care - February 2009
(Monographs & Books)

What the federal government should do to revitalize the primary care infrastructure in the United States - January 2009
Kevin Grumbach, MD; Washington Primary Care Forum #60 (Presentations)

Having a Usual Source of Care Reduces ED Visits - January 2009
The recent growth in the use of emergency departments (EDs) is costly, undesirable, and unnecessary. This trend is partly due to a growing proportion of persons who lack a usual source of care. This group is increasingly likely to rely on EDs for their health care needs compared with those who have a usual source of care. (One-Pagers)


Assuring access to health care: The role and needs for community heath centers - December 2008
John Sawyer, Bob Phillips and Michelle Proser; Washington Primary Care Forum #59 (Presentations)

Characterizing breast symptoms in family practice - November 2008
Of patients with breast symptoms only a small subset is subsequently given a diagnosis of breast cancer (3.2%); however, the presence of a breast mass is associated with an elevated likelihood of breast cancer. These data illustrate the use of systematic data collection and classification from primary care offices to extract information regarding disease symptoms and diagnoses. (Articles)

Off the roadmap? Family medicine's grant funding and committee representation at NIH - November 2008
Departments of family medicine, and family physicians in particular, receive a miniscule proportion of NIH grant funding and have correspondingly minimal representation on standing NIH advisory committees. Family medicine's engagement at the NIH remains near well-documented historic lows, undermining family medicine's potential for translating medical knowledge into community practice, and advancing knowledge to improve health care and health for the US population as a whole. (Articles)

Navigating general practice. The use of geographic information systems - October 2008
Geographic information systems (GIS) are powerful tools for managing, analysing and mapping geographical and associated data. In the health care setting, GIS can be used to map and graph health care provider and social and environmental data. (Articles)

Changing patient health-risk behavior requires new investment in primary care - October 2008
Evidence supports the effectiveness of primary care interventions to improve nutrition, increase physical activity levels, reduce alcohol intake, and stop tobacco use. However, implementing these interventions requires considerable practice expense. If we hope to change behavior to reduce chronic illness, the way we pay for primary care services must be modified to incorporate these expenses. (One-Pagers)

Primary care's eroding earnings: is congress concerned? - September 2008
Issues in primary care are not high on the congressional agenda, and Medicare's Sustainable Growth Rate (SGR) is the physician-payment issue on the minds of congressional staff members. Attempts to solve primary care's reimbursement difficulties should be tied to SGR reform. (Articles)

Impact of Title VII training programs on community health center staffing and national health service corps participation - September 2008
Continued federal support of Title VII training grant programs is consistent with federal efforts to increase participation in the NHSC and improve access to quality health care for underserved populations through expanded CHC capacity. (Articles)

Access transformed: Building a primary care workforce for the 21st century - August 2008
(Monographs & Books)

The Robert Graham Center Update - July 2008
A compendium of slides for public use that includes original and adapted analyses and commentary from the staff of the Robert Graham Center (Presentations)

Will patients find diversity in the medical home? - July 2008
Mexican Americans and blacks experience disparities in health outcomes relative to white populations. During the past five to 10 years, fewer blacks and Mexican Americans are going to medical school and entering primary care professions. To assure the availability of a patient-centered medical home for all Americans, policy makers must work to support a culturally competent and diverse primary care workforce. (One-Pagers)

Testing process errors and their harms and consequences reported from family medicine practices - June 2008
Errors occur throughout the testing process, most commonly involving test implementation and reporting results to clinicians. While significant physical harm was rare, adverse consequences for patients were common. The higher prevalence of harm and adverse consequences for minority patients is a troubling disparity needing further investigation. (Articles)

A perfect storm: Changes impacting Medicare threaten primary care access in underserved areas - June 2008
A convergence of three policies could reduce physician Medicare payments by 14.9 to 22.3 percent in 2008, which could jeopardize access for Medicare beneficiaries in underserved areas. Congress and the Executive Branch should coordinate their roles in setting Medicare payment policy, because their overlapping decisions can have additive impact. (One-Pagers)

HealthLandscape: Putting family medicine on the map - May 2008
Bob Phillips, MD, MSPH; AAFP Annual Leadership Forum 2008 (Presentations)

Brakes for a runaway train? The medical home's role in containing U.S. health care expenditures - May 2008
Cathy Schoen, MD; Washington Primary Care Forum #58 (Presentations)

Residency footprints: Assessing the impact of training programs on the local physician workforce and communities - May 2008
The effect of closing family medicine residency programs is likely to go undetected for many years. Decisions regarding the fate of family medicine programs are often made without benefit of a full assessment. Local and regional effects on physician access are often recognized only after the fact. Novel approaches to analysis and display of local effects of closures are essential for policy decisions concerning physician workforce training. (Articles)

Physician distribution and access: Workforce priorities - May 2008
Most Primary Care Health Professional Shortage Areas (HPSAs) exceed federal population-to-physician designation criteria, yet struggle to maintain access to primary care physicians. Policy options for recruiting and retaining primary care physicians to HPSAs, and new HPSA criteria that support access to primary care practices, should be considered. (One-Pagers)

Nonemergency medicine-trained physician coverage in rural emergency departments - April 2008
Nonemergency physicians provide a significant portion of emergency department care, particularly in rural areas. Medical specialties must cooperate to ensure the availability of high-quality emergency department care to all Americans regardless of physician specialty. (Articles)

Integrating primary care and mental health/substance use - March 2008
Bob Phillips, MD, MSPH, and Mary Jane England, MD; Washington Primary Care Forum #57 (Presentations)

Why there must be room for mental health in the medical home - March 2008
Most people with poor mental health are cared for in primary care settings, despite many barriers. Efforts to provide everyone a medical home will require the inclusion of mental health care if it is to succeed in improving care and reducing costs. (One-Pagers)

GIS and General Practice: Where are we going and when will we get there? - January 2008
(Monographs & Books)


Genomics and health care: Will primary care lead or follow? - December 2007
Greg Feero, MD, PhD; Washington Primary Care Forum #55 (Presentations)

The Patient Centered Medical Home: History, seven core features, evidence and transformational change - November 2007
(Monographs & Books)

Behavioral change counseling in the medical home - November 2007
Health-related behavioral counseling can and should be a central offering in the medical home. Primary care practices currently address unhealthy behaviors with their patients, but most practices lack the integrated approaches needed to effectively change these behaviors. Revisions in practice and financing are necessary to fully realize this capacity, which could affect the millions of patients served by the largest health care delivery platform in the United States. (One-Pagers)

Mrs. Aden wants to see you today... - October 2007
Henk Lamberts and Inge Okkes; Conference on Harmonizing Primary Care Clinical Classification and Data Standards (Presentations)

Harmonizing primary care clinical classification and data standards - October 2007
Presentations by Maurice Wood, MD; Larry A Green, MD; Michael Klinkman, MD, MS; Wilson Pace, MD; David Kibbe, MD, MBA; and Steven Waldren, MD, MS (Presentations)

Harmonizing primary care clinical classification and data standards - October 2007
(Monographs & Books)

Going global: Considerations for introducing global health into family medicine training programs - October 2007
Several hurdles can be anticipated in developing global health programs, including finances, meeting curricular and supervision requirements, and issues related to employment law, liability, and sustainability. (Articles)

The Shoulder to Shoulder Model: Channeling medical volunteerism toward sustainable health change - October 2007
The Shoulder to Shoulder model allows health care professionals to channel short-term medical volunteerism into sustainable health partnerships with resource-poor communities. The resulting network of partnerships offers a powerful resource available to governments and foundations, poised to provide innovative interventions and cost-effective services directly to poor communities. (Articles)

Access granted: The primary care payoff - August 2007
(Monographs & Books)

Seeking a replacement for the Medicare physician services payment method: A new approach improves health outcomes and achieves budgetary savings - July 2007
Key findings are that the single-payment rate is relatively inelastic to the Sustained Growth Rate (SGR) and expenditure levels and that the proposed service-specific payment rate promotes primary care, controls spending, and saves money. (Articles)

Medical school expansion: An immediate opportunity to meet rural health care needs - July 2007
The first expansion of allopathic medical education in 35 years is under way; this could eliminate rural physician shortage areas if students more likely to practice in rural areas are preferentially admitted and supported. (One-Pagers)

Rural origins and choosing family medicine predict future rural practice - July 2007
The shortage of physicians in U.S. rural practice may impact access to health care for one in five citizens. Two medical student characteristics that predict eventual practice in rural settings are clear: being born in a rural county and choosing a residency in family medicine. (One-Pagers)

Will medical school expansion help diversify the physician workforce? - July 2007
The racial/ethnic composition of U.S. medical schools does not reflect the U.S. population. With proper planning, the current medical school expansion could improve physician diversity and reduce health disparities. (One-Pagers)

ABC of patient safety: The healthcare policy context - June 2007
(Monographs & Books)

Primary care value proposition - June 2007
Robert Phillips, MD, MSPH; Academy Health Annual Research Meeting 2007 (Presentations)

Democratizing and displaying health data: Introducing - June 2007
A collaborative effort of the American Academy of Family Physicians, the Robert Graham Center for Policy Studies, the Health Foundation of Greater Cincinnati, and the University of Cincinnati, this site has three components: 1) Community Health View, 2) the Primary Care Atlas, and 3) the Health Center Mapping Tool. We describe the development and applications of this innovative platform, and how HealthLandscape helps its users to understand health and health needs in their community, evaluate programs, and influence policy. (Articles)

Use of patient registries in U.S. primary care practices - June 2007
Patient registries are necessary for high-quality health care, but even in innovative practices, their presence and utilization is inadequate. Registry uptake in primary care may be enhanced by improving the functionality of electronic health records (EHRs) and implementing payment models that reward registry use. (One-Pagers)

The distribution of IMGs in the U.S.: The interplay of poverty, rurality, and length of practice - May 2007
Xingyou Zhang, PhD; Martey Dodoo, PhD; Stephen Peterson, PhD; Andrew Bazemore, MD, MPH; Bob Phillips, MD, MSPH; AAMC Workforce Meeting (Presentations)

Quality: Wherefore art thou? - April 2007
Robert Phillips, MD, MSPH; STFM Health Care Policy Forum (Presentations)

An access deprivation index and HealthLandscape - April 2007
Robert Phillips, MD, MSPH, and Andrew Bazemore, MD, MPH (Presentations)

Impact of Title VII funding on community health center staffing and the National Health Service Corps - April 2007
Bob Phillips, MD, MSPH, and Diane R. Rittenhouse, MD, MPH; AAMC Workforce Meeting (Presentations)

The Canadian contribution to the U.S. physician workforce - April 2007
Minimizing emigration, and perhaps recruiting physicians to return to Canada, could reduce physician shortages, particularly in subspecialties and rural areas. In light of competing physician shortages, it will be important to consider policy options that reduce emigration, improve access to care and reduce reliance on physicians from developing countries. (Articles)

Giving everyone the health of the educated: An examination of whether social change would save more lives than medical advances - April 2007
Higher mortality rates among individuals with inadequate education reflect a complex causal pathway and the influence of confounding variables. Formidable efforts at social change would be necessary to eliminate disparities, but the changes would save more lives than would society’s current heavy investment in medical advances. Spending large sums of money on such advances at the expense of social change may be jeopardizing public health. (Articles)

Access denied: A look at America's medically disenfranchised - March 2007
(Monographs & Books)

The National Health Service Corps in rural counties: A historical review and impact assessment - March 2007
Robert Phillips, MD, MSPH, and Andrew Bazemore, MD, MPH; The National Health Service Corps in Rural Counties (Presentations)

Congruent satisfaction: Is there geographic correlation between patient and physician satisfaction? - January 2007
Despite geographic variation, there is a strong correlation between physician and patient satisfaction living in similar geographic locations. Further analysis of this congruence and examination of areas of incongruence between patient and physician satisfaction may aid in improving the healthcare system. (Articles)

How well do family physicians manage skin lesions? - January 2007
This study demonstrates that most skin lesions seen by office-based family physicians resolve within three months, patients are generally satisfied with the care they receive, and the diagnostic and treatment decisions made by primary care physicians are not significantly different from those of their dermatologic colleagues. (Articles)


Training on the clock: Family medicine residency directors' responses to resident duty hours reform - December 2006
Many FMPDs cited increased faculty burden and the risk of lower-quality educational experiences for their trainees. Innovations for increasing the effectiveness of teaching may ultimately compensate for lost educational time. If not, alternatives such as extending the length of residency must be considered. (Articles)

Imperative integration: Medical care for older patients - October 2006
The ecology of medical care changes for older people, with increases in usage of residential and institutional care, emergency departments, and home care. Care integrated across multiple settings, as is proposed for new models of primary care, is essential for the care of older patients. (One-Pagers)

Access, health and wealth: The impact of the National Health Service Corps in rural America, 1970-2000 - September 2006
(Monographs & Books)

Family physicians in the child health care workforce: Opportunities for collaboration in improving the health of children - September 2006
More than 5 million children and adolescents live in counties with no pediatrician. Unmet need, addressing health in the context of families and communities, and tackling "millennial morbidities" represent common ground for both specialties that could lead to specific, collaborative training, research, intervention, and advocacy. (Articles)

Learning from different lenses: Reports of medical errors in primary care by clinicians, staff, and patients - September 2006
Clinicians and staff offer different and independently valuable lenses for understanding errors and their outcomes in primary care, but both predominantly reported process- or system-related errors. There is a clear need to find more effective ways to invite patients to report on errors or adverse events. These findings suggest that patient safety organizations authorized by recent legislation should invite reports from a variety of health care workers and staff. (Articles)

National Health Service Corps staffing and the growth of the local rural non-NHSC primary care physician workforce - September 2006
These data suggest that the NHSC contributed positively to the non-NHSC primary care physician workforce in the rural underserved counties where its clinicians worked during the 1980s and 1990s. (Articles)

International medical graduates in family medicine in the United States of America: An exploration of professional characteristics and attitudes - July 2006
There are significant differences between IMG and USMG family physicians' professional profiles and attitudes. These differences from 1997 merit further exploration and possible follow-up, given the increased proportion of family physicians who are IMGs in the United States. (Articles)

Prometheus: Igniting payment reform - June 2006
Francois DeBrantes; Washington Primary Care Forum #49 (Presentations)

The US medical liability system: Evidence for legislative reform - June 2006
Significant reductions in malpractice payments could be realized if total or noneconomic damage caps were operating nationally. Hard noneconomic damage and total damage caps could yield lower premiums. If tied to a comprehensive plan for reform, the money saved could be diverted to implement alternative approaches to patient compensation or be used to achieve other systems reform benefiting patients, employers, physicians, and hospitals. (Articles)

Recent studies of the family physician workforce: Implications for education and training - May 2006
Bob Phillips, MD, MSPH; Andrew Bazemore, MD, MPH; Martey Dodoo, PhD; and Perry Pugno, MD; STFM Spring Conference (Presentations)

Examining the impact of closing family medicine residency programs - May 2006
Jessica McCann, MA; Valerie Reese, MD; Andrew Bazemore, MD, MPH; and Robert Phillips, MD, MSPH; STFM Annual Conference (Presentations)

The diminishing role of FPs in caring for children - May 2006
Nationwide, family physicians (FPs) deliver a smaller proportion of the outpatient care of children than they did 10 years ago. Millions of children depend on FPs for care. Family medicine should reevaluate how it will contribute to the care of the nation's children. (One-Pagers)

Family medicine training: Time to be counterculture, again - April 2006
Bob Phillips, MD, MSPH; Thomas L. Stern Lecture (Presentations)

Medicare Part D: Practical and policy implications for family physicians - April 2006
(Commentaries and Editorials)

Family physicians help meet the emergency care needs of rural America - April 2006
Ensuring access to emergency care in rural areas remains a challenge. High costs and low patient volumes make 100 percent staffing of rural emergency departments (EDs) by emergency medicine residency–trained physicians (EPs) unlikely. As rurality increases, so does the dependence on family physicians (FPs) to provide quality emergent care. (One-Pagers)

HealthSTAT: Making America's health care more affordable - February 2006
R. Eric Hart, MD; Washington Primary Care Forum #47 (Presentations)

Mind the gap: Medicare Part D's coverage gaps may affect patient adherence - February 2006
Medicare Part D will lower medication expenditures for many older patients. However, its complex design incorporates a staggered series of cost-sharing mechanisms that create gaps in coverage and may have a negative impact on medication adherence. (One-Pagers)

Medicare Part D: Who wins, who loses? - February 2006
The Medicare Part D prescription drug benefit aims to relieve the burden of out-of-pocket prescription drug costs for persons older than 65 years, but its effects will vary. Persons with low income and those without prior prescription coverage are projected to save the most, whereas those who lose employer-based coverage are predicted to pay more for their existing regimens. (One-Pagers)

Out-of-pocket prescription costs a continuing burden under Medicare Part D - February 2006
Of 29 million expected Part D beneficiaries, 6.9 million are projected to have annual out-of-pocket medication expenses greater than $750. Accounting for one fourth of all Part D enrollees, these beneficiaries also are most likely to have high aggregate health care costs, putting them at continued financial risk unless additional policy options are considered. (One-Pagers)


Primary care in the United States: problems and possibilities - December 2005
(Commentaries and Editorials)

UK lessons for US primary care - November 2005
(Commentaries and Editorials)

Who will have health insurance in the year 2025? - November 2005
If current trends continue, U.S. health insurance costs will consume the average households annual income by 2025. As health care becomes unaffordable for most people in the United States, it will be necessary to implement innovative models to move the system in a more equitable and sustainable direction. (One-Pagers)

Excess, shortage, or sufficient physician workforce: How could we know? - November 2005
At least three models have been used to project the future physician workforce, and each produces different results. No physician workforce predictions can be relied on until there is more consideration of and agreement on desired health outcomes and what physicians must do to achieve them. (One-Pagers)

Physician workforce: Legal immigrants will extend baby boom demands - October 2005
The baby boom generation will place large demands on the Medicare program and the U.S. health care system. These demands may be extended by a large legal immigrant population that will become Medicare-eligible soon after the baby boom generation does. The U.S. health care system should be prepared for sustained stress from this aging population. (One-Pagers)

Physician assistant and nurse practitioner workforce trends - October 2005
The physician assistant (PA) and nurse practitioner (NP) workforces have realized explosive growth, but this rate of growth may be declining. Most PAs work outside primary care; however, the contributions of PAs and NPs to primary care and interdisciplinary teams should not be neglected. (One-Pagers)

Number of persons who consulted a physician, 1997 and 2002 - September 2005
Most people in the United States consult a general physician each year, and some see other subspecialists. However, the proportion of people consulting a general physician who sees adults and children appears to be declining. (One-Pagers)

Patterns of visits to physicians' offices, 1980 to 2003 - September 2005
In the past quarter century, the number of office visits to physicians in the United States increased from 581 million per year to 838 million per year, with slightly more than one half of total visits since 1980 being made to primary care physicians. Most visits to primary care physicians were made to family physicians (FPs) and general practitioners (GPs) until the mid 1990s, when visits to general internists and general pediatricians exceeded visits to FPs and GPs. (One-Pagers)

Who filled first-year family medicine residency positions from 1991 to 2004? - August 2005
Graduates of U.S. allopathic schools have filled less than one half of the family medicine positions offered in the National Resident Matching Program (NRMP) Match since 2001. Overall fill rates in July have been relatively stable at approximately 94 percent. Family medicine has become reliant on international medical graduates (IMGs), who in 2004 made up 38 percent of first-year residents. (One-Pagers)

Osteopathic physicians and the family medicine workforce - August 2005
Historically, osteopathic physicians have made an important contribution to the primary care workforce. More than one half of osteopathic physicians are primary care physicians, and most of these are family physicians. However, the proportion of osteopathic students choosing family medicine, like that of their allopathic peers, is declining, and currently is only one in five. (One-Pagers)

The family physician workforce: The special case of rural populations - July 2005
People living outside metropolitan areas, especially those living in rural counties, depend on family physicians. Resolving the disparities in physician distribution nationwide will require solutions to make rural practice a viable option for more health care workers. (One-Pagers)

Physician workforce: The special case of health centers and the National Health Service Corps - July 2005
Federally funded health centers and the National Health Service Corps (NHSC) depend on family physicians (FPs) and general practitioners (GPs) to meet the needs of millions of medically underserved people. Policy makers and workforce planners should consider how changes in the production of FPs would affect these programs. (One-Pagers)

Notes from visit to National Primary Care Research and Development Centre, University of Manchester, England - June 2005
(Monographs & Books)

Cost-effective roles for nurse practitioners in secondary prevention - June 2005
(Commentaries and Editorials)

The family physician workforce: Quality not quantity - June 2005
(Commentaries and Editorials)

Overcoming obstacles in U.S. health care delivery with a new practice model for family practice - June 2005
This essay highlights some of the hurdles and obstacles that have hindered physicians and presents brief summaries of some proposals currently being discussed to overcome them. (Articles)

Family physicians and the primary care physician workforce in 2004 - June 2005
In 2004, there were 91,600 family physicians (FPs) and general practitioners (GPs) and 222,000 primary care physicians actively caring for patients, one for every 1,321 persons. These primary care physicians represent the largest and best-trained primary care physician workforce that has ever existed in the United States. (One-Pagers)

Four-year residency training for the next generation of family physicians - May 2005
(Commentaries and Editorials)

COGME's 16th Report to Congress: Too many physicians could be worse than wasted - May 2005
(Commentaries and Editorials)

Using the ecology model to describe the impact of asthma on patterns of health care - May 2005
The ecology model confirmed that having asthma changes the likelihood and pattern of care for Americans. More importantly, the ecology model identified a subgroup with asthma who sought only emergent or hospital services. (Articles)

Adding more specialists is not likely to improve population health: Is anybody listening? - March 2005
(Commentaries and Editorials)

What if we were equal? A comparison of the black-white mortality gap in 1960 and 2000 - March 2005
Using 2002 data, an estimated 83,570 excess deaths each year could be prevented in the United States if this black-white mortality gap could be eliminated. (Articles)

Patients' beliefs about racism, preferences for physician race, and satisfaction with care - March 2005
Many African Americans and Latinos perceive racism in the health care system, and those who do are more likely to prefer a physician of their own race or ethnicity. African Americans who have preferences are more often satisfied with their care when their own physicians match their preferences. (Articles)

Changes in age-adjusted mortality rates and disparities for rural physician shortage areas staffed by the National Health Service Corps: 1984-1998 - March 2005
From the early 1980s through the mid-1990s, the National Health Service Corps's goal to see health improve in rural health professional shortage areas was met, but its goal to diminish geographical health disparities was not. Because age-adjusted mortality rates improved in all county groups, the authors conclude that improvement was likely due to a variety of factors, including decreasing poverty and unemployment rates and increasing primary care physician-to-population ratios, to which the National Health Service Corps may have contributed. (Articles)

Report to the Task Force on the care of children by family physicians - January 2005
(Monographs & Books)

Avoiding and fixing medical errors in general practice: Prevention strategies reported in the Linnaeus Collaboration's Primary Care International Study of Medical Errors - January 2005
In general practitioners’ medical errors reports, a culture of individual blame is more evident than recognised need for systems design. A minority of reports contained specific, pragmatic suggestions for changing healthcare systems to protect patients’ safety. Error reporting systems may be a practical way to generate innovative solutions to potentially harmful problems facing general practice patients. (Articles)


The health impact of resolving racial disparities: An analysis of US mortality data - December 2004
Achieving equity may do more for health than perfecting the technology of care. (Articles)

When do older patients change primary care physicians? - November 2004
Older patients, and particularly those who are older and have more education and income, tend to stay with their PCP until they are forced to change. The longer they stay in the relationship, the better they feel about the quality of the primary services they receive. Changes in the health care system may have increased the number of patients forced to change PCP. (Articles)

The continuity of care record - October 2004
(Commentaries and Editorials)

The physician workforce of the United States: A family medicine perspective - October 2004
(Monographs & Books)

Variation in participation in health care settings associated with race and ethnicity - October 2004
Fewer blacks and Hispanics than whites received healthcare in physicians’ offices, outpatient clinics, and emergency departments in contrast to hospitals and home care. Research and programs aimed at reducing disparities in receipt of care specifically in the outpatient setting may have an important role in the quest to reduce racial and ethnic disparities in health. (Articles)

Modifiable determinants of healthcare utilization within the African-American population - September 2004
The three modifiable factors of poverty, uninsurance, and having a primary care medical home have a dramatic effect on patterns of care for African-American patients, and could be independently targeted for intervention (Articles)

The importance of having health insurance and a usual source of care - September 2004
The effects of insurance and having a usual source of care are additive. Efforts to improve health care access for all should provide a medical home and health insurance. (One-Pagers)

Follow-up on family practice residents' perspectives on length and content of training - September 2004
Although most surveyed residents favored a 3-year residency program, a substantial minority still supported extending training to 4 years, and the majority would still choose to enter family mdicine programs if theyr were extended. Given a lack of consensus about specific content areas, family medicine should consider a period of experimentation to determine how to best prepare future family physicians. (Articles)

A string of mistakes: The importance of cascade analysis in describing, counting, and preventing medical errors - August 2004
Cascade analysis of physicians’ error reports is helpful in understanding the precipitant chain of events, but physicians provide incomplete information about how patients are affected. Miscommunication appears to play an important role in propagating diagnostic and treatment mistakes. (Articles)

How family physicians are funded in the United States - July 2004
(Commentaries and Editorials)

Annals of Family Medicine is 1 year old: So what and who cares? - June 2004
(Commentaries and Editorials)

Future of family medicine recommendations confirm need for increased research from family physicians - June 2004
No abstract available. (Articles)

Splitting the difference: Patient preference vs conservation of resources - June 2004
(Commentaries and Editorials)

Geographic retrofitting: A method of community definition in community-oriented primary care practices - June 2004
This paper describes a technique called "geographic retrofitting" that has proved useful in establishing a rigorous definition of a practice's community based on current patterns of health care by the community. It also demonstrates how this approach, used in conjunction with geographic information systems software, facilitates more-powerful capabilities in community characterization and intervention. (Articles)

Chiropractors are not a usual source of primary health care - June 2004
Chiropractors are the largest source of office-based care in the United States that does not involve a physician, but people do not view chiropractors as primary providers of health care or advice. Unlike the care given by primary care providers, the majority of care provided by chiropractors is limited to musculoskeletal problems. (One-Pagers)

The research domain of family medicine - May 2004
The domain of family medicine research is important and ripe for fuller discovery, and it invites the thinking and imagination of the best investigators. It seems unlikely that medical research can ever be complete without a robust family medicine research enterprise. As the domain of family medicine research is explored, not a few, but billions of people will benefit. (Articles)

What people want from their family physician - May 2004
The public wants and is satisfied by care provided within a patient-physician relationship based on understanding, honesty and trust. If the U.S. healthcare system is ever to become patient-centered, it must be designed to support these values and sustain, rather than fracture relationships people have with their primary physician. (One-Pagers)

Few people in the United States can identify primary care physicians - May 2004
Almost one decade after the Institute of Medicine defined primary care, only one-third of the American public is able to identify any of the medical specialties that provide it, and only 17% were able to accurately distinguish primary care physicians from medical or surgical specialists and non-physicians. This lack of discrimination compromises the goal of achieving primary care for all and merits immediate attention. (One-Pagers)

Who are the uninsured elderly in the United States? - April 2004
This study reveals important gaps in the availability of health insurance for the elderly, gaps that are likely to affect an increasing number of older Americans in the coming decade. (Articles)

Specialist physicians providing primary care services in Colorado - April 2004
The contribution of specialists should be considered in future primary care needs assessments, and specialists who experience low demand for their particular specialties may be especially inclined to provide primary care services. (Articles)

Learning from malpractice claims about negligent, adverse events in primary care in the United States - April 2004
Claims data identify conditions and processes where primary health care in the United States is prone to go awry. The burden of severe outcomes and death from malpractice claims made against primary care physicians was greater in primary care outpatient settings than in hospitals. Although these data enhance information about error-related negligent events in primary care, particularly when combined with other primary care data, there are many operating limitations. (Articles)

The new model of primary care: Knowledge bought dearly - March 2004
(Monographs & Books)

Is primary care worthy of physicians? An ecological perspective - January 2004
(Monographs & Books)

The nature of primary care - January 2004
(Monographs & Books)

The Balanced Budget Act of 1997 and the financial health of teaching hospitals - January 2004
Teaching hospitals realized deep cuts in profitability between 1996 and 1999; however, these cuts were not entirely attributable to the Balanced Budget Act of 1997. The role of Medicare in supporting GME has been substantially reduced and needs special attention in the overall debate. (Articles)


The ecology of medical care for children in the United States: A new application of an old model reveals inequities that can be corrected - December 2003
If equal and adequate access to health care for children in the United States is a goal, we are failing. That failing is most prominent in the setting where most children receive care and preventive services—the doctor’s office. (One-Pagers)

A study of closure of family practice residency programs - November 2003
The rate of program closure is increasing, affecting programs that meet most measures of high quality. Quality programs are being lost, and the ultimate impact is yet to be seen. Program directors offer warning signs and advice that is generally applicable to other family practice residency programs. (Articles)

Exploring residency match violations in family practice - November 2003
Real and potential Match violations did occur, but there is also considerable confusion about what constitutes a violation. There are opportunities to investigate violations, train students to recognize and deal with violations, and clarify actual violation definitions and for programs to avoid the real and perceived violations that affect their recruiting. (Articles)

Why does a U.S. primary care physician workforce crisis matter? - October 2003
(Commentaries and Editorials)

General internists and family physicians: Partners in geriatric medicine? - October 2003
(Commentaries and Editorials)

Disparities in health care in the United States apparent in the ecology of medical care - October 2003
No abstract available. (Articles)

The need for research in primary care - October 2003
The knowledge base for family practice must be expanded by integration of multiple methods of comprehension, so we can bridge the gap between evidence and practice. (Articles)

The U.S. primary care physician workforce: Minimal growth 1980-1999 - October 2003
Growth in the primary care physician workforce (physicians per capita) in the United States has trailed the growth of the specialist physician population in recent years. This has occurred despite calls during the same period for increased production of primary care physicians and educational reforms focusing on primary care. (One-Pagers)

The U.S. primary care physician workforce: Undervalued service - October 2003
Primary care physicians work hard, but their compensation is not correlated to their work effort when compared with physicians in other specialties. This disparity contributes to student disinterest in primary care specialties. (One-Pagers)

The U.S. primary care physician workforce: Persistently declining interest in primary care medical specialties - October 2003
A persistent, six-year trend in the choice of specialty training by U.S. medical students threatens the adequacy of the physician workforce of the United States. This pattern should be reversed and requires the attention of policy makers and medical educators. (One-Pagers)

Family physicians are an important source of newborn care: The case of the state of Maine - August 2003
FPs provided 30 percent of inpatient newborn care in Maine in the year 2000. FPs cared for a large proportion of newborns, especially those insured by Medicaid and in smaller, rural hospitals where FPs also delivered babies. Family medicine’s commitment to serve vulnerable populations of newborns requires continued federal, state, and institutional support for training and development of future FPs. (One-Pagers)

Family physicians make a substantial contribution to maternity care: The case of the state of Maine - August 2003
Family physicians provided nearly 20 percent of labor and delivery care in Maine in the year 2000. A substantial proportion of this care was provided to women insured by Medicaid and those delivering in smaller, rural hospitals and residency-affiliated hospitals. As family medicine explores its future scope, research identifying regional variations in the maternity care workforce may clarify the need for maternity care training in residency and labor and delivery services in practice. (One-Pagers)

Variation in the ecology of medical care - July 2003
Frequency and location of health care delivery varies substantially with sociodemographic characteristics, insurance, and having a usual source of care. Understanding this variation can inform public consideration of policy related to access to care. (Articles)

Oral Vitamin D3 decreases fracture risk in the elderly - June 2003
The 5-year overall, age-adjusted fracture risk was lower for the patients receiving vitamin D (relative risk [RR]=0.78; 95% confidence interval [CI]=0.61–0.99). Important fractures were also significantly lower—that is, those occurring at the hip, wrist, forearm, or vertebrae (RR=0.67; 95% CI=0.48–0.93) Hip fractures, a known cause of severe morbidity in the elderly, were not significantly lower in the treated group; again, the study was probably too small or too brief to find a difference if one existed. With respect to secondary outcomes, the vitamin D group, compared with the placebo group, had no statistically significant difference in self-reported health and falls, or mortality from cardiovascular disease, cancer, or all causes. (Articles)

Receipt of preventive care among adults: Insurance status and usual source of care - May 2003
Having a usual source of care and health insurance are both important to achieving national prevention goals. (Articles)

The ecology of medical care for children in the United States - May 2003
The ecology of children's medical care is similar to that of adults in the United States in that a substantial proportion of children receive health care each month, mostly in community-based, outpatient settings. In all settings except emergency departments, receipt of care varies significantly by children's age, race, ethnicity, income, health insurance status, and whether they have a usual source of care. (Articles)

Family physicians are an important source of mental health care - April 2003
While comprising about 15 percent of the physician workforce, family physicians provided approximately 20 percent of physician office-based mental health visits in the United States between 1980 and 1999. This proportion has remained stable over the past two decades despite a decline in many other types of office visits to family physicians. Family physicians remain an important source of mental health care for Americans. (One-Pagers)

International medical graduates and the primary care workforce for rural underserved areas - March 2003
IMGS appear to have been no more likely than USMGs were to practice primary care in RUAs, but the distribution by specialty differs. (Articles)

Family physicians' solutions to common medical errors - March 2003
In two U.S. studies about medical errors in 2000 and 2001, family physicians offered their ideas on how to prevent, avoid, or remedy the five most often reported medical errors. Almost all reports (94 percent) included at least one idea on how to overcome the reported error. These ideas ranged from “do not make errors” (34 percent of all solutions offered to these five error types) to more thoughtfully proposed solutions relating to improved communication mechanisms (30 percent) and ways to provide care differently (26 percent). More education (7 percent) and more resources such as time (2 percent) were other prevention ideas. (One-Pagers)

Consequences of medical errors observed by family physicians - March 2003
In two studies about medical errors, family physicians reported health, time, and financial consequences in nearly 85 percent of their error reports. Health consequences occurred when the error caused pain, extended or created illness, or placed patients, their families, and others at greater risk of harm. Care consequences included delayed diagnosis and treatment (sometimes of serious health conditions such as cancer), and disruptions to care that sometimes even resulted in patients needing care in a hospital. Other important consequences were financial and time costs to patients, health care providers, and the health system generally. However, sometimes no consequence was apparent. (One-Pagers)

The effects of the 1997 Balanced Budget Act on family practice residency training programs - February 2003
The 1997 BBA did not have an immediate significant negative impact on family practice residency programs. However, there is a worrisome increase in the rate of family practice residency closures since 1997. A mechanism needs to be established to monitor all primary care program closures to give an early warning should this trend continue. (Articles)

Types of medical errors commonly reported by family physicians - February 2003
In a group of studies about medical errors in family medicine, the five error types most often observed and reported by U.S. family physicians were: (1) errors in prescribing medications; (2) errors in getting the right laboratory test done for the right patient at the right time; (3) filing system errors; (4) errors in dispensing medications; and (5) errors in responding to abnormal laboratory test results. “Errors in prescribing medications” was the only one of these five error types that was also commonly reported by family physicians in other countries. (One-Pagers)

Mapping tools for monitoring the safety net - January 2003
(Monographs & Books)

Family physicians increase provision of well-infant care despite decline in prenatal services - January 2003
Over the past 20 years, both FP/GPs and pediatricians have upheld their commitment to preventive care for infants. Non-Metropolitan Statistical Areas (non-MSAs) depend on family physicians for almost half of their well-infant care. In fact, FP/GPs have increased their overall provision of well-infant care despite a decline in delivery of prenatal services. This commitment to child health care demands continued excellence of FP training in pediatric medicine, preventive care, and child advocacy. (One-Pagers)


Family physicians are the main source of primary health care for the Medicare population - December 2002
Of people 65 years and older who reported an individual provider as their usual source of health care, 60 percent identified a family physician or general practitioner. The Medicare population relies heavily on family physicians. (One-Pagers)

Family physicians' declining contribution to prenatal care in the United States - December 2002
There has been a substantial decline in prenatal care by family physicians over the past 20 years in all geographic regions of the country. Even so, during the past two decades, FP/GPs have provided over two million prenatal visits per year. As the field re-explores future scope, it should consider the erosion of the provision of prenatal care, its effect on the U.S. population and the specialty, and possibilities for revitalization of prenatal care in residency curricula and practice. (One-Pagers)

Classification of medical errors and preventable adverse events in primary care: A synthesis of the literature - November 2002
Original research on medical errors in the primary care setting consists of a limited number of small studies that offer a rich description of medical errors and preventable adverse events primarily from the physician's viewpoint. We describe a classification derived from these studies that is based on the actual practice of primary care and provides a starting point for future epidemiologic and interventional research. Missing are studies that have a patient, consumer, or other health care provider input. (Articles)

Can nurse practitioners and physicians beat parochialism into plowshares? - September 2002
The country can ill afford doctors and nurses who ignore one another's capabilities and fail to maximize each other's contributions cost-effectively. A collaborative, integrated health care workforce could improve patient care. (Articles)

Family practice in the United States: A status report - September 2002
To reflect on and reconsider the role of family practice in US health care, this article reviews the development of the status of family medicine in the United States, and comments on issues that are of ongoing important to family practice. (Articles)

Accounting for graduate medical education funding in family practice training - September 2002
More than half of family practice training programs do not know how much GME they receive. These findings call for improved accountability in the use of Medicare payments that are designated for medical education. (Articles)

A preliminary taxonomy of medical errors in family practice - September 2002
This medical error taxonomy, developed from self-reports of errors observed by family physicians during their routine clinical practice, emphasizes problems in healthcare processes and acknowledges medical errors arising from shortfalls in clinical knowledge and skills. Patient safety strategies with most effect in primary care settings need to be broader than the current focus on medication errors. (Articles)

GME financing reform: The saga continues - August 2002
(Commentaries and Editorials)

Family practice in the United States: Position and prospects - August 2002
Family practice's mistakes include expending much effort on justification and less on assuring practical means to accomplish its work; permitting an erosion of public trust; failing to strengthen relationships with interfacing specialties and organizations; and neglecting research. Nonetheless, there are promising opportunities to improve health and health care through strengthening family practice that depend in part on redesigning the family practice setting, defining carefully critical interactions with other elements of the health care system, fostering discovery of family practice, and further differentiating family practice as a scientific and caring field. Another period of adaptation by family practice is already under way; this may be the first time in history that its ambitious aspirations are actually achievable. (Articles)

Title VII funding is associated with more family physicians and more physicians serving the underserved - August 2002
Title VII funding of departments of family medicine at U.S. medical schools is significantly associated with expansion of the primary care physician workforce and increased accessibility to physicians for the residents of rural and underserved areas. Title VII has been successful in achieving its stated goals and has had an important role in addressing U.S. physician workforce policy issues. (One-Pagers)

An international taxonomy for errors in general practice: A pilot study - July 2002
This pilot study indicates that errors are likely to affect primary care patients in similar ways in countries with similar primary healthcare systems. Further comparative studies are required to improve our understanding of general practice error differences between Australia and other countries. (Articles)

What physicians need to know about seniors and limited prescription benefits and why - July 2002
More and more often, seniors are faced with outpatient prescription benefits that have annual spending limits and may be forced to cut back on use of medications when they run out of benefits before the end of the year. Family physicians can play a valuable role by helping seniors choose the best value medications for their budgets and by checking whether or not seniors can afford their prescriptions. (One-Pagers)

First morning back - June 2002
This diary-based report documented the increasing difficulty of practicing in primary care settings. Medical knowledge and skills are, in general, the easy part; getting into a position to apply them is the challenge. (Articles)

The association of Title VII funding to departments of family medicine with choice of physician specialty and practice location - June 2002
Title VII has been successful in achieving its stated goals and legislative intent and has had an important role in addressing US physician workforce policy issues. (Articles)

The increase in international medical graduates in family practice residency programs - June 2002
Family practice is becoming increasingly reliant on IMGs to fill residency positions. (Articles)

Making choices about the scope of family practice - May 2002
(Commentaries and Editorials)

The delicate task of workforce determination - March 2002
(Commentaries and Editorials)

Length and content of family practice residency training - March 2002
Most respondents support the current three year model of training. There is considerable interest in changing both the length and content of family practice training. Lack of consensus suggests a period of elective experimentation may be needed to assure that family physicians are prepared to meet the needs and expectations of their patients. (Articles)

Does career dissatisfaction affect the ability of family physicians to deliver high-quality patient care? - March 2002
An inability to care for patients is significantly associated with career dissatisfaction. This relationship has implications for the achievement of policy objectives related to access, having a usual source of care and quality. (Articles)

Patients' rights in the United States: From 'down-under' the situation seems upside-down - February 2002
No abstract available. Free full text version available. (Articles)

The role of family practice in different health care systems: A comparison of reasons for encounter, diagnoses, and interventions in primary care populations in the Netherlands, Japan, Poland, and the United States - January 2002
Even under different conditions there was substantial overlap in the top 30 symptom/complaint reasons for encounter, incidence rates, and encounters per diagnosis in the 4 countries we studied. This striking resemblance supports the concept of the reason for encounter as a core element of the consultation with a family physician. Similarities between the databases are much better reflected by the way patients formulate their demand for care than in the diagnoses by the family physician. US patients also see providers other than family physicians for common problems; it remains unclear whether a limited group brings most of their health problems to a family physician or whether most people visit a series of primary care physicians. Possibilities to further develop episode-oriented epidemiology in family practice have considerably increased with this study. The potential for comparative studies has also increased with the introduction of complete electronic patient records based on the documentation of episodes of care with the ICPC and with its mapping to International Classification of Disease-10th revision (or the 9th revision clinical modification.) (Articles)


It takes a balanced health care system to get it right - December 2001
(Commentaries and Editorials)

Taking necessary steps to position U.S. health care to be the best - November 2001
No abstract available. Full, free text available. (Articles)

Using geographic information systems to understand health care access - November 2001
Given the relative universality of such data collection from CHCs nationwide and recent political commitment to doubling the capacity of CHCs over the next five years, we suggest options for developing centralized processes for evaluating CHC service areas and local unmet health care access needs. (Articles)

Uncoordinated growth of the primary care workforce - November 2001
Family physicians, nurse practitioners and physician assistants are distinctly different in their clinical training, yet they function interdependently. Together, they represent a significant proportion of the primary care work force. Training capacity for these three professions has increased rapidly over the past decade, but almost no collaborative work force planning has occurred. (One-Pagers)

The ecology of medical care revisited - October 2001
No abstract available. (Articles)

Family physicians' experiences of their fathers' health care - October 2001
Even patients with a knowledgeable physician family member face challenges in receiving optimal medical care. Patients might receive better treatment if health care systems reinforced the role of an accountable attending physician, encouraged continuity of care, and emphasized the value of knowing the patient as a person. (Articles)

Role conflicts of physicians and their family members: Rules but no rulebook - October 2001
Conflicting rules of appropriate conduct, compounded by the inadequacies of modern health care, make the role of physician-family member especially challenging. The medical profession needs a clearer, more trenchant understanding of this role. (Articles)

Trumping professional roles: Collaboration of nurse practitioners and physicians for a better U.S. health care system - October 2001
Professional turf battles have yielded variations in the scope of practice for nurse practitioners (NPs) obstructing collaboration with physicians that would enhance patient care. Patients would be better served if NPs and physicians worked together to develop better combined models of education and service that take advantage of the benefits of both professions' contributions to care. (One-Pagers)

The contemporary ecology of US medical care confirms the importance of primary care - September 2001
More women, men and children receive medical care each month in the offices of primary care physicians than any other professional setting. There is an urgent need for health policies that encourage further innovation and implementation of first-rate primary care for everyone. (One-Pagers)

Hispanic versus white, non-Hispanic physician medical practices in Colorado - August 2001
These findings argue for special provision to admit ethnic minorities to undergraduate and graduate medical education programs. (Articles)

Direct graduate medical education payments to teaching hospitals by Medicare: Unexplained variation and public policy contradictions - May 2001
Inherent inequities in DME funding seriously undermine the current Medicare GME payment system's capacity to contribute to US physician workforce reform and to improve access to care. There is actually a financial incentive to train residents in areas in which there is relatively less need for their services. (Articles)

The United States relies on family physicians, unlike any other specialty - May 2001
Designation of a county as a Primary Care Health Personnel Shortage Area (PCHPSA) depends on the number of primary care physicians practicing there. Without family physicians, an additional 1332 of the United States' 3082 urban and rural counties would qualify for designation as primary care HPSAs. This contrasts with an additional 176 counties that would meet the criteria for designation if all internists, pediatricians and ob/gyns in aggregate were withdrawn. The United States relies on family physicians, unlike any other specialty. (One-Pagers)

Keystone III: The role of family medicine in a changing health care environment - April 2001
A dialogue conference proceedings (Monographs & Books)

The view from 2020: How family practice failed - April 2001
This article is part of a special issue of Family Medicine dedicated to The Keystone Papers: Formal Discussion Papers from Keystone III. (Articles)

A preface concerning Keystone III - April 2001
This article is part of a special issue of Family Medicine dedicated to The Keystone Papers: Formal Discussion Papers from Keystone III. (Articles)

Practice based primary care research networks - March 2001
(Commentaries and Editorials)

The patient safety grid: Toxic cascades in health care settings - March 2001
The Patient Safety Grid shows the fields where action is necessary in a comprehensive national effort to reduce harm from medical errors. Each segment of the grid is important and connected to others, sometimes forming a toxic cascade. (One-Pagers)

Toxic cascades: A comprehensive way to think about medical errors - March 2001
Current thinking about threats to patient safety caused by medical errors is often focused in hospital on the immediate consequences of mistakes that affect specific aspects of care, such as testing procedures or medications. Some mistakes, however, become apparent distant from where they were committed and only after a lapse in time. The model of a toxic cascade organizes an approach to making U.S. health care safer for patients by locating upstream sources and downstream consequences of errors within a comprehensive, multilevel scheme. (One-Pagers)

Shortchanging adolescents: Room for improvement in preventive care by physicians - February 2001
Adolescents visit physicians infrequently. When they do, few receive counseling on critical adolescent health issues. Both family physicians and pediatricians have room for improvement. (Articles)


The importance of primary care physicians as the usual source of healthcare in the achievement of prevention goals - November 2000
Having a usual source of care enhances achieving clinical prevention goals for both children and adults. There is room for improvement, and differences between the practices of internists and family physicians suggest that slightly longer visits and having health insurance might contribute to achieving proven prevention strategies. medica (One-Pagers)

The importance of having a usual source of health care - August 2000
Most people (82%) in the United States have and use a usual source of care, and a majority of them name a particular primary care physician as that source. Regardless of self-reported health status, people benefit from having a usual source of health care even if they are uninsured. (One-Pagers)

The effect of accredited rural training tracks on physician placement - July 2000
Accredited family practice rural training tracks place their graduates in rural settings at very high rates: 76% overall and 88% among programs implemented in the last ten years. Favorable, immediate results could be expected from their continuation and expansion, permitted by adjustments in the Balanced Budget Act of 1997. (One-Pagers)

Putting practice into research - June 2000
(Commentaries and Editorials)

Primary care research - March 2000
(Commentaries and Editorials)

Educating doctors to provide counseling and preventive care: Turning 20th century professional values head over heels - March 2000
We draw on data from the National Ambulatory Medical Care Survey to compare roles of primary care physicians and other office-based medical specialties in delivering preventive health care. We also estimate the cost of providing preventive care in terms of physician time. Finally, we contemplate how medical education values must change in the US and other countries if 21st century physicians are to be prepared to meet the health care needs of their communities. (Articles)


Rhetoric, reality and revolution in family practice and primary care - December 1999
(Commentaries and Editorials)

The development and goals of the AAFP Center for Policy Studies in Family Practice and Primary Care - November 1999
In this article we describe the creation and role of the Center for Policy Studies in Family Practice and Primary Care established by the American Academy of Family Physicians in Washington, DC, this year. We recount the events leading to the decision to implement the Center, list its guiding assumptions, and explain its initial structure and function. We also identify the three themes that will guide the early work of the Center: sustaining the functional domain of family practice and primary care; investing in key infrastructures; and securing universal health coverage. (Articles)

Multi-method assessment of access to primary medical care in rural Colorado - March 1999
The results of simultaneous application of distance-to-care and provider-to-population techniques unrestricted by geographic boundaries, depict access to primary medical care and corresponding consumer difficulty more fully than previously done. Further combination of methods of needs assessment such as those used in this analysis may better inform the future efforts of organizations mandated to address health care underservice in rural areas. (Articles)

Health care transition counseling for youth with special health care needs -

Trends in Office-Based Care for Reproductive-Aged Women According to Physician Specialty: A Ten-Year Study -

Evidence and Tools for Advocacy from The Robert Graham Center -
(Presentations - 33-page PDF file; About PDFs)

Innovations in Family Medicine Education: Early Learnings from the P4 Initiative -
(Presentations - 18-page PDF file; About PDFs)

Residencies as a high leverage policy target: Learnings from the I3 and I3 PCMH Collaboratives -
(Presentations - 13-page PDF file; About PDFs)