No Job Is Finished Until the Electronic Work Is Done

A FEW EXAMPLES

Here are just a few examples of how the TRACK discussion since the last issue provides important context for published articles.

In the last issue of Annals, research by Starfield and Freyer concludes that “the United States disproportionately uses graduates of foreign medical schools from the poorest and most deprived countries to maintain its primary care physician supply.”¹ From the TRACK discussion you can:

• Read Fitzhugh Mullan’s analysis from Washington (and the author response) that “underlying the current primary care brain drain is the chronic failure of the United States to train sufficient physicians for our overall practice needs. International medical graduates essentially fill the residency positions that US graduates don’t take. They are a massive buffer in our system. We currently train 75% of our physicians and import 25%. As long as we create a physician labor vacuum by not educating enough medical students, doctors from the rest of the world will arrive to fill our residency vacancies and remain in practice destabilizing and impoverishing health systems in many parts of the world.”^2,3

• See a defense from a physician in Beaver Dam, Kentucky, of foreign physicians pursing the American Dream⁴ and Dr Starfield’s reply.⁵

• See how market forces in Moscow, Idaho, where an experienced family physician earns $90,000 and a new radiologist earns $350,000 per year, might be contributing to the disproportionate market-driven training of specialists over generalists in the United States.⁶

• Read a detailed perspective from a health care professional in Cuba who was allowed to post his comment anonymously because of fear of retribution for his views.⁷

• Find a suggestion from a health economist at the World Health Organization regional office in Brazzaville, the Congo, on how the United States can provide “atonement for poaching of human resources for health from poor countries.”⁸

In another study in the last issue of Annals, Ferrer finds that “primary care clinicians, especially family physicians, deliver a disproportionate share of ambulatory care to disadvantaged populations.”⁹ In TRACK comments we read:

• George Rust’s analysis of “primary care and the pursuit of health equity.”¹⁰

• Elizabeth Bayliss’ challenge “not to leap to the assumption that just because FPs provide more care to disadvantaged populations than do the other provider groups examined, that subsequent policies to increase numbers of FPs could reduce health disparities by increasing visit access for these at-risk populations. This approach assumes that a major problem behind health disparities is that disadvantaged populations are getting insufficient access to care due to insufficient numbers of primary care clinicians. But disadvantaged populations are complex and are ‘disadvantaged’ for multiple reasons.”¹¹

You also can read online the perspective of Azeem Majeed, Professor of Primary Care and head of the Department of Primary Care & Social Medicine at Imperial College, London,¹² on Mercer and Watt’s study¹³ that finds evidence for Julian Tudor-Hart’s Inverse Care Law.¹⁴

A working mother and psychologist¹⁵ brings both perspectives to interpreting a study of the health of working mothers 11 weeks after the birth of their baby.¹⁶

Reflections from 2 residency directors^17,18 on the article on no-shows featured in last issue’s Annals Journal Club¹⁹ led the study author to summarize his review of related literature and his own experience “that most people really do tend to make choices that look entirely rational once you understand their circumstances.”²⁰

A family physician uses TRACK to challenge a Family Medicine Update on a new organizational initiative from one of the Annals sponsors. Under the title “Let’s not confuse advocacy for our specialty with advocacy for patients,” she writes,

[W]e must be honest with ourselves and others when engaging in our public advocacy. Meeting our goals as an organization may also benefit our patients and patients in general; I hope very much it does. But our priorities as a profession and specialty are not the same as those of patients. … Often when I read statements released by physician groups tying their interests to the needs of patients, the connection rings false, and the patient benefit argument is thin. Family medicine has a proud tradition of doing what is right rather than what is expeditious. Let us continue in that vein as we proceed down this next path we’ve chosen. Let us be honest about what we hope to accomplish with each advocated position, and about whom we hope to benefit.²¹

A CALL TO JOIN THE COMMUNITY

Which articles in this or previous issues stimulate your thinking and feeling? Are your insights represented in the knowledge community? Please complete your contribution to the electronic work by sharing your insights on at least one Annals article at http://www.AnnFamMed.org. Each article has a link to click in the upper right-hand corner, or you can click on “Discussion of Articles” on the home page.