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Research ArticleOriginal Research

Who is Caring for the Underserved? A Comparison of Primary Care Physicians and Nonphysician Clinicians in California and Washington

Kevin Grumbach, L. Gary Hart, Elizabeth Mertz, Janet Coffman and Lorella Palazzo
The Annals of Family Medicine July 2003, 1 (2) 97-104; DOI: https://doi.org/10.1370/afm.49
Kevin Grumbach
MD
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L. Gary Hart
PhD
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Elizabeth Mertz
MPA
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Janet Coffman
MPP
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Lorella Palazzo
MA
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  • The underserved need all the help they can get!
    Howard K. Rabinowitz
    Published on: 30 July 2003
  • Caring for the under-served: who, when and where?
    Roger A Rosenblatt
    Published on: 29 July 2003
  • Published on: (30 July 2003)
    Page navigation anchor for The underserved need all the help they can get!
    The underserved need all the help they can get!
    • Howard K. Rabinowitz, family physician

    This is an excellent study. It clearly shows that irrespective of the definition of underserved which is used, family physicians and nonphysician primary care providers take care of a disproportionate share of these populations. Prior research has also shown that these outcomes can be increased even further through programs that provide preferential admissions (for special characteristics such as rural background), cl...

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    This is an excellent study. It clearly shows that irrespective of the definition of underserved which is used, family physicians and nonphysician primary care providers take care of a disproportionate share of these populations. Prior research has also shown that these outcomes can be increased even further through programs that provide preferential admissions (for special characteristics such as rural background), clinical experiences, and financial and practice support. Taken together, I agree with Roger Rosenblatt that there is more than enough ‘evidence’ about what to do in order to better address this problem.

    This study also makes it clear that no single discipline is going to be able to solve this problem by itself. Those who are underserved need all the help they can get – from all types of primary care providers! And primary care providers will have more clout if they address these issues cooperatively.

    Competing interests:   None declared

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    Competing Interests: None declared.
  • Published on: (29 July 2003)
    Page navigation anchor for Caring for the under-served: who, when and where?
    Caring for the under-served: who, when and where?
    • Roger A Rosenblatt, family physician

    One reason that the under-served are under-served is that most clinicians practice in urban areas near insured patients. As Grumbach and his collaborators show, about 13% of Californians and 24% of Washingtonians live in rural areas of their states, but pediatricians, internists and obstetricians work in cities, for the most part. Only family physicians and especially physician assistants are consistently more likely...

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    One reason that the under-served are under-served is that most clinicians practice in urban areas near insured patients. As Grumbach and his collaborators show, about 13% of Californians and 24% of Washingtonians live in rural areas of their states, but pediatricians, internists and obstetricians work in cities, for the most part. Only family physicians and especially physician assistants are consistently more likely to settle in rural areas than general members of the population at large.

    The most fascinating part of this article in my opinion is the extent to which physician assistants have distributed themselves in under-served locations. This is a case where an entire profession was created largely around the need to augment the supply of health professionals to under-served populations – and it worked! Family physicians and nurse practitioners have also followed this pattern, fulfilling the expectation of those who sparked these programs. We can affect the distribution of health professionals, and we can do it with the programs that we have built and sustained over the last 30 years.

    So the question is why don't we do more of it? Given the failure of attempts to craft universal health insurance, health professional interventions are relatively inexpensive ways to affect access to health care. Although Grumbach's evidence is indirect, it certainly suggests that we do know how to make a difference. So let's do more of it!

    Competing interests: None declared

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    Competing Interests: None declared.
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The Annals of Family Medicine: 1 (2)
The Annals of Family Medicine: 1 (2)
Vol. 1, Issue 2
1 Jul 2003
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Who is Caring for the Underserved? A Comparison of Primary Care Physicians and Nonphysician Clinicians in California and Washington
Kevin Grumbach, L. Gary Hart, Elizabeth Mertz, Janet Coffman, Lorella Palazzo
The Annals of Family Medicine Jul 2003, 1 (2) 97-104; DOI: 10.1370/afm.49

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Who is Caring for the Underserved? A Comparison of Primary Care Physicians and Nonphysician Clinicians in California and Washington
Kevin Grumbach, L. Gary Hart, Elizabeth Mertz, Janet Coffman, Lorella Palazzo
The Annals of Family Medicine Jul 2003, 1 (2) 97-104; DOI: 10.1370/afm.49
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