A consistent pattern in medical training is hard to ignore: many students enter wanting to work in primary care with underserved groups, yet later choose to pursue specialty careers. I’d like to think these intentions are sincere, but something during training redirects them. That pattern isn’t about greed or moral failure–it’s a signal that we… Read More »
Burnout among physicians and clinicians has reached alarming levels. Primary care, in particular, sits at the intersection of growing patient complexity, rising administrative burden, and relentless performance pressures tied to quality metrics and value-based care. Health systems increasingly look to team-based care as part of the solution, yet integration often happens without fully understanding how… Read More »
Veterans experiencing housing insecurity face severe health risks. They have high rates of chronic disease, mental health disorders, and substance use. These conditions drive emergency department visits and hospitalizations far above population norms. Homelessness and unstable housing are powerful social determinants of acute care use. Addressing them is essential to improve outcomes and reduce costs.… Read More »
Greetings, dear readers, and welcome to our 2025 wrap-up! In the US, 2025 has been a very challenging year for many in clinical and public health practice and research. With funding cuts, layoffs, and reductions-in-force, many of our readers (and yours truly) had to face the fact that our livelihoods were no longer secure. It… Read More »
Imagine walking into an indoor public health conference and many people are smoking cigarettes. The air is filled with toxic smoke. You might be coughing and likely outraged. It wasn’t long ago that this was the reality of life in public spaces. That is, until public health stepped in and worked to enact smoking bans… Read More »
What just happened, and why people are talking about it In late September 2025, FDA announced it would start a process to add language to acetaminophen labels noting a possible association with autism and ADHD when used during pregnancy, and it sent a notice to physicians [pdf] summarizing the concern. The move followed statements from… Read More »
Imagine being discharged from the hospital, IV bandage still fresh, only to recover on a sidewalk with no shelter, no food, and no doctor to check on you. In the turbulent landscape of American healthcare, medical respite (MR) services have emerged as one of the most promising interventions for people experiencing homelessness. Medical respite programs… Read More »
The Centers for Medicare & Medicaid Services (CMS) released its proposed rule for the 2026 Medicare Physician Fee Schedule. And big changes may be coming–including some potential for payments to primary care to increase, and for payments to other specialties to decrease. Though the changes are controversial, they might be just what primary care needs.… Read More »
The Medicaid cuts are dire in the Big Beautiful Bill. Some of the forthcoming changes and cuts are still a couple of years away, but now is the time to prepare. We should remember how important Medicaid is and why, and continue to talk widely about its value and its challenges. We should also understand… Read More »
This post from KFF Health News is republished here in line with The Medical Care Blog’s declaration that our theme for 2025 is ‘the Political Determinants of Health‘. As fired and retired scientists rallied outside in the Atlanta heat, an advisory panel that Robert F. Kennedy Jr. handpicked to replace experts he’d fired earlier met… Read More »
There has been a constant battle for Medicaid in America – from states slashing Medicaid reimbursements or refusing to expand access, to Congress now threatening to cut and restrict Medicaid funding altogether. The program, which funds 78.4 million of our most vulnerable patients, is a necessity to primary care. Medicaid beneficiaries look like pregnant women… Read More »
The transition to value-based care (VBC) is fundamentally transforming the healthcare landscape, and 2025 is poised to be an inflection point to see whether the promise of VBC can be realized. For healthcare professionals – and especially for ambulatory care practices – embracing the nuances of this dynamic environment is essential not only for delivering… Read More »
When we talk about chronic illness, the conversation usually centers on medications, treatment plans, or physical symptoms. But for those who live with long-term health conditions, it’s often about so much more than what’s happening in the body. Chronic illness doesn’t just disrupt routines, it affects how people work, plan, connect with others, and, crucially,… Read More »
Breast cancer is the second leading cause of cancer death in the US for women. The American Cancer Society estimates that over 40,000 women will die from breast cancer in 2025. On top of that, according to the Centers for Disease Control and Prevention, there are around 11,500 new cases of cervical cancer, and about… Read More »
The recent budget resolution passed by the House of Representatives proposes significant spending cuts, including approximately $880 billion from programs under the jurisdiction of the House Committee on Energy and Commerce, which encompasses Medicaid. This proposal has raised concerns about potential reductions in Medicaid funding, a program that currently provides health coverage to over 72… Read More »
I ask my patients to do a lot of things: reduce stress, move more, and eat healthier. I also encourage them to use phones, cigarettes and other addictive substances less. One thing I don’t often ask them to do is play more, and I think I am missing something important. And maybe I am missing… Read More »
Women’s health is a broad and multifaceted concept that extends far beyond reproductive anatomy and sexual health. Historically, the focus of women’s health care and research has centered on reproduction, often overshadowing other critical aspects of physical and mental health and wellness. However, women’s health encompasses a wide array of issues, from cardiovascular and autoimmune… Read More »
The pharmaceutical industry is a behemoth in the United States. In 2023, the 20 largest pharmaceutical companies had a market capitalization of $3.78 trillion dollars. Pharma companies spent more than $15 million dollars in contributions through political action committees during the 2020 election cycle. Analysts constantly see new avenues of generating revenues and profits for… Read More »
I am a health economist, trained to make sense of messy data. I generally work amidst a sea of numbers. But I’ve found that seeking out stories in health services research–those of doctors and patients–can help me anchor what’s truly important in research. These stories may also help researchers communicate the value of their work… Read More »
How patients are seeing their doctor is changing, and that could shape access to and quality of care for decades to come. More than 100 million Americans don’t have regular access to primary care, a number that has nearly doubled since 2014. Yet demand for primary care is up, spurred partly by record enrollment in… Read More »
What comes to mind when you hear the word “weathering”? Perhaps you think of erosion, depletion, and wearing down. Or maybe enduring, surviving, and withstanding. All of these associations accurately describe what happens to our bodies in response to chronic stress. This particular type of physiological stress affects the brain and other parts of the… Read More »
In this post, we examine how the COVID-19 pandemic affected frequencies of diagnoses and claims costs in the Affordable Care Act (ACA) marketplaces in 2020 and 2021. The ACA marketplaces are critical sources of coverage for millions of Americans and were increasingly so during the COVID-19 pandemic due to job losses and coverage disruptions. The… Read More »
The United States Preventive Services Task Force has recommended lung cancer screening for at-risk groups since 2013, and updated again in 2021. This is a simple procedure involving a low dose of radiation used to take a CT image of the chest. If utilized by most eligible Americans, screening could reduce lung cancer mortality by… Read More »
Human Immunodeficiency Virus (HIV) has gone from a deadly infection to a manageable health condition in the last thirty years. Today, we have medications available that can treat those with HIV and prevent HIV in uninfected people. Pre-exposure prophylaxis, also known as PrEP, is a medication given to individuals without HIV to keep them from… Read More »
Last month, the Centers for Medicare and Medicaid Services (CMS) Innovation Center announced its newest alternative payment model for primary care, Making Care Primary (MCP). MCP builds upon lessons learned from previous CMS primary care models: the Comprehensive Primary Care Initiative, the Comprehensive Primary Care Plus (CPC+) initiative, the Maryland Primary Care Program, and Primary… Read More »
Primary care in the US is segregated by racial/ethnic identification. What are the implications? Most people in the US are aware that our neighborhoods are often highly segregated by race and ethnicity. Racism — historical and current, structural and individual — plays a role in neighborhood demographics. The same forces also result in segregated workplaces,… Read More »
Public health has preached a lot of things in the three years of the COVID-19 pandemic. It has promoted social distancing, masks, vaccines, and quarantine to help prevent the spread. And it has helped spread awareness about antivirals for people infected with COVID-19. But what about “social fitnessing”? This is the premise that the… Read More »
To address calls for improving health equity, organizations could consider using CLAS Standards to advance diversity, equity, and inclusion (DEI). In recent years, health organization leaders have prioritized the need to address systemic inequities. A 2021 survey of health care organizations identified health equity as a top priority [pdf]. This focus has grown since the… Read More »
Community-based clinicians sometimes see patients who have been recently released from immigration detention. Those encounters can be challenging, especially when patients reveal health harms experienced while in detention. It is obviously critical that clinicians provide high-quality medical care and address any health issues potentially brought about or exacerbated by their detention history. But do they… Read More »
Better care coordination may improve access to primary care for people who are dually eligible for Medicare and Medicaid. Recent evaluations of the Financial Alignment Initiative (FAI)–an initiative incentivizing the financial alignment of Medicare and Medicaid–suggests care coordination could improve access to primary care services for some dually eligible beneficiaries. Care coordination alone, however, may… Read More »
It is more important than ever to expand access to a broad range of safe and effective contraceptives that includes long-acting reversible contraception (LARC) methods. We are living in a new era in the US. As of early November, 2022, abortions are banned from the point of conception in 12 states and severely restricted in… Read More »
Over the last 25 years, researchers have documented the broad impact of behavioral interventions on a range of psychological and physical health outcomes. Despite the promise of evidence-based treatments, a common challenge for practitioners is ensuring treatment adherence to maximize benefits. This is especially challenging for most chronic conditions. Integrating research and recommendations from medication… Read More »
It is not too late to fix the US healthcare system. But every day spent in this folly, the problem gets worse. It is time to move this conversation forward. We are excited to share that in November 2021, the American Public Health Association (APHA) formally adopted a policy statement titled “Adopting a Single-Payer Health… Read More »
In a previous post, we shared highlights from an event about fixing health care featuring Dr. Michael Fine, a family medicine physician, former public health official, and the author of Health Care Revolt. The faculty of the Department of Public Health at California State University Los Angeles led the event as part of a department-wide book read.… Read More »
In our first blog post of this series, we discussed how the current medical approach misses so much of what influences health, and how it perpetuates health inequities in our society. In this post, we go in-depth on the elements of Whole Person Health (WPH) that are necessary components of a just and equitable approach… Read More »
Our current U.S. medical system doesn’t work. It is not able to adequately care for the sickest, most vulnerable, and least resourced people. It often excludes those seen as “other” in our society. To become a just system, we need a new focus on Whole Person Health (WPH). Very briefly, WPH cares for the whole person and… Read More »
Like others working at the intersection of public health and medicine, my faith in primary care has long been unshakeable. Increasingly actualized as the Patient-Centered Medical Home (PCMH), primary care has experienced a decade plus of attention thanks to efforts at retooling and rebranding the field. But in the last week, a tiny crack formed… Read More »
While some health outcomes improve in the United States, racial and ethnic disparities in pregnancy-related outcomes persist. In the United States, Black women are three times more likely to die from a pregnancy-related complication than white women. In Kansas, Black women are more than three times as likely to die of pregnancy-related complications compared to… Read More »
The pace of progress is never fast enough for those who stand to suffer the biggest losses. Nowhere is this more apparent than in the glaring health inequities impacting Black mothers and babies in Kansas. Among the multitude of injustices Black Kansans face today, the disproportionate rates of death and devastating health complications for Black… Read More »
In March 2020, the Centers for Disease Control and Prevention (CDC) confirmed COVID-19 as a pandemic. More than 18 months later, the nation has yet to return to ‘normal’. Hope for normalcy increased with the rollout of COVID-19 vaccines in the months that followed. Reluctance and resistance to vaccination, however, have made it difficult to… Read More »
Front-line workers are always at risk. It’s in the name. The COVID-19 pandemic has made this reality more salient for everyone. Risks of sickness from COVID-19 include death and morbidity. Front-line workers may also have lost more friends and co-workers than the average person. Healthcare workers have also been subject to violence and see the… Read More »
Homelessness persists in the US, and across the world, despite decades of recognition and longstanding efforts to end the condition. There have been major successes in our understanding of what policies and programs work to prevent and end homelessness. However, the work must and will find new ways to adapt and improve if we are… Read More »
How is research on patient-centered transitional care going? A supplement on this topic funded by the Patient-Centered Outcomes Research Institute (PCORI) was recently published in Medical Care. Care transitions are “ripe with hazard,” as discussed in an editorial from Amy Berman. As pointed out by Berman, figuring out what works and what doesn’t is critical to… Read More »
Until a few years ago Veterans generally had to visit a Veterans Affairs (VA) facility to receive care. Long wait times and long travel times caused problems for Veterans who needed healthcare. In response, the VA MISSION Act (2018) expanded access to community providers and increased benefits for caregivers. A recent supplement in Medical Care explores some… Read More »
The US maternal mortality rate is higher than it was a quarter of a century ago. For every one person that dies, another 65 almost die. We do not adequately care for mothers and mothers-to-be. Not only that, but as providers, we inadvertently (and at times overtly) inflict obstetric violence, through both individual actions and our… Read More »
During its recent mid-year meeting, the American Public Health Association’s Medical Care Section was honored to hear from two physician leaders serving at the heart of the fight against COVID-19. Hailing from opposite ends of the country, Drs. Atul Nakhasi (California) and Ayne Amjad (West Virginia) shared their insight about teamwork in a public health… Read More »
COVID-19-related scams are spreading nearly as fast as COVID-19 and threatening the health and safety of our communities. Since January 2020, people across the country have filed over 426,000 COVID-19-related complaints to the Federal Trade Commission (FTC) about fraud, identify theft, and other consumer protection. They have reported losses totaling over $397 million. As trusted… Read More »
As we are overcoming the COVID-19 pandemic, the obesity pandemic is worsening. The United States is the most obese country in the world. Is it time to admit defeat in this 30-year battle against obesity? Only 1 in 122 mildly obese people with a primary care physician will achieve a normal weight, according to a… Read More »
President Biden released the National Strategy for the COVID-19 Response and Pandemic Preparedness on January 21, 2020. It is an ambitious attempt to decrease the spread of the novel coronavirus and get hundreds of millions of Americans immunized. This COVID-19 vaccine plan, however, is missing a key element. Namely, primary care. An incomplete national strategy for… Read More »
Last week, we discussed three noteworthy trends from the past decade in treating the opioid crisis. The first was recognizing medication for opioid use disorder (MOUD) as the standard of care. The second was formalizing an addiction medicine specialty. And the third was expanding the availability of MOUD. This week, we’ll consider three additional trends in… Read More »