A complete shift in society is not likely or even advisable, for a number
of reasons.

However a shift of a small % or incremental change is possible.

For great improvements in rural hospitals, all it took was a few % diverted
to Critical Access Hospitals.

For maximal physician distribution to serve rural and underserved peoples,
just a few % more into family medicine did it as in the graduates of 1995 -
1997.

For greatly improved child development and education interventions, we need
to (example of Headstart)
1. focus on teachers with degrees
2. relieve funding agencies of the constant pressures of funding that can
take half or more of energies and resources
3. can steadily increase funding to meet current demand and work toward
future demand

When we focus too much on the big picture, sometimes all we do is overwhelm
people, even our colleagues who work with us, as I recently found out.

In all of our everyday existence trying to work with challenging
populations on a one to one basis, the last thing our colleagues need is to
find out that there is little hope since this is pervasive, across systems,
across all levels, etc.

We can also overwhelm those in government that we hope to influence.

We can also be easily discarded by leaders in medicine or other areas, who
would often like to ignore the poor, the rural, the different, etc.
Overwhelming needs make it easy to do so. Specific and incremental
improvements based on natural experiments and real outcomes are a different
matter.

Robert C. Bowman, M.D.
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