Health Service Professionals

Health Service

Professionals

Chapter 4

Health Services ProfessionalsLearning Objectives

To recognize the different types of health service professionals

To differentiate between primary and specialty care, and the causes for imbalance between the two in the U.S.

Discuss maldistribution in the physician labor force

To help overcome the physician imbalance and maldistribution

To understand the role of non physician providers

To identify Allied Health professionals and their role

The discuss the functions and qualifications of health service administrators

Health Services Professionals

• The US health care industry is the largest and most powerful employer– 3% of the total labor force– 16% of the Gross Domestic Product in 2005

• Health care will continue to grow because:1) growth in population

2) aging of the population

Types of professionals:– Physicians– Nurses– Dentists– Pharmacists– Optometrists– Psychologists– Podiatrists– Chiropractors– Nonphysician practitioners– Health administrators– Allied health professionals

• Therapists• Social Workers• Educators


• Health professionals among most educated and diverse– Look at Tabl 4-1, page 118

• Work places– Hospitals– Managed Care Organizations– Nursing Homes– Mental health facilities– Insurance firms– Pharmaceutical Companies– Outpatient– Community Health Centers– Mental Health Centers– School Clinics– Many others – you name a few


• 42.6% employed by hospitals

• 13% by nursing and personal care facilities

• 11.4% physician offices and clinics


Health Personnel • Physicians

– Play a central role in evaluating the patient

– States require licensure• Graduate from an accredited medical

school

• Pass licensure

• Complete residency– Paid graduate medical education

» 2-6 years

– number of active physicians increased

• Look at Table 4-2, page 120

• Physicians Two types:

– MD - Doctor of Medicine

» views medical treatment as active intervention to counter reaction to neutralize the effects of disease

» Most are Specialist

– DO – Doctor of Osteopathic Medicine

» emphasizes the musculoskeletal system of the body such corrections of joints or tissue

» Most are Generalist

Health Personnel

• MDs and DOs – Both use accepted methods of treatment

• (ie drugs, surgery)

– They differ in their:• Philosophies and approach to medicine

Health Personnel

• Osteopathic medicine

– Practiced by DO’s

– Stresses preventative medicine• (ie diet, environment, other factors)

– Takes a holistic approach

– < 6% of physicians are osteopaths

Health Personnel

Health PersonnelPhysicians: Generalists and Specialists

– Primary Care Physicians (Primary Care Provider) / Generalists

• Train in family medicine/general practice, general internal medicine and pediatrics

• Provide preventative medicine– (ie exams, immunizations, mammographies, pap smears)

• Patients problems less severe and occur less frequently

Physicians: Generalists and Specialists

– Specialists• Physicians in nonprimary care specialties

• Must seek certification in a medical specialization

• Takes more years of advanced residence training plus years of practice

• 6 Functional Groups:1) internal med2) medical3) Obstetrics/Gynecology4) Surgery5) Hosp-based Radiology, anesthesiology, pathology6) Psychiatry

• Look at Exh 4-1, page 122• Look at Tbl 4-3, page 123

Health Personnel

Physicians: Generalists and Specialists

– Specialists

• General Practitioner/Family Practice accounts for greatest proportion of ambulatory care visits

• Obstetrics/Gynecology:– spent most hours in patient care per week

– highest in operating expense and malpractice premium

• Surgeons paid most ($269,000 per year)

Health Personnel

Difference between Primary and Specialty CareDifference between Primary and Specialty Care

Primary Care– Different accord to time, focus and scope of service to patients

• 5 Areas of Distinction:

1) the first contact to the health care system

2) in managed care, primary care providers are “gate-keepers”

3) primary care is longitudinal, they follow up in treatment and coordinate care

• they serve as patient advisors and advocates

4) focuses on the whole person• holistic, integrates

5) spend much time in ambulatory care settings

Specialty Care

– 5 Areas of Distinction:

1) Seen after patient has seen a General Practitioner usually

2) Requires referral from a Primary Care Provider to see a patient

3) Episodic, more focused and intense

4) Limited to an illness episode– Deal with specific disease or body organs

5) Time spent in inpatient hospitals, using state-of art technology

Difference between Primary and Specialty CareDifference between Primary and Specialty Care

Issues in Medical Practices1) Involvement in Clin Practice Guidelines

2) Threat of Compromise

3) Lopsided Medical Training

4) Aggregate physician Oversupply

5) Geographic Maldistribution

6) Specialty Maldistribution

7) International Medical Graduates (IMG)

Issues in Medical Practices1) Involvement in Clinical Practice Guidelines

– To align practices with research

– Due to increase in health care cost, the viability of the health care delivery system is under constant threat

– Physicians are constantly justifying cost over benefit

2) Threat of Compromise– Physicians’ professional judgment

compromised to meet managed care’s financial arrangements

3) Lopsided Medical Training– Too many specialists in a primary care setting

Issues in Medical Practices4) Aggregate Physician Oversupply

– 173% increase from 1950 to 1990

– Balanced Budget Act ’97 capped residency that Medicare would pay

– Payments >$7 billion per year, >$70,000 per resident– Government does not mandate how these physicians

will be trained

– Led to unnecessary health care expense

– Shortages in parts of the country exist

– Maldistribution• a surplus or shortage of physician types needed to

maintain the health status of a population

Issues in Medical Practices5) Geographic Maldistribution

– Shortages outside metropolitan areas (<50k)

• Shortages exist because:– Less income

– Less professional interaction

– Little access to facilities and technology

– Less continuing education and professional growth

– Lower standards of living

– Fewer social and cultural diversities

– Less education for children

Issues in Medical Practice6) Specialty Maldistribution

– An imbalance between primary and specialty care

• From 1979 to 1999, – the number of primary care physicians increased by

only 18%,

– the number of specialists increased 118%

• In the US, – approximately 40.8% of the physicians are generalists

– approximately 59.2% are specialists

» 25-50% in other countries are specialists

Issues in Medical PracticeReasons for specialty maldistribution:

1) Medical technology

2) Reimbursement methods

3) Specialty-oriented medical education• (See Table 4-6 page132)

• Specialists:– Make more– Better work hours– More prestige– Use high technology– Intellectual challenge

Issues in Medical Practice

Consequences of Too Many Specialists:

– High volume of intensive, expense and invasive procedures

– Rises health care costs

– Surgeries grew at two times the rate of population growth

Key Issues in Medical Practice

7) International Medical Graduates (IMG)

– Steadily growing

– ¼ of residency positions are filled by IMGs

– Move from rural to urban areas thereafter

– Not the solution to the maldistribution

Types of Health Care Personnel• Dentists

– Dental Hygienists– Dental Assistants

• Pharmacists• Other Doctoral-Level Health

Professionals– Optometrists– Psychologists– Podiatrists– Chiropractors

• Nurses– Registered Nurses– Licensed Practical Nurses– Advanced Practice Nurses

• Non Physician Practitioners– Physician

Assistants– Nurse

Practitioners– Certified Nurse

Midwives• AH Professionals

– (includes many health-related professionals)

– See Chart 4-2, page 144

• Health Services Administrators

Dentists• Must be licensed to practice

– DDS – Doctor of Dental Surgery– DDM – Doctor of Dental Medicine

• Eight specialties recognized by American Dentist Association

• Orthodontics – straighten teeth• Oral/maxillofacial surgery – mouth and jaw• Pediatric dentistry• Periodontics – treat gums• Prosthodontics – artificial teeth or dentures• Endodontics – root canals• Public health dentistry – community• Oral pathology – disease of the mouth

Dentists• Major role:

– Diagnose and treat dental problems related to teeth, gums and mouth

• Dental hygienists– Do preventative dental care

• Clean, educate• Must be licensed

• Dental Assistants– Help in the preparation, exam and treating of

patients– Do not need licensure

PharmacistsRole:

– Dispense medicine prescribed by doctors, dentists, podiatrists, psychiatrists

– Consult on selected uses of medicine

– Need license to practice• PharmD degree, 6 years of education• $84,900 in 2004

Other Doctoral-Level Health Professionals

• Optometrists

• Psychologists

• Podiatrists

• Chiropractors


• Optometrists

– Provide vision care with• Exams, diagnostics, correction

– Need license

– Doctor of Optometry (OD)

– Usually work in solo or group practices


• Psychologists

– Provide patients with mental health care

– Need license

– Doctor of Philosophy (PhD)

or Doctor of Psychology (PsyD)


• Podiatrists

– Treat disease or deformities of the feet• Includes surgeries, medicine, corrective

devises

– Need a license

– Doctor of Podiatric Medicine (DPM)


• Chiropractors

– Treatment by hand manipulation, physiotherapy and dietary counseling

– Help patients with neurological, muscular, vascular problems

– Believes body is self-healing

– Do not prescribe medicine or do surgery

– Need license to practice

– Doctor of Chiropractic (DC), 4 years

Nurses

• The largest group of health care professionals

• Profession developed after World War I

• The major caregivers of sick and injured patients– Addressing physical, mental and emotional needs

• Need to be licensed to practice– 2 levels:

• Registered Nurses (RN)• Licensed practical nurses (LPN)

Nurses

• As average length of stay decreased, demand for nursing fell,– but patients are sicker and more nurses are

needed– work more intensive

• Shortfall of 110,000 nurses– 120,000 trained but not working

• In 2020, shortfall will be 340,000 RNs if current trends continue

NursesReasons for shortfall:

– sluggish wages

– low job satisfaction

– inadequate career mobility

– falling nursing enrollments

– demand from other alternative hospital sites

Nurses

Nurse Reinvestment Act of 2002– grants and scholarships to attract and keep

– most money goes to nursing schools, but hospitals will benefit

– encouraging nurses to get:• higher education • training • internships • retention • to enhance role of nurses

Advanced Practice NursesNurses who have an education and clinical

experience is required for a Registered Nurse

4 Areas of Specialization:1) Clinical Nurse Specialist (CNS) – hospital

2) Certified Registered Nurse Anesthetist (CRNA)

3) Nurse Practitioners (NP) - primary care

4) Certified Nurse Midwives (CNM)

Nonphysician Practioners (NPP)

– Clinical professionals who practice in many areas similar to a physician, but

• do not have a physician or DO degree

– “Delivery extenders”

Nonphysician Practioners– Physician Assistant (PA)

• Part of the health care team who works in a dependent relationship with a supervising physician to provide comprehensive care

• Licensed to do medical procedures under supervision of a physician

– supervision can be on or off-site

• Duties include:– evaluation, monitor, diagnostics, therapy, counseling,

referral

• Follows a medical model– focuses on disease

Nonphysician Practioners

Nurse Practitioners

– have completed study with competence of an RN in an expanded role

– largest group of NPPs that has most growth, but• may be declining

– follows a nursing model with• health promotion and education

Allied Health Professionals

• Includes many health-related areas

• Constitutes 60% of U.S. health care workforce

• 2 Broad Categories:1) technicians/assistants2) Therapists/technologists

– Look at Exh 4-2, page 144

Health Service Administrators

• Employed at various levels of organizations

• Manage integrated delivery organizations that are complex

• MHA - Master in Health Administration• MHSA - Master in Health Serv Admin• MBA – Master in Business Administration• MPH – Master in Public Health• MPA - Master in Public Administration/Affairs

Health Service Administrators

Challenges:– financing and payment structures– work with decreasing levels of reimbursement– pressure of uncompensated care– high quality– community health service– demands by both public and private payers– new policy developments– changing competitive environment– maintaining integrity

Summary

• Health care is the largest labor force

• Professions influenced by:– demographic trends– advances in research and technology– disease and illness trends– changing environment

Health Service Professionals

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