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Today’s Topic: Health Care Professionals
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Transcript of Today’s Topic: Health Care Professionals
Today’s Topic:
Health Care Professionals
Objectives for today Describe the evolution of the medical
profession and medical practices
Discuss the supply of physicians in the United States
Discuss the other major health care professionals
Rise of the medical profession
Medicine is the most powerful profession (at least in America)
How have MDs achieved more power than architects, engineers, or even managers?
Docs haven’t always been so dominant (from Starr)
Romans Physicians frequently slaves, freedmen, or
foreigners 18th c. England
Only persons beneath physicians were surgeons and apothecaries
19th c. America Surgeons in same social class as barbers
What about the rest of the world?
Medical profession not as powerful in other highly developed nations
Former Soviet Union - $ comparable to factory workers
Japan - managers make more $
United Kingdom - $ salaries much lower than U.S. docs
The Rise of the Medical Profession
General characteristics of a profession: Self-regulating Unique body of knowledge High level of training Service orientation Code of ethics
Authority of medical profession (from Starr)
The authority of MDs differentiates them from other professions
Authority is the ability to control others’ behaviors
2 roots of authority Dependence Legitimacy
Derivations of dependence
Knowledge, competence of a professional
Belief that bad consequences will occur if one does not obey professional
Unique reasons we are dependent upon medical profession They have scientific knowledge They make decisions for us
Derivations of legitimacy
Acceptance that you should obey Based on...
Rational, scientific grounds Affirmation by peer group Judgement/advice is meant to do good
When legitimacy is in doubt, dependence almost usually still exists
Cultural and social authority
Social authority: Giving of commands (e.g. when parent tells you what to do; when boss tells you what to do)
Cultural authority: Our views of reality which affect our reactions to commands from others.
Consolidation of medical authority
Greater cohesion Referrals to specialists Changes in pre-industrial America Better transportation Telephones Differentiation of labor
Consolidation (continued)
Standardization of medial education In mid to late 19th c., a lot of sects within
medicine Homeopaths: thought disease could be
cured/caused by drugs; thought that disease caused by a suppressed itch.
Eclectics: thought herbal medicine was best treatment.
Consolidation (continued)
First medical school at Univ. of Pennsylvania in 1765 Doctors only went to school for four years
Abraham Flexner’s report Recommended closure of many medical schools
Now, over 100 medical schools in U.S. Doctors have 8 years of undergraduate education
Medical authority and conversion into economic power
AMA: established in 1846. Hospitals and drug companies dependent
upon physicians as gatekeepers Doctors against national health insurance,
prepaid group practices, and company employment
Physician incomeSpecialty Mean Std. Dev.Internal Medicine $133,346 54,218
Family/General Practice 131,968 55,755
Pediatrics 118,366 54,015
Medical Specialties 162,087 76,778
Surgical Specialties 226,917 91,860
Psychiatry 128,459 52,141
ObGyn 201,526 87,554
All 148,271 72,945
Measuring supply No. of physicians per 100,000
enrollees No. of physicians per 10,000 residents
Supply/pop. ratios do not account for.. Physician productivity Health of the population Physicians who travel around to provide
care
No. of excess physicians (from Wennberg)
780
24403
1283
5074
3469
8385
6706
131065
12871
8406
0 20000 40000 60000 80000 100000 120000 140000
Radiologists
Primary Care
Urologists
Anesthesiologists
Ophthalmologists
OB/GYN
Orthopedic surgeions
All specialists
General surgeons
Cardiologists
Consequences of increased supply
Increased competition, shift in employment Solo practice, fee for service Group practice, capitation
HMOs Staff model Group model Network model IPA
Rural/urban distribution of M.D.s
While there is an oversupply overall, too few physicians in many rural counties
Strategies to increase rural supply
Medical schools have increased output from 1965 to now Assume that graduates will go to rural
areas Oversupply, competition in urban areas
could drive some to rural areas Training in rural areas
Strategies to increase rural supply
National Health Services Corp. Indenture program Physicians often leave after their time is
completed Oversupply, competition in urban areas
could drive some to rural areas Training in rural areas
International medical graduates
Supply has increased in 1990s Why?
Some specialties need more docs Rural locations Teaching hospitals
Osteophathic medicine
Osteopathy is similar to allopathic medicine Reimbursed by Medicaid, Medicare, &
most private insurance Tends to stress joint manipulation and
diet more than allopathic
Physician Assistants (PAs) and Nurse Practitioners (NPs)
PAs work under supervision of physicians can diagnose, manage, treat common
diseases NPs have a similar role
Midwives, family NPs, psych. NPs Emphasize prevention, counseling
Rise of nursing
Early 1900’s, Nurses tended to be social derelicts, past
prostitutes (Rosenberg’s The Care of Strangers)
Today, a respected and large (the largest) health care profession
Professionalization of nursing
Led by Florence Nightingale Argued that only women are caring
enough to be nurses Physicians agreed with this
they didn’t want nurses involved in technical aspects
Nurse training in early 20 c.
Nurse training was a good deal Free room and board Usually sponsored by hospitals (as is still
the case in Japan) Hospitals got cheap labor in return
Hospital & Health Administration
Relatively young “profession” Is it even a profession? Demand, education accompanied
hospital growth
HHA Education
1st master’s degree program University of Chicago, 1934
1st Ph.D. degree program University of Iowa, 1950
MHA predominant degree, # MBA programs increasing
Public health education
Educational cores Epidemiology Health behavior and promotion Environmental health and toxicology Health management and policy Biostatistics
Primary degree: MPH