U.S. Health Care Delivery:
Providers & Professionals
Objectives
• Gain broad understanding of the different
health services professionals employed in health
delivery settings
• Understand the training requirements, major
roles, practice settings, and critical issues of
various health services professions
• Learn of imbalances between primary care and
specialty care services as well as practitioner
maldistribution affecting health services
U.S. Health Care
Providers & Professionals
• Health care: largest, most powerful employer
• Continued growth of health care industry
• Reasons for growth in demand for
professionals
– Population trends
– Research & technology
– Disease trends
– Changes in health care financing & service delivery
Who are the people in your
neighborhood?
Who Are Health Services
Professionals?
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Physicians
Nurses
Dentists
Pharmacists
Optometrists
Psychologists
Podiatrists
Chiropractors
Health services
administrators
• Non-physician
practitioners (NPP)
– Physician Assistants
– Nurse Practitioners
– Nurse Midwives
• Allied health
professionals
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Therapists
Laboratory technicians
Radiology technicians
Social workers
Health educators
Where Do Health Services
Professionals Work?
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Hospitals
Nursing care facilities
Physicians’ offices & clinics
Managed care organizations
Mental health centers
Insurance firms
Pharmaceutical companies
Outpatient facilities
Community health centers
Diagnostic imaging centers
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Ambulatory surgery centers
Ambulatory care clinics
Migrant health centers
School clinics
Laboratories
Voluntary health agencies
Professional health
associations
• Colleges of medicine and
allied health professions
• Research institutions
Physicians
• Long, irregular hours
• Highly competitive
• Demanding education
and training
requirements
• Good job opportunities
– particularly in rural &
low-income areas
• http://www.bls.gov/oco
/ocos074.htm
Physicians
• Key role
– Evaluate patient’s health condition & determine
significance
– Diagnose abnormalities & prescribe treatment
• Training requirements
– Medical school, Licensure, Residency
• Typical work settings
– Offices, Hospitals, Outpatient clinics
Physicians
• Reasons for growth in physician power
– Urbanization
– Advances in science and technology
– Institutionalization
– Dependency
– Cohesiveness and organization
– Licensing
– Educational reform
Physicians: MDs vs. DOs
• Both use traditionally accepted methods of
treatment, including drugs & surgery
• Doctor of Medicine (MD): Allopathic
– Philosophy of intervention
– Most MDs are specialists
• Doctor of Osteopathic Medicine (DO)
– Philosophy of prevention & holistic approach
– Most DOs are generalists
Physicians: Generalists vs. Specialists
• Generalists (a.k.a. primary care physicians)
– Provide preventive services and treat frequently
occurring to less severe problems
• Specialists
– Provide services to treat problems that occur less
frequently or require complex approaches
• Hospitalists
– Specialty organized around the site of care
Generalists vs. Specialists:
Training Requirements
• Generalists
– Complete 3-year residency
• Specialists
– Seek certification in an area of medical
specialization
– Additional years of advanced residency training
& practice in the specialty
• Hospitalists
– Train under various primary care concentrations
Physicians:
Primary Care vs. Specialty Care
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Point of contact?
Utilizing resources?
Course of treatment?
Focus?
Level of care?
Training settings?
Physicians:
Imbalance & Maldistribution
• Aggregate physician oversupply
• Despite sharp increases in the aggregate
surplus of physicians, physician shortages still
exist in certain parts of the country
– Geographic & specialty maldistribution
– What is a maldistribution?
– How does maldistribution affect health services?
Physicians:
Imbalance & Maldistribution
• Geographic maldistribution
– Metropolitan areas vs. rural or inner-city areas
– Basic source of problem:
need-based vs. market-based models
• Specialty maldistribution
– Oversupply of specialists
– Contributing factors?
Physicians:
Imbalance & Maldistribution
• Imbalance between generalists and
specialists has several undesirable
consequences
– High volume of expensive services = rising costs
– Shortage of primary care = less effective care
– Shortage of primary care = access problems
• How to counteract maldistribution?
Physicians: Defensive Medicine
• Malpractice insurance represents a
considerable cost of doing business for
physicians
• Ways to reduce likelihood of lawsuits
• Physicians perform services or tests that may
not be medically necessary to protect
themselves from the threat of future
litigation…but what are the consequences?
Dentists
• 3 out of 4 are solo
practitioners
• Admission to dental
school competitive
• Good job opportunities
– large number of
dentists expected to
retire
• http://www.bls.gov/oco
/ocos072.htm
For fun…
http://www.youtube.com/watch?v=bOtMizMQ6oM&feature=related
Dentists
• Key role
– Diagnose and treat problems related to teeth,
gums, and tissues of the mouth
– Prevention of dental decay and gum disease
• Training requirements
– Graduation, Examination, Licensure
• Typical work settings
– Private offices, Retail stores, Government clinics
Dentists
• Eight specialty areas
– Growth of dental specialties influenced by
technological advances
• Growing demand for dental care
– Reasons?
• Growing concerns
– Efficiency, competition, financing
Pharmacists
• Variable hours: some
required to work nights,
weekends, & holidays
• 65% work in retail
settings
• Increasing involvement
in counseling &
planning drug therapy
programs
• http://www.bls.gov/oco
/ocos079.htm
Pharmacists
• Key role
– Prepare & dispense medicines prescribed by
physicians, dentists, and podiatrists
– Provide education and consultation on the
proper selection and use of medicines
– Identify, prevent, and resolve drug-related
problems
• Training requirements
• Typical work settings
Pharmacists
• Most pharmacists are generalists, but some
pharmacists become specialists
– Pharmacotherapists
– Nutrition-support pharmacists
– Radiopharmacists or nuclear pharmacists
Other Doctoral-Level
Health Professionals
• Optometrists
– Provide vision care
• Psychologists
– Provide patients with mental health care
• Podiatrists
– Treat patients with foot diseases or deformities
• Chiropractors
– Provide chiropractic treatment to patients
Nurses
• Largest health care
occupation
• RNs, LVN/LPNs
• 60% of RNs, 25% LVN/LPNs
work in hospitals
• Issues with job retention,
replacement due to aging
work force
• RNs:
http://www.bls.gov/oco/oc
os083.htm
• LVN/LPNs:
http://www.bls.gov/oco/oc
os102.htm
Nurses
• Key role
– Major caregivers of sick and injured patients
– Address physical, mental, and emotional needs
• Training requirements
– Educational preparation distinguishes between
two levels of nurses
• Registered nurses (RNs)
• Licensed practical (vocational) nurses
(LPNs/LVNs)
Nurses
• Largest group of health care professionals
• Originally most nurses worked in private duty
• Profession developed around hospitals after
World War I
• Federal support for nursing education
increased after WWII
Nurses
• Work in a variety of settings
• Nursing encompasses numerous roles
• Current shortfall of nurses
– Aging workforce
– Nursing work becoming more intensive
– Growth in alternative settings
– Increasing patient population
– Major impediments to attract and retain nurses
Advanced-Practice Nurses
• General name for nurses who have education
and clinical experience beyond that required
of an RN
• Four areas of specialization
• Serve as direct caregivers and perform other
various professional activities
• Includes nurses with master’s- or PhD-level
nursing education
Nonphysician Practitioners
• Clinical professionals who practice in many of
the areas in which physicians practice but do
not have an MD or a DO degree
• Also referred to as “nonphysician clinicians”
or “midlevel providers” or “physician
extenders”
• Work in close consultation with physicians
Nonphysician Practitioners
• Physician Assistants
– Assist supervising physicians in patient care
– Evaluation, monitoring, diagnostics, therapeutics,
counseling, and referral
• Nurse Practitioners
– Largest group of nonphysician practitioners
– Promote wellness and good health through patient
education
• Certified Nurse Midwives
– Deliver babies, provide family planning education,
and manage gynecologic and obstetric care
Nonphysician Practitioners
• Efforts to establish roles began in 1960s
• Studies have confirmed efficacy of NPPs
– High-quality and cost-effective care
– More time spent with patients
– Improved access to primary care
• Numerous issues to be resolved among NPPs
Allied Health Professionals
• Defined as an individual who has received a
certificate; associate’s, bachelor’s, or
master’s degree; doctoral level preparation;
or, postbaccalaureate training in a science
related to health care
• Constitute approximately 60% of the U.S.
health care work force
• Divided into two broad categories
Allied Health Professionals
• Technicians & Assistants
– Trained to perform procedures requiring supervision
from therapists or technologists
– Respiratory therapy technicians
• Technologists & Therapists
– Receive more advanced training
– Know how to evaluate patients, diagnose problems,
and develop treatment plans
– PTs, OTs, Dietitians, Dispensing opticians,
Audiologists, Social workers, etc.
Allied Health Professionals: History
• Growth in technology and specialized
interventions placed greater demands on the
time physicians and nurses spent with patients
• Allied Health Professionals received specialized
training
• Provided physicians and nurses with time to
effectively serve in their areas of expertise and
keep informed of latest advances in their
disciplines
Health Services Administrators
• Excellent job
opportunities for those
with business skills
• Master’s degree a
standard credential
• Typically work long
hours, on-call
• http://www.bls.gov/oco
/ocos014.htm
Health Services Administrators
• Top-level
– Responsible for operational, clinical, and financial
outcomes of the entire organization
– Provide leadership and strategic direction
• Mid-level
– Direct and supervise, contribute to operations and
financial management, and participate in decision
making
• Entry-level
– Assist mid-level managers in unit operations
We Could Go On and On…
• For a thorough summary of health care
professions (e.g., allied health professionals),
visit the Bureau of Labor Statistics:
http://www.bls.gov/oco/oco1002.htm#diag
and
http://www.bls.gov/oco/oco1002.htm#techno
logist
What We’ve Learned
• Health services professionals constitute the
largest portion of the U.S. labor force
– Growth and development influenced by various
trends and advances in health care
– Physicians play a leading role
– Many other health services professionals
contribute significantly to the delivery of health
care
Focus Points
• Spectrum of health services professionals
employed in health delivery settings
• Characteristics and roles of various health
services professions
• Distinctions between primary and specialty care
• Imbalances and maldistribution of practitioners
– How has it affected the U.S. health care delivery
system?