Health
Service
Professionals
Chapter 4
Health Services
Professionals
Learning Objectives
 To recognize the diff 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
• 13.2% of the Gross Domestic Product
• Health care will continue to grow because:
1) growth in population
2) aging of the population
Health Services
Professionals
Types of professionals:
•
•
•
•
•
•
•
•
•
•
•
Physicians
Nurses
Dentists
Pharmacists
Optometrists
Psychologists
Podiatrists
Chiropractors
Nonphysician practitioners
Health administrators
Allied health professionals
• Therapists
• Social Workers
• Educators
Health Services
Professionals
• 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
Health Services
Professionals
• 43.4% employed by hospitals
• 14.8% by nursing and personal care facilities
• 14.6% 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
Health Personnel
• 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
Physicians: 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
Health Personnel
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 med
2) medical
3) Obstetrics/Gynecology
4) Surgery
5) Hosp-based Radiology, anesthesiology, pathology
6) Psychiatry
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)
Difference 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
Difference between
Primary and Specialty Care
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
Issues in Medical Practices
1) 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 Practices
1) 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 Practices
4) 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 Practices
5) 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 Practice
6) Specialty Maldistribution
• An imbalance between primary and
specialty care
• From 1965 to 1992,
• the number of primary care physicians increased
by only 13%,
• the number of specialists increased 121%
• In the US,
• approximately 34.5% of the physicians are
generalists
• approximately 65.5% are specialists
• 25-50% in other countries are specialists
Issues in Medical Practice
Reasons 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 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
Pharmacists
Role:
• Dispense medicine prescribed by
doctors, dentists, podiatrists,
psychiatrists
• Consult on selected uses of medicine
• Need license to practice
• PharmD degree, 6 years of education
• $70,000 in 2000
Other Doctoral-Level
Health Professionals
• Optometrists
• Psychologists
• Podiatrists
• Chiropractors
Other Doctoral-Level
Health Professionals
• Optometrists
• Provide vision care with
• Exams, diagnostics, correction
• Need license
• Doctor of Optometry (OD)
• Usually work in solo or group practices
Other Doctoral-Level
Health Professionals
• Psychologists
• Provide patients with mental health
care
• Need license
• Doctor of Philosophy (PhD) or
Doctor of Psychology (PsyD)
Other Doctoral-Level
Health Professionals
• Podiatrists
• Treat disease or deformities of the feet
• Includes surgeries, medicine, corrective
devises
• Need a license
• Doctor of Podiatric Medicine (DPM)
Other Doctoral-Level
Health Professionals
• 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 2008, 331,000 RNs will need to be
replaced
Nurses
Reasons 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 Nurses
Nurses 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/assistants
2) 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