Lecturer:
Monika M. Wahi, MPH, CPH
At the end of this lecture, student should be able to:
 Explain why health care professionals make up
such a large proportion of the U.S. work force
 Name three types of allied health professionals
 Describe the role and value of non-physician
practitioners
 List two differences between primary and specialty
care
 Understand the role of dentists, pharmacists, and
other doctoral-level health professionals

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
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U.S. health care industry is the largest employer in
the U.S. – 13% of the U.S. labor force
Over the years, services offered and types of health
care professionals available are closely linked
 Remember Market Justice?
Likewise, the distribution of types of services and
types of providers has evolved over time
Current imbalances
 Too many specialists, not enough generalists
 Maldistribution of practitioners – oversupply of
the wrong type of physicians
 Roles for NPPs, PA’s, and nurse midwives
increasing
Pharmacists
Physicians
NPPs
Nurses
Chiropractors
Allied Health
Dentists
Professionals
Podiatrists
Optometrists
Health Service
Administrators
Psychologists
Therapists
Lab/Rad Technicians
Social Workers
Health Educators
Laboratories
Colleges of
Allied
Health
Professions
Hospitals
Voluntary
Health
Agencies
Mental
Health
Centers
Insurance
Firms
Hospitals
School
Clinics
Colleges
of
Medicine
Migrant
Health
Centers
MCOs
Community
Health
Centers
Nursing
Research
Care
Institutions Facilities
Pharmaceutical
Professional
Companies
Health
Associations
Physicians’
Offices
Outpatient
Facilities
Number of Persons in Thousands
7,000
6,000
5,000
Phys. Ofc's/Clin
4,000
Dent. Ofc's/Clin
Chiro. Ofc's/Clin
3,000
Hospitals
Nurs. Care Facs.
2,000
Other Svc. Sites
1,000
0
1994
From Table 4.1 (page 81)
2001
2009
100%
90%
80%
70%
Other Svc. Sites
60%
Nurs. Care Facs.
50%
Hospitals
40%
Chiro. Ofc's/Clin
30%
Dent. Ofc's/Clin
20%
Phys. Ofc's/Clin
10%
0%
1994
From Table 4.1 (page 81)
2001
2009
30
25
20
15
10
5
0
1950
1960
From Table 4.2 (page 83)
1970
1980
1990
1995
2000
2009
900,000
800,000
All Active
Physicians
700,000
600,000
500,000
Doctors of
Medicine
400,000
300,000
Doctors of
Osteopathy
200,000
100,000
0
1950
1960
From Table 4.2 (page 83)
1970
1980 1990
1995 2000 2009
MD’S
DO’S
 Allopathic
medicine
 Less likely to be
generalists (1/3)
 Non-holistic
approach
 Osteopathic
medicine
 More likely to be
generalists (>1/2)
 Holistic approach
Primary
First contact
Specialty
If needed
Gatekeeper
Requires
referral
Longitudinal
Episodic
Person as
whole
Disease/organ
Specialty
training
Generalist
training
Too many specialists
Shortage?
Not enough OB/GYN,
Peds, IM, Gen/Fam
Practice
 Geographic maldistribution
 Specialty maldistribution
Figure 4.1 (page 86)
7%
14%
OB/GYN
40%
Peds
Int. Med.
17%
Gen./FP
Specialists
22%
Table 4.3 (page 90)
6,700, 5%
7,400, 5%
7,700, 5%
Dentists
Orthodontists
Oral Surgeons
Dentists, all other
120,200, 85%
Table 4.4 (page 91)
13%
Retail
22%
Hospitals
Other
65%
170,200
180,000
Number of Professionals
160,000
140,000
Optometrists
120,000
Psychologists
100,000
Podiatrists
80,000
60,000
49,100
34,800
40,000
20,000
0
From Table 4.5 (page 92)
12,200
Chiropractors
Largest Group of
HC Professionals
• WWII beginnings
• Major caregivers
of sick/injured
patients
• Address
physical, mental,
emotional needs
Levels of Nurses
Employment
• RNs require
ADN, diploma,
or BSN
• LPNs/LVNs statelevel
certification
• APNs are NPPs,
include CNSs,
CRNAs, NPs, and
CNMs
• Many practice
locations (home,
hospital, clinic,
etc.)
• Setting
specialties (longterm care, public
health)
• Staffing issues,
nursing shortage
50%/50% split
between Primary and
Specialty Care
2
8,000, 3%
Work predominantly in
Primary Care
70,383, 30%
158,348, 67%
NP's
PA's
CNM's
Less training than MD/DO, but more
than RNs
Physician extenders – work closely with
physicians
Not entire range of primary care, and not
complex cases – these given to physician
Expansion of NPPs in 1960s in primary care;
clients often more satisfied by NPPs than
physicians
Current issues: legal restrictions, financial
barriers to reimbursement, shut out of
decision/policy-making
60% of U.S. health care workforce
Certificate/degree in health care science
Delivery of health or related services
Identify, evaluate, prevent disease/disorders
Dietary/nutrition
Rehabilitation
Health system management
Technicians and Assistants
Technologists and Therapists
<2 years training
Advanced training
PT and OT assistants
PT/DPT and OTs
Lab., rad., resp. techs
Dietitians/nutritionists
Dispensing opticians
Speech/lang. pathologists
Social workers
Physicians
Researchers
Lawyers
Environmentalists
Social
Scientists
Epidemiology
Biostatistics
Health Svcs.
Admin.
Health Ed./Beh.
Science
Environmental
Health
Leadership,
strategic direction,
governing boards
Lead outpatient or
nursing services,
department managers,
logistics and operations
MHA, MHSA,
MBA, MPH,
MPA
Assistants to mid-level managers,
supervise small teams
BA,
BS
 As health care evolves, we are challenged with the
maldistribution of physicians
 NPPs are needed to help, but there are obstacles there
as well
 Strong role for nurses, and many career opportunities
for nurses at different levels
 Other health care professionals have various levels
of training, dx/tx authority, and roles
 Dentists, public health professionals, health service
administrators, pharmaceuticals
At the end of this lecture, student should be able to:
 Explain why health care professionals make up
such a large proportion of the U.S. work force
 Name three types of allied health professionals
 Describe the role and value of non-physician
practitioners
 List two differences between primary and specialty
care
 Understand the role of dentists, pharmacists, and
other doctoral-level health professionals