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 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