U.S. Health Care Delivery: Providers & Professionals

Objectives

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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?

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Who Are Health Services Professionals?

Physicians Nurses Dentists Pharmacists Optometrists Psychologists Podiatrists Chiropractors Health services administrators • • Non-physician practitioners (NPP) – Physician Assistants – Nurse Practitioners – Nurse Midwives Allied health professionals – Therapists – Laboratory technicians – Radiology technicians – Social workers – Health educators

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Where Do Health Services Professionals Work?

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 • • • • • • • • • 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

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Key role

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Evaluate patient’s health condition & determine significance

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Diagnose abnormalities & prescribe treatment Training requirements

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Medical school, Licensure, Residency Typical work settings

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Offices, Hospitals, Outpatient clinics

Physicians

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Reasons for growth in physician power

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Urbanization

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Advances in science and technology

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Institutionalization

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Dependency

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Cohesiveness and organization

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Licensing

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Educational reform

Physicians: MDs vs. DOs

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Both use traditionally accepted methods of treatment, including drugs & surgery Doctor of Medicine (MD): Allopathic

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Philosophy of intervention

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Most MDs are specialists Doctor of Osteopathic Medicine (DO)

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Philosophy of prevention & holistic approach

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Most DOs are generalists

Physicians: Generalists vs. Specialists

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Generalists (a.k.a. primary care physicians)

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Provide preventive services and treat frequently occurring to less severe problems Specialists

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Provide services to treat problems that occur less frequently or require complex approaches Hospitalists

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Specialty organized around the site of care

Generalists vs. Specialists: Training Requirements

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Generalists

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Complete 3-year residency Specialists

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Seek certification in an area of medical specialization

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Additional years of advanced residency training & practice in the specialty Hospitalists

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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

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Aggregate physician oversupply Despite sharp increases in the aggregate surplus of physicians, physician shortages still exist in certain parts of the country

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Geographic & specialty maldistribution

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What is a maldistribution?

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How does maldistribution affect health services?

Physicians: Imbalance & Maldistribution

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Geographic maldistribution

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Metropolitan areas vs. rural or inner-city areas

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Basic source of problem: need-based vs. market-based models Specialty maldistribution

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Oversupply of specialists

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Contributing factors?

Physicians: Imbalance & Maldistribution

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Imbalance between generalists and specialists has several undesirable consequences

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High volume of expensive services = rising costs

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Shortage of primary care = less effective care

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Shortage of primary care = access problems How to counteract maldistribution?

Physicians: Defensive Medicine

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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

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Key role

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Diagnose and treat problems related to teeth, gums, and tissues of the mouth

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Prevention of dental decay and gum disease Training requirements

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Graduation, Examination, Licensure Typical work settings

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Private offices, Retail stores, Government clinics

Dentists

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Eight specialty areas

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Growth of dental specialties influenced by technological advances Growing demand for dental care

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Reasons?

Growing concerns

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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

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Key role

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Prepare & dispense medicines prescribed by physicians, dentists, and podiatrists

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Provide education and consultation on the proper selection and use of medicines

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Identify, prevent, and resolve drug-related problems Training requirements Typical work settings

Pharmacists

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Most pharmacists are generalists, but some pharmacists become specialists

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Pharmacotherapists

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Nutrition-support pharmacists

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Radiopharmacists or nuclear pharmacists

Other Doctoral-Level Health Professionals

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Optometrists

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Provide vision care Psychologists

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Provide patients with mental health care Podiatrists

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Treat patients with foot diseases or deformities Chiropractors

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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

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Key role

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Major caregivers of sick and injured patients

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Address physical, mental, and emotional needs Training requirements

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Educational preparation distinguishes between two levels of nurses Registered nurses (RNs) Licensed practical (vocational) nurses (LPNs/LVNs)

Nurses

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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

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Work in a variety of settings Nursing encompasses numerous roles Current shortfall of nurses

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Aging workforce

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Nursing work becoming more intensive

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Growth in alternative settings

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Increasing patient population

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Major impediments to attract and retain nurses

Advanced-Practice Nurses

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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

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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

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Physician Assistants

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Assist supervising physicians in patient care

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Evaluation, monitoring, diagnostics, therapeutics, counseling, and referral Nurse Practitioners

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Largest group of nonphysician practitioners

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Promote wellness and good health through patient education Certified Nurse Midwives

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Deliver babies, provide family planning education, and manage gynecologic and obstetric care

Nonphysician Practitioners

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Efforts to establish roles began in 1960s Studies have confirmed efficacy of NPPs

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High-quality and cost-effective care

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More time spent with patients

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Improved access to primary care Numerous issues to be resolved among NPPs

Allied Health Professionals

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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

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Technicians & Assistants

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Trained to perform procedures requiring supervision from therapists or technologists

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Respiratory therapy technicians Technologists & Therapists

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Receive more advanced training

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Know how to evaluate patients, diagnose problems, and develop treatment plans

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PTs, OTs, Dietitians, Dispensing opticians, Audiologists, Social workers, etc.

Allied Health Professionals: History

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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

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Top-level

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Responsible for operational, clinical, and financial outcomes of the entire organization

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Provide leadership and strategic direction Mid-level

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Direct and supervise, contribute to operations and financial management, and participate in decision making Entry-level

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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

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Health services professionals constitute the largest portion of the U.S. labor force

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Growth and development influenced by various trends and advances in health care

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Physicians play a leading role

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Many other health services professionals contribute significantly to the delivery of health care

Focus Points

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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

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How has it affected the U.S. health care delivery system?