Transcript HAS 3111: Health Care Professions

HSA 3111: Health Service Professionals
Topics
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Overview
Statistics and Measures
Physicians
Physician Issues
Other Providers
Nursing
Non-physician Providers
Health Service Administrators (You?)
“The U.S. healthcare industry is the largest and most powerful employer in
the nation.”
Text (p. 120)
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Health Service Professionals
Overview
• The chapter is filled largely with descriptive
material about various healthcare professions
• The inferences are much more important
– Look for incentives that shape current structures
– Look for trends and how they may change
structures directly or by changing incentives
– How do trends affect patients and providers?
– How will trends affect you in your career?
• The chapter short-changes the involvement of
and impact on healthcare administrators
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
2
HSA 3111: Health Service Professionals
Statistics and Measures
• Healthcare represents 3% of the total labor force
– 16% of gross domestic product
– Average HC worker much more productive in the
labor market than the average worker*
• 7 of 10 fastest growing professions are in HC
– Growth at 29% through 2010
– Growing population
– Aging population
• HC labor among the most highly educated
– What are implications of this fact?
* There are huge caveats to this statement
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Health Service Professionals
Statistics and Measures (cont.)
• HC workers are in a variety of settings
– Changing HC organizational structure changes
labor needs
– Changing demographics and disease patterns
also affect HC labor needs
• Demand for HC labor related to funding for care
– How might changing funding change demand?
• HC tasks are distributed among an increasingly
varied group of professionals
– Scope of roles and responsibilities is also dynamic
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Health Service Professionals
Statistics and Measures (cont.)
• 40% of HC professionals are employed by
hospitals but the percentage of physicians is
much lower
– 8% of physicians (after internship and residency)
work in hospitals
• The supply of HC labor is marked by two
imbalances
– Primary vs. Specialty services
– Geographic
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
5
HSA 3111: Health Service Professionals
Physicians
• Recall Chapter Three’s history of HC in the U.S.
and the singular evolution of physician
qualifications and roles
• We can identify two trends in HC workers related
to the roles of physicians
– Increased specialization among physicians
– Increased divestiture of tasks formerly performed
by physicians to other HC workers
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Health Service Professionals
Physicians (cont.)
• Two Trends (cont.)
– Physicians remain the focal point of service for the
hard cases
– Significant organization is designed to
• Channel the hard cases to the right specialist
• Reduce the physician’s distractions
– Other HC professionals now do many tasks
formerly performed by physicians
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Health Service Professionals
Physicians (cont.)
• Increasing ratio of physicians to population
– 14.1/10,000 in 1950 to 27.0/10,000 by 2001
– Increases in non-physician providers increases
coverage intensity
• Why do you think this is?
– Growth of knowledge
& effectiveness
Growth in Demand
– Ability to pay
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Health Service Professionals
Physicians (cont.)
• Specialization
– Explosive growth in knowledge has resulted in too
much for one person to know
– Expensive specialized knowledge should not be
wasted on routine tasks
– Primary care providers becoming specialists in
their own rights
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Health Service Professionals
Physicians (cont.)
• Primary Care
– Typically first to treat and diagnose
– Serve as gatekeepers in formalized managed care
organizations
– Have longer term relationship with patient
– Sees whole patient
• Primary care issues
• All specialist issues
– Requires ‘specialty’ training in being a generalist
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Health Service Professionals
Physicians (cont.)
• Hospitalists
– Takes on role of primary care physician for
hospitalized patients
– May coordinate work of multiple specialists
– Why does it make sense to create this specialty?
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Health Service Professionals
Physicians (cont.)
• Clinical Practice Guidelines
– Wide variations in the way different physicians
treat the same condition
– Balance advanced available treatments with risk
and cost
• Increased pressures in MCO
• MCO payment mechanisms also pressure
physicians
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Health Service Professionals
Physicians (cont.)
• Clinical Practice Guidelines (cont.)
– Standardize protocols for the same condition
– Reduce physician’s discretion
– Standardize costs and treatments
– Reduce (and increase) exposure to liability
– Recent news:
• Prostrate treatments
• CPR protocols
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Health Service Professionals
Physician Issues
• Physician oversupply
– Some studies indicate that the U.S. will be
oversupplied with physicians
– Exacerbated by increasing treatments given by
other providers (PAs, Nurse Practitioners, etc.)
– Thought to increase healthcare costs (p. 130)
• I don’t see the mechanism for this
– Federal government is restricting the paid support
for residency training
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Health Service Professionals
Physician Issues (cont.)
• Overspecialization
– In general specialized physicians earn more
money than PCPs*
– Sometimes have more predictable lifestyles
– Often enjoy more prestige
– Increased specialist use leads to increased
invasive and costly procedures
– Hospital-based internship and residency steers
more physicians to specialty training
– Shifts toward MCO** and preventive care are
increasing the demand for PCP
* Primary Care Physicians ** Managed Care Organizations
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Health Service Professionals
Physician Issues (cont.)
• Geographic Distribution
– Other pressures steer physicians away from rural
and poor areas
• Fewer insured (paying) patients
• Fewer professional growth opportunities
• Lower income
• Fewer cultural opportunities
– Corresponding oversupply in urban areas
– How can these distributions be affected?
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
16
HSA 3111: Health Service Professionals
Physician Issues (cont.)
• International Medical Graduates
– Almost 25% of US physicians graduated from
foreign medical schools
– Quality differences are unclear
– Distribution among specialties and geography is
also unclear
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Health Service Professionals
Other Providers
• Dentists
– Most are sole practitioners or in small groups
– Employ related staff
– Have business management as well as
professional service responsibilities
• Pharmacists
– Most are employees of other organizations
– Taking on some health management
responsibilities
– Critical integration of services by multiple
physicians
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Health Service Professionals
Other Providers (cont.)
• Optometrists, Chiropractors, Podiatrists, and
Psychologists mimic many characteristics of
dentists in terms of
– Employment
– Practice management
• All require licensing
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Health Service Professionals
Nursing
• Key profession for leveraging the physician’s
time
– Provide skilled medical services not at the level of
the physician
– Increased education for Nurse Practitioners
increase range of tasks and further free physician
time
• Nurses have an incredible variety of working
conditions
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
20
HSA 3111: Health Service Professionals
Nursing (cont.)
• Expected shortfall of 340,000 nurses by 2020
– Lower pay
– Difficult work conditions
– Too few training programs
• Some programs established to increase number
of nurses but funding remains an issue
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Health Service Professionals
Nonphysician Practitioners
• Physician Assistants, Nurse Practitioners,
Certified Nurse Midwifes
• Sometimes referred to as physician extenders
• Work under the (sometimes loose) supervision of
a physician
• Have differing treatment and prescription
authority by specialty and state
• Differing educational requirments
• Patients often report increased satisfaction with
NPs and PAs than with physicians
– Why do you think?
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Health Service Professionals
Allied Health Professionals
• A dizzying variety of specialty professions not
requiring an MD have developed
– Often related to specific medical technologies
– All have specific domain-related knowledge
• Some may practice independently
– Speech Therapist
– Occupational or Physical Therapist
• Some support a physician or other professional
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Health Service Professionals
Health Service Administrators
• These are the managers of health service
organizations
– Hospitals and clinics
– Medical offices or groups
• Heavily business and process focused
– Often have a holistic view of the organization,
though not of specific medical techniques
– Must anticipate changes
– See the first new paragraph on p. 149 for a
daunting description
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Health Service Professionals
Health Service Administrators (cont.)
• Senior HSAs must coordinate the work of and
allocate resources to medical professionals,
including physicians
– Incredibly challenging work
• Many educational paths to the field
– Specialty degrees
– Business degrees
• Wide variety of work environments
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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