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HCA 701: Survey of the U.S. Healthcare System

HCA 701: Survey of the U.S. Healthcare System. Physicians and Ambulatory Care. RESOURCES NEEDED TO MAINTAIN A HEALTH CARE DELIVERY SYSTEM. Financing. Health Care Delivery System. Technology & Supplies. Healthcare Professionals. Facilities. Source: Williams and Torrens,

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HCA 701: Survey of the U.S. Healthcare System

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  1. HCA 701: Survey of the U.S. Healthcare System Physicians and Ambulatory Care

  2. RESOURCES NEEDED TO MAINTAIN A HEALTH CARE DELIVERY SYSTEM Financing Health Care Delivery System Technology & Supplies Healthcare Professionals Facilities Source: Williams and Torrens, Introduction to Health Services, 2002

  3. Healthcare Professionals • Healthcare is a major employer • It has a rapidly growing labor sector • Professionals • Non-professionals and technicians • Non-institutional workers • Rapid growth due to: • Technology growth and specialization • Health insurance coverage • Aging population • Emergence of hospitals

  4. Types of Healthcare Worker Certification • Licensure – state or legal designation • Certification and registration • Independent and dependent professions • Independents practice without physician supervision (e.g., doctors, dentists) • Dependents need physician supervision (most nurses, CNAs)

  5. Ambulatory Care • Personal health care given to the patient in an non-hospital or institutional setting • Types of settings: • Physician owned private practice • Managed care clinic settings • Community health care settings • “Urgent care” facilities • Shift to ambulatory care due to several factors: • Medicare PPS • Managed care • Improved technology

  6. Patient Visits per 100 persons by Ambulatory Service Type, 1993-94 and 1999-2000

  7. Physician Authority • Based on modern science and scientific knowledge. • Physicians become the intermediaries between science and private experience • Authority signifies the presence of status and quality • Requires legitimacy and dependence. • Legitimacy – acceptance by subordinates • Dependence – bad things can happen if we don’t obey • Types of Physician Authority • Social Authority • Cultural Authority • Professional Authority

  8. The Evolution of the Physician in the U.S. • Allopathic • Homeopathy • Osteopathic • Chiropractic

  9. Physicians • Comprised of two types by practice • Primary care physicians – short supply in U.S. • Family Practice, Internal medicine, OB/GYN, Pediatricians • Specialists – Surplus in U.S. • Specialize in specific areas

  10. Physician Surplus or Shortage? • Rapid growth of physicians, esp. specialists, during 1980-95 due to: • Massive federal outlays • Influx of International Medical Graduates (IMGs) • Distribution of physicians gives appearance of shortage • Not enough primary care providers • Medical underserved areas in rural communities and inner cities • Malpractice and the impact on physicians

  11. Physicians: NV vs. US

  12. Changing Role of the Physician • More employed physicians • By managed care organizations and hospitals (the emergence of the “Hospitalist”) • Large group practices emerged with the growth of managed care • Emphasis away from specialty areas to managed care • More female physicians

  13. Physicians who would recommend the practice of medicine

  14. For physicians who wouldn’t recommend medical profession

  15. Distribution of Physicians by Specialty: 1980, 1986, 1995, 2000 (In thousands 1980 1986 1995 2000 Pct. Change Specialty No./% No./% No./% No./% 1986-2000 All specialties 414/100 521/100 630/100 684/100 31.4 Primary Care 159/38.5 179/34.4 205/32.5 219/32.0 22.2 Other Medical Specialties 25/6.2 62/12.0 83/13.2 94/13.7 50.2 Surgical Specialties 110/26.7 134/25.7 158/25.2 170/24.9 27.0 All other specialties 118/28.5 144/27.8 183/29.1 201/29.4 38.9

  16. Physician Medical Education • Undergraduate medical curriculum • Most emphasize the acute care setting • Increase in women and minorities • Graduate medical education • Major increases in residencies • Shifts in the organization of medical schools • Must compete for patients • Shift to managed care by med school hospitals • Trends medical education in for-profit hospitals • Flexnor Report

  17. Will doctors meet demand in a bio-terror event

  18. Nurses • Typifies the concern of healthcare: “nursing is concerned with human response to health problems” • Historic factors that shaped nursing as a career: • Occupation to support physicians • Emergence of hospitals as community institutions • Acceptable female occupations, primarily white females • Linked to religious orders

  19. Understanding the Nursing Shortage • Changes in occupational opportunities for women since 1970s • Majority of RNs are 50+ years of age or married with children at home • Low salaries – pay compression • Burnout • Lack of clinical career ladder • Active vs. Inactive – about 1/3 of nurses not working fulltime

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