U.S. Health Care Delivery: Providers & Professionals

1. U.S. Health Care Delivery:Providers & Professionals

2. Objectives • 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

3. 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

4. Who are the people in your neighborhood?

5. 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

6. 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

7. 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

8. Physicians • Key role • Evaluate patient’s health condition & determine significance • Diagnose abnormalities & prescribe treatment • Training requirements • Medical school, Licensure, Residency • Typical work settings • Offices, Hospitals, Outpatient clinics

9. Physicians • Reasons for growth in physician power • Urbanization • Advances in science and technology • Institutionalization • Dependency • Cohesiveness and organization • Licensing • Educational reform

10. Physicians: MDs vs. DOs • Both use traditionally accepted methods of treatment, including drugs & surgery • Doctor of Medicine (MD): Allopathic • Philosophy of intervention • Most MDs are specialists • Doctor of Osteopathic Medicine (DO) • Philosophy of prevention & holistic approach • Most DOs are generalists

11. Physicians: Generalists vs. Specialists • Generalists (a.k.a. primary care physicians) • Provide preventive services and treat frequently occurring to less severe problems • Specialists • Provide services to treat problems that occur less frequently or require complex approaches • Hospitalists • Specialty organized around the site of care

12. Generalists vs. Specialists: Training Requirements • Generalists • Complete 3-year residency • Specialists • Seek certification in an area of medical specialization • Additional years of advanced residency training & practice in the specialty • Hospitalists • Train under various primary care concentrations

13. Physicians: Primary Care vs. Specialty Care • Point of contact? • Utilizing resources? • Course of treatment? • Focus? • Level of care? • Training settings?

14. Physicians:Imbalance & Maldistribution • Aggregate physician oversupply • Despite sharp increases in the aggregate surplus of physicians, physician shortages still exist in certain parts of the country • Geographic & specialty maldistribution • What is a maldistribution? • How does maldistribution affect health services?

15. Physicians:Imbalance & Maldistribution • Geographic maldistribution • Metropolitan areas vs. rural or inner-city areas • Basic source of problem: need-based vs. market-based models • Specialty maldistribution • Oversupply of specialists • Contributing factors?

16. Physicians:Imbalance & Maldistribution • Imbalance between generalists and specialists has several undesirable consequences • High volume of expensive services = rising costs • Shortage of primary care = less effective care • Shortage of primary care = access problems • How to counteract maldistribution?

17. Physicians: Defensive Medicine • 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?

18. 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

19. Dentists • Key role • Diagnose and treat problems related to teeth, gums, and tissues of the mouth • Prevention of dental decay and gum disease • Training requirements • Graduation, Examination, Licensure • Typical work settings • Private offices, Retail stores, Government clinics

20. Dentists • Eight specialty areas • Growth of dental specialties influenced by technological advances • Growing demand for dental care • Reasons? • Growing concerns • Efficiency, competition, financing

21. 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

22. Pharmacists • Key role • Prepare & dispense medicines prescribed by physicians, dentists, and podiatrists • Provide education and consultation on the proper selection and use of medicines • Identify, prevent, and resolve drug-related problems • Training requirements • Typical work settings

23. Pharmacists • Most pharmacists are generalists, but some pharmacists become specialists • Pharmacotherapists • Nutrition-support pharmacists • Radiopharmacists or nuclear pharmacists

24. Other Doctoral-Level Health Professionals • Optometrists • Provide vision care • Psychologists • Provide patients with mental health care • Podiatrists • Treat patients with foot diseases or deformities • Chiropractors • Provide chiropractic treatment to patients

25. 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/ocos083.htm • LVN/LPNs: http://www.bls.gov/oco/ocos102.htm

26. Nurses • Key role • Major caregivers of sick and injured patients • Address physical, mental, and emotional needs • Training requirements • Educational preparation distinguishes between two levels of nurses • Registered nurses (RNs) • Licensed practical (vocational) nurses (LPNs/LVNs)

27. Nurses • 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

28. Nurses • Work in a variety of settings • Nursing encompasses numerous roles • Current shortfall of nurses • Aging workforce • Nursing work becoming more intensive • Growth in alternative settings • Increasing patient population • Major impediments to attract and retain nurses

29. Advanced-Practice Nurses • 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

30. Nonphysician Practitioners • 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

31. Nonphysician Practitioners • Physician Assistants • Assist supervising physicians in patient care • Evaluation, monitoring, diagnostics, therapeutics, counseling, and referral • Nurse Practitioners • Largest group of nonphysician practitioners • Promote wellness and good health through patient education • Certified Nurse Midwives • Deliver babies, provide family planning education, and manage gynecologic and obstetric care

32. Nonphysician Practitioners • Efforts to establish roles began in 1960s • Studies have confirmed efficacy of NPPs • High-quality and cost-effective care • More time spent with patients • Improved access to primary care • Numerous issues to be resolved among NPPs

33. Allied Health Professionals • 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

34. Allied Health Professionals • Technicians & Assistants • Trained to perform procedures requiring supervision from therapists or technologists • Respiratory therapy technicians • Technologists & Therapists • Receive more advanced training • Know how to evaluate patients, diagnose problems, and develop treatment plans • PTs, OTs, Dietitians, Dispensing opticians, Audiologists, Social workers, etc.

35. Allied Health Professionals: History • 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

36. 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

37. Health Services Administrators • Top-level • Responsible for operational, clinical, and financial outcomes of the entire organization • Provide leadership and strategic direction • Mid-level • Direct and supervise, contribute to operations and financial management, and participate in decision making • Entry-level • Assist mid-level managers in unit operations

38. 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#diagand http://www.bls.gov/oco/oco1002.htm#technologist

39. What We’ve Learned • Health services professionals constitute the largest portion of the U.S. labor force • Growth and development influenced by various trends and advances in health care • Physicians play a leading role • Many other health services professionals contribute significantly to the delivery of health care

40. Focus Points • 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 • How has it affected the U.S. health care delivery system?