U.S. Health Care Delivery: Providers & Professionals 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 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? 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 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 • 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 Physicians • Reasons for growth in physician power – Urbanization – Advances in science and technology – Institutionalization – Dependency – Cohesiveness and organization – Licensing – Educational reform 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 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 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 Physicians: Primary Care vs. Specialty Care • • • • • • Point of contact? Utilizing resources? Course of treatment? Focus? Level of care? Training settings? 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? 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? 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? 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? 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 • 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 Dentists • Eight specialty areas – Growth of dental specialties influenced by technological advances • Growing demand for dental care – Reasons? • Growing concerns – 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 • 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 Pharmacists • Most pharmacists are generalists, but some pharmacists become specialists – Pharmacotherapists – Nutrition-support pharmacists – Radiopharmacists or nuclear pharmacists 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 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 • 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) 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 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 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 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 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 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 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 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. 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 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 • 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 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 • 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 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?