Lesson 4 - Providers

U.S. Health Care Delivery:
Providers & Professionals
• 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
– Population trends
– Research & technology
– Disease trends
– Changes in health care financing & service delivery
Who are the people in your
Who Are Health Services
Health services
• Non-physician
practitioners (NPP)
– Physician Assistants
– Nurse Practitioners
– Nurse Midwives
• Allied health
Laboratory technicians
Radiology technicians
Social workers
Health educators
Where Do Health Services
Professionals Work?
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
Voluntary health agencies
Professional health
• Colleges of medicine and
allied health professions
• Research institutions
• Long, irregular hours
• Highly competitive
• Demanding education
and training
• Good job opportunities
– particularly in rural &
low-income areas
• http://www.bls.gov/oco
• Key role
– Evaluate patient’s health condition & determine
– Diagnose abnormalities & prescribe treatment
• Training requirements
– Medical school, Licensure, Residency
• Typical work settings
– Offices, Hospitals, Outpatient clinics
• 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
– Additional years of advanced residency training
& practice in the specialty
• Hospitalists
– Train under various primary care concentrations
Primary Care vs. Specialty Care
Point of contact?
Utilizing resources?
Course of treatment?
Level of care?
Training settings?
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?
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?
Imbalance & Maldistribution
• Imbalance between generalists and
specialists has several undesirable
– 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
• 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?
• 3 out of 4 are solo
• Admission to dental
school competitive
• Good job opportunities
– large number of
dentists expected to
• http://www.bls.gov/oco
For fun…
• 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
• Eight specialty areas
– Growth of dental specialties influenced by
technological advances
• Growing demand for dental care
– Reasons?
• Growing concerns
– Efficiency, competition, financing
• Variable hours: some
required to work nights,
weekends, & holidays
• 65% work in retail
• Increasing involvement
in counseling &
planning drug therapy
• http://www.bls.gov/oco
• 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
• Training requirements
• Typical work settings
• 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
• Largest health care
• 60% of RNs, 25% LVN/LPNs
work in hospitals
• Issues with job retention,
replacement due to aging
work force
• RNs:
• 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
• 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
• 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
• 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
• 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
• Provided physicians and nurses with time to
effectively serve in their areas of expertise and
keep informed of latest advances in their
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
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
• 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:
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
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

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