Lecturer: Monika M. Wahi, MPH, CPH At the end of this lecture, - PowerPoint PPT Presentation

Lecturer: Monika M. Wahi, MPH, CPH

At the end of this lecture, student should be able to:  Explain why health care professionals make up such a large proportion of the U.S. work force  Name three types of allied health professionals  Describe the role and value of non-physician practitioners  List two differences between primary and specialty care  Understand the role of dentists, pharmacists, and other doctoral-level health professionals

 U.S. health care industry is the largest employer in the U.S. – 13% of the U.S. labor force  Over the years, services offered and types of health care professionals available are closely linked  Remember Market Justice?  Likewise, the distribution of types of services and types of providers has evolved over time  Current imbalances  Too many specialists, not enough generalists  Maldistribution of practitioners – oversupply of the wrong type of physicians  Roles for NPPs, PA’s, and nurse midwives increasing

Pharmacists Physicians Chiropractors NPPs Nurses Allied Health Dentists Professionals Podiatrists Optometrists Health Service Administrators Psychologists

Therapists Lab/Rad Technicians Social Workers Health Educators

Colleges of Colleges of Medicine Allied Laboratories Health Migrant Professions Health Hospitals Centers Community Mental Health Health MCOs Voluntary Centers Centers Health Nursing Agencies Research Care Institutions Insurance Facilities Firms Hospitals Pharmaceutical Professional Companies School Outpatient Health Clinics Facilities Associations Physicians’ Offices

7,000 Number of Persons in Thousands 6,000 5,000 Phys. Ofc's/Clin Dent. Ofc's/Clin 4,000 Chiro. Ofc's/Clin 3,000 Hospitals Nurs. Care Facs. 2,000 Other Svc. Sites 1,000 0 1994 2001 2009 From Table 4.1 (page 81)

100% 90% 80% 70% Other Svc. Sites 60% Nurs. Care Facs. Hospitals 50% Chiro. Ofc's/Clin 40% Dent. Ofc's/Clin 30% Phys. Ofc's/Clin 20% 10% 0% 1994 2001 2009 From Table 4.1 (page 81)

30 25 20 15 10 5 0 1950 1960 1970 1980 1990 1995 2000 2009 From Table 4.2 (page 83)

900,000 800,000 All Active 700,000 Physicians 600,000 500,000 Doctors of Medicine 400,000 300,000 Doctors of 200,000 Osteopathy 100,000 0 1950 1960 1970 1980 1990 1995 2000 2009 From Table 4.2 (page 83)

MD’S DO’S  Allopathic  Osteopathic medicine medicine  Less likely to be  More likely to be generalists (1/3) generalists (>1/2)  Non-holistic  Holistic approach approach

Primary Specialty If needed First contact Requires Gatekeeper referral Episodic Longitudinal Disease/organ Person as whole Specialty training Generalist training

Too many specialists Shortage? Not enough OB/GYN, Peds, IM, Gen/Fam Practice ✓ Geographic maldistribution ✓ Specialty maldistribution

Figure 4.1 (page 86) 7% 14% OB/GYN 40% Peds Int. Med. Gen./FP 17% Specialists 22%

Table 4.3 (page 90) 7,400, 5% 6,700, 5% 7,700, 5% Dentists Orthodontists Oral Surgeons Dentists, all other 120,200, 85%

Table 4.4 (page 91) 13% Retail 22% Hospitals Other 65%

170,200 180,000 160,000 Number of Professionals 140,000 Optometrists 120,000 Psychologists 100,000 Podiatrists 80,000 Chiropractors 49,100 60,000 34,800 40,000 12,200 20,000 0 From Table 4.5 (page 92)

Largest Group of Levels of Nurses Employment HC Professionals • WWII beginnings • RNs require • Many practice ADN, diploma, locations (home, • Major caregivers or BSN hospital, clinic, of sick/injured etc.) patients • LPNs/LVNs state- level • Setting • Address certification specialties (long- physical, mental, term care, public emotional needs • APNs are NPPs, health) include CNSs, CRNAs, NPs, and • Staffing issues, CNMs nursing shortage

2 50%/50% split between Primary and 8,000, 3% Specialty Care Work predominantly in Primary Care 70,383, 30% NP's PA's 158,348, 67% CNM's

Less training than MD/DO, but more than RNs Physician extenders – work closely with physicians Not entire range of primary care, and not complex cases – these given to physician Expansion of NPPs in 1960s in primary care; clients often more satisfied by NPPs than physicians Current issues: legal restrictions, financial barriers to reimbursement, shut out of decision/policy-making

60% of U.S. health care workforce Certificate/degree in health care science Delivery of health or related services Identify, evaluate, prevent disease/disorders Dietary/nutrition Rehabilitation Health system management

Technicians and Assistants Technologists and Therapists <2 years training Advanced training PT and OT assistants PT/DPT and OTs Lab., rad., resp. techs Dietitians/nutritionists Dispensing opticians Speech/lang. pathologists Social workers

Environment- Social Physicians Researchers Lawyers alists Scientists Health Svcs. Health Ed./Beh. Environmental Epidemiology Biostatistics Admin. Science Health

Leadership, strategic direction, MHA, MHSA, governing boards MBA, MPH, Lead outpatient or MPA nursing services, department managers, logistics and operations BA, Assistants to mid-level managers, BS supervise small teams

 As health care evolves, we are challenged with the maldistribution of physicians  NPPs are needed to help, but there are obstacles there as well  Strong role for nurses, and many career opportunities for nurses at different levels  Other health care professionals have various levels of training, dx/tx authority, and roles  Dentists, public health professionals, health service administrators, pharmaceuticals

At the end of this lecture, student should be able to:  Explain why health care professionals make up such a large proportion of the U.S. work force  Name three types of allied health professionals  Describe the role and value of non-physician practitioners  List two differences between primary and specialty care  Understand the role of dentists, pharmacists, and other doctoral-level health professionals