Transcript SOC 574 The Health Professions

SOC 574 The Health
Professions
James G. Anderson, Ph.D.
Purdue University
Professionalization of an
Occupation
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Making the occupation a full-time pursuit
Linking training to schools and colleges and
gaining control of professional education training
Establishing strong national and state
professional associations
Obtaining a legal monopoly over a sphere of
work by expanding the scope of practice
Developing a code of ethics that regulates
professional behavior
Shaping the public image of the profession
Parameters of a Profession
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Entry into the profession/curricula
controlled by the profession
Profession is the guardian of its specialized
knowledge and skills
Credentialing
Occupational degrees
Certification
Licensing
Parameters of a Profession
Cognitive Characteristics
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Specialized knowledge, skills, mode of
reasoning
Learning specialized skills through an
extended process of education, training
and socialization
Post-baccalaureate degree for entry level
into the profession
Indicators
Cognitive Characteristics
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Post-baccalaureate degree required for
entry into the profession
Entry level degree (e.g., DPT, PharmD,
AuD, etc.)
Profession controls professional education
Profession sets standards and accredits
professional education programs
Parameters of a Profession
Autonomy and Collective Self-Control
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Technical autonomy
Control over services, resources
Direct access to patients/clients
Self-control based on socialization of
attitudes, beliefs, practice patterns
Informal control by peers
Professional associations exercise control
by licensing
Indicators
Autonomy
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State licensure laws
Control over board certification
Ability to exclude competitors from practice
Percent of professionals in independent practice
compared to organizational practice
Profession has direct access to patients
Profession sets fees and rates of payment
Direct third-party reimbursement
Parameters of a Profession
Value Components: Service,
Commitment, Calling
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Code of ethics
Fiduciary relationship with clients
Making the welfare of the client the first
consideration
Conception of the larger ends and purposes
that professional work serves
Commitment to a higher level of competence
Indicators
Organizational Cohesion
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Homogeneity of membership in the
profession
Membership commitment (e.g., %
members who join the professional
association)
Membership stability over time (e.g.,
lifetime members)
Overlap of membership with other
professional associations
Indicators
Relational Cohesion
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Competing professional associations
Membership in the major professional
association
Major professional association includes
other organizations within the profession
Establishment and circulation of
professional journals
Parameters of a Profession
Value Components: Service,
Commitment, Calling
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“Do no harm” to patients
Confidentiality
Code of professional ethics
Licensing Professions
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Licensing protects the public from
incompetence/charlatans
Licensing also creates a professional
monopoly for services
Process by Which Occupations
Evolve into Professions
Licensed Professionals
Qualifying
Examinations
Certified Professionals
Academic Training
Tradesmen
Apprenticeship
Individual Workers
On-the-Job Training
Competition
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Clinical psychologists (PhDs) versus
Psychiatrists (MDs)
Optometrists versus Opthamologists (MDs)
Nurse Midwives versus OBGYNs (MDs)
Sociologists versus Social Workers,
Marriage and Family Therapists, and
Professional Counselors
Public Prestige Ratings for Health Care
Occupations
Occupation
Rating
Dentists
96
Osteopaths
96
Lawyers/Judges
93
Physicians/Surgeons
92
Pharmacists
82
Social Scientists
81
Optometrists
Veterinarians
79
78
Secretaries
61
Therapists/Healers
58
Public Prestige Ratings for Health Care
Occupations
Occupation
Mail Carriers
Rating
53
Student Nurses
51
Medical/Dental
Technicians
48
RNs
46
Postal Clerks
44
Opticians
39
Dieticians/Nutritionists
Policeman
39
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Physician Office
Attendants
38
Public Prestige Ratings for Health Care
Occupations
Occupation
Rating
Plumbers/Pipe-fitters
34
Machinists
33
Bus Drivers
24
LPNs
22
Carpenters
19
Hospital Attendants
13
Critical Elements in Achieving
professional Status
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Unified national organization
Integrated state and national professional
organizations
Accreditation of professional education
Use of studies and other activities to
enhance the profession’s public image
Legislation to support changes in scope of
practice and entry to the profession
Optometry
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Since 1898 optometry has benefited from
a strong national organization, the AOA
From 1940 state and national associations
have worked for legislation to ensure
favorable reimbursement rates
National Board of Examiners in Optometry
was created in 1951
The 1965 Medicare Act included
Optometrists as qualified providers
Optometry
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By 1989 all 50 states and DC had passed
legislation to allow optometrists to employ
pharmaceutical agents
Currently 49 states all optometrists to
treat glaucoma
Optometrists are gaining the right to
perform laser procedures.
Physical Therapy
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Physical therapists in the U.S. created a
professional association in 1920 that became the
APTA in 1946
The educational requirements have been
gradually upgraded from a certificate to a BS in
the 1950s. In the 1980 some programs began
offering graduate degrees including the DPT
degree
In 1983 APTA became the accrediting body in
place of the AMA
Physical Therapy
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By 2002 there were about 60 accredited DPT
programs and 85 MPT programs in the U.S.
The APTA is lobbying state legislatures and the
federal government to change Medicare to allow
patients direct access to PTs instead of through
medical referrals.
To date 39 states allow patients direct access to
PTs for evaluation and some level of treatment
Podiatry
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By 1940 podiatrists needed a doctorate in
podiatric medical education to take the
licensing exam in many states.
Today podiatrists enjoy a broad scope of
practice in treating foot and ankle
problems
The APMA Council on Podiatric Medical
Education accredits podiatric medical
schools and residency programs
Podiatry
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Podiatrists were defined as “physicians’ in
the 1965 Medicare Act. But Medicaid
defines them as “optional services”
The Balanced Budget Act of 1997 stated
that podiatrists should be paid equally to
medical doctors providing the same
service.
Audiology
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Audiology has three major national
associations
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American Speech—Language-Hearing
Association (ASHA)
American Academy of Audiology (AAA)
Academy of Dispensing Audiologists (ADA)
Audiology
Only 15-20 states have strong audiology
associations. Some states have two
associations
ASHA affiliated organizations are dominated by
concerns of speech-language pathologists, the
dominant profession in ASHA.
There is little agreement over which organization
should accredit degree programs. An ASHAaffiliated organization accredits degree
programs and certifies competency of
audiologists.
Audiology
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In 2003 the Accreditation Commission on
Audiology Education (ACAE) was created
representing the AAA, ADA and direcvtors of
AuD programs
Federal legislation in 1998 allows federal
employees to obtain care from an audiologisxt
without a physician’s referral
Audiology is lobbying for an amendment to
Medicare to authorize audiologists to provide
services to beneficiaries without a physician
refferal
Dangers in Licensing
Professions
Culture dominated by professionals
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Monopoly.
The public relinquishes control.
Medicalization -Professionals determine
“needs”.
Conflicts of interest.
Needs/interests of patient vs. profit for
professionals Misdiagnosis, over prescription,
unnecessary surgery
Dangers in Licensing
Professions
Creates Professional Dominance
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Legitimizes monopoly.
Limits competition through licensing boards dominated
by members of the profession.
Enhances professional’s prestige, authority, income
Inadequate self-regulation
Resistance to change - Limited experimentation and
innovation.
Higher direct costs to consumers.
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Services unavailable to poor, those who can’t pay.
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Dangers in Licensing
Professions
Attempts in state legislatures to license:
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Auctioneers
Well diggers
Home improvement contractors
Pet groomers
Electrologists
Sex therapists
RV repairmen
Appraisers
Tattoo artists
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Lightening rod salesmen
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Solutions to the Problems
Created by the Licensing
Professions
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Courts have struck down state laws
prohibiting professional advertising.
Certification is an alternative to licensing to
protect against fraud and deception.
Separation of diagnosis from services.
Second opinions allow consumers to
comparison shop.
How Serious is the Problem of
Fraudulent Physicians?
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1/50 or 10,000 practicing medicine with
fraudulent credentials.
1982-1984 Medicare payments.
$8.5 million sent to 271 unlicensed
doctors in Florida.
60% of the patients of fake MDs are
elderly.
Who are likely to become bogus
doctors/nurses?
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Chiropractors
Pharmacists
Nurses
Physician Assistants
Nurse Practitioners
Medics
How do Bogus Doctors Obtain
their Credentials?
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Some obtain forged medical degrees and
become licensed.
Some open clinics/apply to hospitals where
documents aren’t checked.
Assume the name of a living or dead or
retired physicians.
Purchase fake credentials form phony
universities
Graduates from foreign medical schools.
How can Bogus Doctors be
Detected?
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National practitioner clearing house lists
disciplinary actions against physicians.
Some licensing agencies fingerprint
applicants and perform background checks.
Laws can make it a felony to pose as an
MD.
Provide state medical licensing boards with
more investigators.