Transcript HEALTH SERVICE PROFESSIONALS

HEALTH SERVICE
PROFESSIONALS
PHYSICIANS
 PHYSICIANS PLAY A CENTRAL
ROLE IN EVALUATING A
PATIENT’S HEALTH
CONDITION, DIAGNOSING
ABNORMALITIES, AND
PRESCRIBING TREATMENT.
 SOME PHYSICIANS ARE
ENGAGED IN MEDICAL
EDUCATION AND RESEARCH
TO FIND NEW AND BETTER
WAYS TO CONTROL AND CURE
HEALTH PROBLEMS.
 A GROWING NUMBER ARE
INVOLVED IN THE
PREVENTION OF ILLNESS.
 LICENSING
 ALL STATES REQUIRE
PHYSICIANS TO BE LICENSED
IN ORDER TO PRACTICE.
 SUCCESSFUL COMPLETION OF
A LICENSING EXAMINATION
AND COMPLETION OF A
SUPERVISED
INTERNSHIP/RESIDENCY
PROGRAM.
 REQUIREMENTS INCLUDE
GRADUATION FROM AN
ACCREDITED MEDICAL
SCHOOL THAT AWARDS A
DOCTOR OF MEDICINE (MD) OR
DOCTOR OF OSTEOPATHIC
MEDICINE (DO);
 DOCTOR OF OSTEOPATHIC
MEDICINE (DO)
 OSTEOPATHIC MEDICINE
EMPHASIZES THE
MUSCULOSKETETAL SYSTEM OF
THE BODY SUCH AS THE
CORRECTION OF JOINTS OR
TISSUES. THEY STRESS DIET AND
THE ENVIRONMENT AS FACTORS
WHICH MIGHT INFLUENCE
NATURAL RESISTENCE.
 DOCTOR OF MEDICINE (MD)
 MEDICAL DOCTORS VIEW
MEDICAL TREATMENT AS
ACTIVE INTERVENTION TO
PRODUCE A COUNTERACTING
REACTION IN AN ATTEMPT TO
NEUTRALIZE THE EFFECTS OF
DISEASE.
 (MEDICAL MODEL)
 PHYSICIANS TRAINED IN
FAMILY MEDICINE/GENERAL
PRACTICE, GENERAL
INTERNAL MEDICINE, AND
GENERAL PEDIATRICS ARE
CONSIDERED PRIMARY CARE
PHYSICIANS OR GENERALISTS.
 PHYSICIANS IN NON-PRIMARY
CARE SPECIALITIES ARE
REFERRED TO AS
SPECIALISTS.
 SPECIALISTS MUST SEEK
CERTIFICATION IN AN AREA OF
MEDICAL SPECIALIZATION WHICH
OFTEN REQUIRES ADDITIONAL
YEARS OF ADVANCED RESIDENCY
TRAINING FOLLOWED BY SEVERAL
YEARS OF PRACTICE IN THE
SPECIALITY.
 PRIMARY AND SPECIALITY
CARE
•PRIMARY CARE IS FIRSTCONTACT CARE AND IS
REGARDED AS THE PORTAL
TO THE HEALTH CARE
SYSTEM. SPECIALITY
CARE, WHEN NEEDED,
GENERALLY FOLLOWS
PRIMARY CARE.
•IN A MANAGED CARE
ENVIRONMENT WHERE
HEALTH SERVICES ARE
INTEGRATED, PRIMARY
CARE PHYSICIANS SERVE
AS GATEKEEPERS.
•GATEKEEPERS SERVE AN
IMPORTANT ROLE IN
CONTROLLING COST,
UTILIZATION, AND THE
RATIONAL ALLOCATION OF
RESOURCES.
•IN THE GATEKEEPING
MODEL, SPECIALITY CARE
REQUIRES A REFERRAL
FROM A PRIMARY CARE
PHYSICIAN.
• PRIMARY CARE PROVIDERS
FOLLOW THROUGH THE
COURSE OF TREATMENT AND
COORDINATE VARIOUS
ACTIVITIES INCLUDING INITIAL
DIAGNOSIS, TREATMENT,
REFERRAL, CONSULTATION,
MONITORING, AND FOLLOW-UP.
•PRIMARY CARE FOCUSES
ON THE PERSON AS A
WHOLE, WHEREAS
SPECIALTY CARE CENTERS
ON PARTICULAR DISEASES
OR ORGAN SYSTEMS OF
THE BODY.
• PRIMARY CARE STUDENTS
SPEND A SIGNIFICANT
AMOUNT IN AMBULATORY
CARE SETTINGS,
FAMILIARIZING THEMSELVES
WITH A VARIETY OF PATIENT
CONDITIONS AND PROBLEMS.
•STUDENTS IN MEDICAL
SUBSPECIALTIES SPEND
SIGNIFICANT TIME IN
INPATIENT HOSPITALS,
WHERE THEY ARE
EXPOSED TO STATE-OFTHE-ART MEDICAL
TECHNOLOGY.
 SOME KEY ISSUES IN MEDICAL
PRACTICE
• THE BALANCING ACT
BETWEEN THE AVAILABILITY
OF THE MOST ADVANCED
TREATMENT PLANS,
UNCERTAINTIES ABOUT THEIR
POTENTIAL BENEFIT, AND
WHETHER THE HIGHER COSTS
OF TREATMENT ARE
JUSTIFIED.
•THE DEVELOPMENT OF
MANAGED CARE IS LIKELY
TO SUBJECT PHYSICIANS
TO GREATER
CONSTRAINTS IN
EXERCISING THEIR
PROFESSIONAL
JUDGEMENT.
• MANAGED CARE
ARRANGEMENTS GENERALLY
LIMIT PAYMENTS TO
PARTICIPATING PHYSICIANS
THROUGH CAPITATION OR
DISCOUNTED FEES.
• ACCESS TO SPECIALISTS IS
CONTROLLED BY
GENERALISTS GATEKEEPERS
WHO ARE PROVIDED
INCENTIVES TO REDUCE
INPATIENT CARE, X-RAYS,
LABORATORY SERVICES, AND
SPECIALISTS CONSULTATIONS.
•HOSPITAL BASED
TRAINING HAS PRODUCED
TOO MANY SPECIALISTS.
MEDICARE SPENDS $7
BILLION A YEAR ON
RESIDENCY TRAINING.
•NIH HAS FUNDED
RESEARCH THUS
CREATING A LARGE POOL
OF PHYSICIAN
RESEARCERS.
•THERE ARE TOO MANY
PHYSICIANS IN THE WORK
FORCE ILL-PREPARED TO
PRACTICE IN THE WELLNESS ORIENTED,
AMBULATORY-BASED
ENVIRONMENT.
•IT HAS BEEN ESTIMATED
THAT THE US NEEDS
BETWEEN 145 AND 185
PHYSICIANS PER 100,000
POPULATION. CURRENTLY
THE SUPPLY IS ABOUT 200
PER 100,000.
•A SURPLUS OF
PHYSICIANS LEADS TO
UNNECESSARY INCREASES
IN HEALTH CARE
EXPENDITURES. A
SHORTAGE ADVERSELY
AFFECTS THE DELIVERY OF
HEALTH SERVICES.
•THERE IS A SURPLUS AT
THE AGGREGATE,
HOWEVER, PHYSICIAN
SHORTAGES STILL EXIST
IN CERTAIN PARTS OF THE
COUNTRY.
• PHYSICIANS ARE MORE LIKELY TO
CONCENTRATE IN METROPOLITAN
AND SUBURBAN AREAS RATHER
THAN IN RURAL AND INNER-CITY
AREAS. THE CITY OFFERS GREATER
PROSPECTS FOR HIGH INCOME,
PROFESSIONAL INTERACTION,
ACCESS TO MODERN FACILITIES
AND TECHNOLOGY, CONTINUING
EDUCATION, PROFESSIONAL
GROWTH, HIGHER STANDARD OF
LIVING, AND SOCIAL AMENITIES.
Physician’s Salaries at the median
 End of lecture for September
13th 2010, 6th Period
 Questions?
 Discussion?
 NURSING
 “BIG RISE IN DEMAND FOR
RN’S FORECAST”
 NEARLY 800,000 JOB
OPENINGS FOR REGISTERED
NURSES ARE EXPECTED IN
THE U.S. BETWEEN 1998 AND
2008.
 REFLECTS A 21.7% INCREASE
OVER THE NUMBER OF RN’S
THE NATION EMPLOYS TODAY.
 THIS PROJECTED HIRING
NEED WILL HAVE A MAJOR
IMPACT ON HOSPITALS,
WHICH EMPLOY ABOUT TWOTHIRDS OF ALL REGISTERED
NURSES.
Nursing Salaries by Length of
Service
 THE AVERAGE RN IN 2007 WAS
46.8 YEARS OLD, AGING
NEARLY 10 YEARS FROM AN
AVERAGE OF 37 IN 1983.
 THE NUMBER OF RN’S UNDER
AGE 30 HAS DECLINED BY
41%.
 THE PRIMARY CONTRIBUTOR
APPEARS TO BE A TWODECADE DECLINE IN YOUNG
WOMEN CHOOSING NURSING
AS A CAREER.
 IT IS PROJECTED THAT THE
NUMBER OF RN’S IN THE
LABOR FORCE WILL PEAK IN
2007, THEN DECLINE
THROUGH 2020 TO ABOUT THE
SAME LEVEL AS TODAY (2.1
MILLION) AS OLDER RN’S
RETIRE.
 HOSPITALS WILL HAVE TO
REPLACE THESE RETIRING
NURSES AS THE STAPLE OF
NURSING STUDENTS
DECLINES AND 78 MILLION
BABY BOOMERS BEGIN TO
ENTER THE MEDICARE
SYSTEM.
 THE SIZE OF RN GRADUATING
CLASSES IS SHRINKING, IN
SOME CASES TO HALF OF
THEIR SIZE IN THE 1970’S AND
1980’S. THIS TREND IS
EXPECTED TO CONTINUE INTO
THE NEXT DECADE.
 HOSPITALS ALREADY ARE
REPORTING RN SHORTAGES,
PARTICULARLY IN CRITICAL
CARE, EMERGENCY SERVICES,
MEDICAL-SURGICAL AND
OPERATING ROOM CARE.
 FUELING THE DEMAND FOR
REGISTERED NURSES
 U.S. HOSPITALS ARE
EXPERIENCING INCREASING
ACUITY OF ILLNESS,
PARTICULARLY AMONG THE
ELDERLY PATIENTS WHO
REQUIRE MORE NURSING
SERVICES.
 PATIENTS, REFLECTING AGING
OF THE POPULATION, NEED
MORE INTENSIVE CARE.
 HOSPITALS IN THE U.S. HAVE
INCREASED THE NUMBER OF
INTENSIVE CARE UNIT BEDS
BY 17,000 SINCE 1980; THESE
REQUIRE FOUR TIMES AS
MANY NURSES TO STAFF AS
NON-INTENSIVE CARE UNITS
OF THE SAME SIZE.
 WHERE DO NURSES WORK?
 HOSPITALS ARE THE MAJOR
EMPLOYERS OF RN’S, HIRING
OVER 60 PERCENT OF THE RN
SUPPLY.
 WITHIN THE HOSPITAL, 40
PERCENT OF THE PERSONNEL
ARE FROM THE NURSING
DEPARTMENT.
 FACTORS AFFECTING THE
SUPPLY OF NURSES
 AN OVERALL DECLINE IN
NURSING SCHOOL
APPLICANTS, TURNOVER,
PART-TIME WORKERS, AND
DECLINING AGE AND ACTIVITY
OF WORKING NURSES.
 OTHER CAREER CHOICES FOR
WOMEN….BOTH IN THE
MEDICAL FIELD, BUSINESS,
AND EDUCATION.
 OVERALL FUNDING FROM THE
FEDERAL GOVERNMENT TO
SUPPORT NURSING
EDUCATION HAS BEEN
SHARPLY REDUCED.
 A SHORTAGE OF NURSING
SCHOOL FACULTY IS
RESTRICTING NURSING
PROGRAM ENROLLMENTS.
 WITH FEWER NEW NURSES
ENTERING THE PROFESSION,
THE AVERAGE AGE OF THE RN
IS CLIMBING.
 TOTAL POPULATION OF
REGISTERED NURSES IS
GROWING AT THE SLOWEST
RATE IN 20 YEARS.
 JOB BURNOUT AND
DISSATISFACTION ARE
DRIVING NURSES TO LEAVE
THE PROFESSION.
 CHANGING DEMOGRAPHICS
SIGNAL A NEED FOR MORE
NURSES TO CARE FOR OUR
AGING POPULATION.
 THE NURSE PRACTITIONER
 A NURSE PRACTITIONER IS A
REGISTERED NURSE (RN) WHO
HAS ADVANCED EDUCATION
AND CLINICAL TRAINING IN A
HEALTH CARE SPECIALITY
AREA.
 NURSE PRACTITIONERS WORK
WITH PEOPLE OF ALL AGES
AND THEIR FAMILIES
PROVIDING INFORMATION
PEOPLE NEED TO MAKE
INFORMED DECISIONS ABOUT
THEIR HEALTH CARE AND
LIFESTYLE CHOICES.
 NURSE PRACTITIONERS MAY BE
FOUND IN ALL 50 STATES. THEY
 OBTAIN MEDICAL HISTORIES AND
PERFORM PHYSICAL
EXAMINATIONS.
 DIAGNOSE AND TREATE ACUTE
HEALTH PROBLEMS SUCH AS
INFECTIONS AND INJURIES.
 DIAGNOSE, TREAT, AND
MONITOR CHRONIC DISEASES
SUCH AS DIABETES AND HIGH
BLOOD PRESSURE.
 ORDER X-RAYS, PRESCRIBE
MEDICATIONS
 END OF LECTURE FOR
SEPTEMBER 15th 2010, 6th
PERIOD.
 QUESTIONS?
 DISCUSSION?
 DENTISTRY
 DENTISTRY IS DEFINED AS THE
EVALUATION, DIAGNOSIS,
PREVENTION AND/OR
TREATMENTS OF DISEASES,
DISORDERS OF THE ORAL CAVITY,
MAXILLOFACIAL AREA AND/OR THE
ADJACENT AND ASSOCIATED
STRUCTURES AND THEIR IMPACT
ON THE HUMAN BODY.
 THERE ARE MORE THAN
152,000 ACTIVE DENTISTS IN
THE UNITED STATES.
 ABOUT 92% ARE IN PRIVATE
PRACTICE.
 A 1991 NATIONAL POLL
REPORTED THAT 83% OF
AMERICAN ADULTS WERE
VERY SATISFIED WITH
SERVICE RECEIVED FROM
THEIR DENTIST.
Median Salary by Years
Experience - Job: Dentist (United
States)
 THE AVERAGE INCOME OF A
DENTIST IS IN THE HIGHEST 8
PERCENT OF U.S. FAMILY
INCOME.
 CURRENTLY, APPROXIMATELY
100 MILLION PEOPLE ARE
COVERED UNDER DENTAL
PLANS WHICH PAYS ALL OR
PART OF THEIR DENTAL
EXPENSES.
 DENTAL SPECIALITIES
 DENTAL PUBLIC HEALTH
 ENDODONTICS
 ORAL AND MAXILLIOFACIAL
PATHOLOGY
 ORAL AND MAXILLOFACIAL
RADIOLOGY
 ORAL AND MAXILLOFACIAL
SURGERY
 ORTHODONTICS
 PEDIATRIC DENTISTRY
 PERIODONTICS
 PROSTHODONTICS
 THE FUTURE OF DENTISTRY
 THE DEMAND FOR DENTAL
SERVICES WILL GROW. DUE TO
THE SUCCESSES OF
PREVENTATIVE DENTISTRY,
PEOPLE WILL KEEP THEIR TEETH
LONGER AND WILL SEEK REGULAR
DENTAL CARE.
 OTHER HEALTH CARE
ROFESSIONALS
 THE PHYSICIAN ASSISTANT
 PHYSICIAN ASSISTANTS ARE
HEALTH CARE PROFESSIONALS
LICENSED TO PRACTICE MEDICINE
WITH MEDICAL SUPERVISION.
 PA’S CONDUCT PHYSICAL EXAMS,
DIAGNOSE AND TREAT ILLNESS,
ORDER AND INTERPRET TESTS,
COUNSEL ON PREVENTATIVE
HEALTH CARE, AND IN SOME
STATES, WRITE PRESCRIPTIONS.
 IN THE 1960’S, IT WAS
RECOGNIZED THAT THERE
WAS A SHORTAGE AND AN
UNEVEN DISTRIBUTION OF
PRIMARY CARE PHYSICIANS.
 DUKE UNIVERSITY CREATED A
PROGRAM AND SELECTED
RETURNING NAVY CORPSMAN
WHO HAD SERVED IN VIETNAM.
 CURRICULUM WAS BASED ON THE
FAST TRACK PROGRAM USED TO
TRAIN DOCTORS IN WORLD WAR II.
 PHYSICIAN ASSISTANTS ARE
FOUND IN ALL AREAS OF
MEDICINE.
 OVER 50% PRACTICE IN THE AREA
OF PRIMARY CARE.
 19% PRACTICE IN SURGICAL
SPECIALITIES
 STATE LAW DICTATES JUST WHAT
A PHYSICIAN ASSISTANT MAY DO.
 IN GENERAL, PA’S SEE MANY OF
THE SAME TYPE OF CASES AS THE
PHYSICIAN. CASES HANDLED BY
THE PHYSICIAN ARE THE MORE
COMPLICATED ONES.
 IN 47 STATES PA’S CAN PRESCRIBE
MEDICATIONS.
 ARKANSAS AND ILLINOIS ARE
CHANGING THEIR LAWS TO PERMIT
PA’S TO WRITE PRESCRIPTIONS.
 IN CALIFORNIA PA’S WRITE WHAT
IS CALLED “TRANSMITTAL ORDER.”
 IT IS ESTIMATED THAT IN
2002, THERE ARE 42,000+ PA’S
IN CLINICAL PRACTICE.
 THERE ARE 132 ACCREDITED
EDUCATIONAL PROGRAMS IN
THE UNITED STATES.
 THE TYPICAL PA PROGRAM IS 2425 MONTHS.
 THE MAJORITY OF THE STUDENTS
HAVE A BA/BS DEGREE AND 45
MONTHS OF EXPERIENCE BEFORE
ADMISSION.
 IN 2002, THERE WERE ABOUT
10,000 ENROLLED IN PA
PROGRAMS.
 THE UNITED STATES BUREAU
OF LABOR STATISTICS
PROJECTS THAT THE NUMBER
OF PA JOBS WILL INCREASE
BY 53% BETWEEN 2000 AND
2010.
 THE PHYSICAL THERAPIST
 DEFINITION:
 THE PHYSICAL THERAPIST
PROVIDES SERVICES AIMED AT
PREVENTING THE ONSET
AND/OR SLOWING THE
PROGRESSION OF CONDITIONS
RESULTING FROM INJURY,
DISEASE AND OTHER CAUSES.
 PROFESSION FINDS ITS ROOTS
DURING WORLD WAR I WITH
THE WORK DONE BY
RESTORATIVE AIDES.
 A PHYSICAL THERAPIST WILL
EVALUATE AND TREAT THOSE
WITH MUSCULOSKELETAL
DISORDERS, NUEROLOGICAL
DYSFUNCTIOINS AND THOSE
WITH OTHER TYPES OF
DISEASE, INJURY OR ILLNESS.
 WHAT DO THEY EARN?
 THERE ARE MORE THAN
120,000 LICENSED PT’S IN THE
UNITED STATES. MEDIAN
SALARY IS $52,000.
 WHERE DO THEY PRACTICE?
 OUTPATIENT CLINICS OR
OFFICES
 INPATIENT REHAB FACILITIES
 SKILLED NURSING, EXTENDED
CARE OR SUBACUTE
FACILITIES.
 HOMES
 EDUCATION OR RESEARCH
CENTERS
 SCHOOLS
 HOSPICES
 FITNESS CENTERS
 PART OF THE MEDICAL TEAM
 REHABILITATION DONE IN
COORDINATION WITH
DOCTORS, NURSES, SOCIAL
WORKERS, AND
OCCUPATIONAL THERAPISTS.
 OCCUPATIONAL THERAPISTS
CONCENTRATE ON ACTIVITIES
OF DAILY LIVING, THE ABILITY
TO COOK, CLEAN AND
MANAGE SAFELY IN A HOMR
ENVIRONMENT.
 PHYSICAL THERAPY WILL
FOCUS ON BASIC GROSS
MOBILITY SKILLS.
 BOTH PROFESSIONS AIM TO
REDUCE PAIN, RESTORE
FUNCTION, AND PROMOTE
INDEPENDENCE.
 EDUCATIONAL REQUIREMENTS –
PHYSICAL THERAPY

 MINIMUM: POST-BACCALAUREATE
DEGREE
 MASTERS OF PHYSICAL THERAPY
 DOCTOR OF PHYSICAL THERAPY
 EDUCATIONAL REQUIREMENTS
– OCCUPATIONAL THERAPY

 MINIMUM: POSTBACCALAUREATE DEGREE
 MASTERS OF OCCUPATIONAL
THERAPY
 LICENSURE REQUIREMENTS
 MUST PASS A STATEADMINISTERED TEST.
 EMPLOYMENT OPPORTUNITIES
ARE NOW VERY GOOD
 END OF LECTURE FOR SEPTEMBER
15th 2010
 7TH PERIOD
 Questions?
 Discussion?