Transcript Chapter 12 Health Care Professionals

Chapter 12
Health Care Professionals
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Table 12.1 Health Care Sector as a
Proportion of All Employed Persons, Selected Years
1970
1990
2003
Employment in
health sector
(thousands)
4,246
9,447
13,615
Total number of
persons employed
(thousands)
76,805
117,914
137,736
Health sector as a
proportion of all
occupations
5.5%
8.0%
9.9%
Total resident U.S.
population
(millions)
203.2
248.7
290.8
Number of health
personnel per
100,000 population
2,090
3,799
4,682
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Factors Contributing to the
Increased Supply of Health Care Professionals
•
•
•
•
•
•
Technological growth
Specialization
Health insurance coverage
Aging population
Emergence of ambulatory clinics
Array of post-hospitalization venues
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Physician Supply
• Between 1965 and 2005, there was a 218
percent increase in the supply of active
physicians.
• In 2005, there were approximately 845,684
active nonfederal physicians, including
osteopaths.
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Factors Influencing
the Supply of Physicians
• Movement away from managed care
• Increase in the number of female
physicians
• Lifestyle preferences
• Population growth
• Increase in average lifespan
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International
Medical Graduates (IMGs)
• By the early 1970s
– IMGs accounted for more than 40 percent of
new physician licentiates
– 30 percent filled residency positions
– 20 percent were active physicians in the United
States
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International
Medical Graduates (IMGs)
• In 2005, there were 204,369 IMGs in the
United States
– Accounted for 24 percent of the total active
nonfederal physician population.
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Factors
Contributing to Supply of IMGs
• Specialties, geographic locations, and
employment settings avoided by U.S.
medical graduates.
• Surplus of residency positions in teaching
hospitals.
• Increased market penetration of managed
care plans in urban areas.
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Table 12.3
Number of Active Physicians and
Percentage Distribution by Specialty, Selected Years
1980
2002
Specialty
Number
Percent
Number
Percent
Percent
Change
All
435,264
100%
768,498
100%
76.6%
Primary
Care
170,705
39.2%
286,294
37.3%
67.7%
Medical
25,328
5.8%
57,579
7.5%
127.3%
Surgical
72,050
16.6%
104,871
13.6%
45.6%
Other
167,181
38.4%
319,754
41.6%
91.3%
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Reference Table 12.3
• Primary care specialties have grown
substantially.
• Growth in medical specialties has increased
over this period, reaching to more than 120
percent.
• Percentage of primary care physicians in
any given year has remained fairly
constant.
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Reference Table 12.3
• Sources of growth in primary care
specialties have come from IMGs and
women.
• In 1980, IMGs constituted 18 percent of all
primary care physicians.
• In 2003, they accounted for 29.2 percent.
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Reference Table 12.3
• In 1980
– Women constituted 13.1 percent of all primary
care physicians
– In 2002, they accounted for 33.5 percent
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Geographic
Distribution of Physicians
• Rural areas and inner-city locations
continue to experience physician shortages.
• Rural areas with no nearby cities still have
fewer than 100 physicians per 100,000
civilians.
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Geographic
Distribution of Physicians
• Nonmetro places with less than 2,500
inhabitants have experienced no
improvement in physician availability in 60
years.
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Efforts to Improve
the Unequal Distribution of Physicians
• Federal efforts to improve the distribution of
physicians include loan forgiveness and
extensive support for the development of
family practice training programs.
• At the state level, there have been efforts to
improve physician distribution through the
authority of Offices of Rural Health.
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Osteopathy
• Osteopaths traditionally emphasize the
importance of the musculoskeletal system
on general health.
• Osteopaths are licensed to practice
medicine and perform surgery in all states.
• In 2005, there was a total of 50,532
osteopaths in the Unites States.
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Dentists
• Majority of dentists are in general practice.
• Approximately,14 percent of all dentists are
specialists.
• Orthodontists comprise roughly 33 percent
of all dental specialists.
• Oral surgeons constitute 25 percent of the
specialist population.
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Table 12.5
Total and Active Dentists
and Dentist/Population Ratios: Selected Years
Number of Dentists
Year
Total
Active
Total
Population
(Thousands)
Active
Dentists per
100,000
population
1960
105,200
90,120
182,287
49.4
1980
147,280
126,240
228,831
55.2
168,000
276,740
60.7
2000
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Reference Table 12.5
• In 2000
– Approximately 168,000 active dentists
practicing in the United States.
• The earlier increases in the number of
dentists can be attributed to federal
legislation passed in the early 1960s and
1970s that attempted to remedy the
perceived shortage.
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Reference Table 12.5
• Between 2000-2001
– There were 55 dental schools and 4,327 firstyear dental students in the United States.
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Public Health Professionals
• Administration of health agencies
• Planning and evaluating prevention,
screening, and health education programs
• Surveillance and control of environmental
hazards and pollutants
• Incidence and prevalence of disease in
populations
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New Roles
for Public Health Professionals
• Role in managed care
– Monitor disease incidence
– Prevalence and outcome
– Develop, implement, and monitor programs of
prevention
• Bioterrorism surveillance and prevention
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Nurses
• RNs are the largest group of licensed health
care professionals in the United States.
• In 2000, an estimated 81.7 percent of RNs
were employed in nursing.
• Despite an overall increase in the number
of nurses employed in nursing, a shortage
still exists.
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Factors Contributing
to the Nursing Shortage
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Decline in nursing school enrollments
Aging of the RN workforce
Nurses not employed in nursing
Decline in relative earnings
Emergence of alternative job opportunities
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Pharmacists
• In the 1980s and 1990s
– Pharmacists expanded their role to include
drug production education and to act as experts
on the effects of specific drugs, drug
interactions, and generic drug substitutions.
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Pharmacists
• In the early twenty-first century
– Role was further expanded to include selecting,
monitoring, and evaluating appropriate drug
regimens
– Providing information to patients and health
care professionals
– Preventing medication errors
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Physicians’ Assistants
• Qualified by academic and practical training
to provide patient services under
supervision of a licensed physician.
• May diagnose, manage, and treat common
illnesses, provide preventive services, and
respond to emergency situations.
• May prescribe certain classes of
medications.
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Advanced Practice Nurses
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•
•
•
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Basic nursing education
Basic licensure
Graduate degree in nursing
Experience in a specialized area
Professional certification from a national
certifying body
• An APN license, if required
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Seven Core Competencies
• Direct clinical practice
• Expert guidance and coaching of patients,
families, and other care providers
• Consultation
• Research skills
• Clinical and professional leadership
• Collaboration
• Ethical decision-making skills
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Issues in PA and NP Use
• Legal restrictions concerning practice
• Reimbursement policies
• Relationships with physicians
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