Lecturer: Monika M. Wahi, MPH, CPH. Explain why health care professionals make up such a large proportion of the U.S. work force Name three types of allied.

Chapter 4: Health Care Providers and Professionals

Lecturer: Monika M. Wahi, MPH, CPH

Learning Objectives

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

At the end of this lecture, student should be able to:

Introduction

Introduction 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

Health Services Professionals

Physicians

Dentists

Pharmacists

Optometrists

Chiropractors

Psychologists

Nurses

Podiatrists

NPPs

Health Service

Administrators

Allied Health

Professionals

Allied Health Professionals

Therapists

Lab/Rad Technicians

Social Workers

Health Educators

Health Care Settings

Hospitals

Nursing Care

Facilities

Migrant Health Centers

Hospitals

Community Health Centers

Outpatient Facilities

MCOs

Insurance Firms

Mental Health Centers

Pharmaceutical

CompaniesSchool Clinics Physician

s’ Offices

Laboratories

Voluntary Health

Agencies

Professional Health

Associations

Colleges of

Medicine

Colleges of Allied Health

Professions

Research Institutio

ns

Persons Employed at Health Service Sites

1994 2001 20090

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Phys. Ofc's/ClinDent. Ofc's/ClinChiro. Ofc's/ClinHospitalsNurs. Care Facs.Other Svc. Sites

Nu

mb

er

of

Pers

on

s in

Th

ou

san

ds

From Table 4.1 (page 81)

Persons Employed at HealthService Sites

1994 2001 20090%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Other Svc. SitesNurs. Care Facs.HospitalsChiro. Ofc's/ClinDent. Ofc's/ClinPhys. Ofc's/Clin

From Table 4.1 (page 81)

Physicians

Active Physicians per 10,000 Population

1950 1960 1970 1980 1990 1995 2000 20090

5

10

15

20

25

30

From Table 4.2 (page 83)

Type of Active Physicians

1950 1960 1970 1980 1990 1995 2000 20090

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

All Active Physicians

Doctors of Medicine

Doctors of Osteopa-thy

From Table 4.2 (page 83)

MD’s and DO’sMD’S

Allopathic medicine

Less likely to be generalists (1/3)

Non-holistic approach

DO’S

Osteopathic medicine

More likely to be generalists (>1/2)

Holistic approach

Primary vs. Specialty Care

First contactGatekeeper

LongitudinalPerson as whole

Generalist training

Primary If neededRequires referral

Episodic

Disease/organSpecialty training

Specialty

Aggregate Physician Oversupply

Too many specialists

Not enough OB/GYN, Peds, IM, Gen/Fam Practice

Shortage?

Geographic maldistributionSpecialty maldistribution

Ambulatory Visits by Generalists and Specialists in the U.S., 2005

7%

13%

17%

22%

40%

Figure 4.1 (page 86)

OB/GYNPedsInt. Med.Gen./FPSpecialists

Dentists

Distribution of Specialties for Dentists, 2008

120200; 85%

7700; 5%

6700; 5%7400; 5%Table 4.3 (page 90)

DentistsOrthodontistsOral SurgeonsDentists, all other

Pharmacists

Sites of Employment for Pharmacists, 2008

65%

22%

13%

Table 4.4 (page 91)

RetailHospitalsOther

Other Doctoral-level Health Professionals

Employment Levels of Doctoral-level Health Professionals in the United States, 2008

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

34,800

170,200

12,200

49,100

OptometristsPsychologistsPodiatristsChiropractors

Nu

mb

er

of

Pro

fessio

nals

From Table 4.5 (page 92)

Nurses

NursesLargest Group

of HC Professionals

• WWII beginnings

• Major caregivers of sick/injured patients

• Address physical, mental, emotional needs

Levels of Nurses

• RNs require ADN, diploma, or BSN

• LPNs/LVNs state-level certification

• APNs are NPPs, include CNSs, CRNAs, NPs, and CNMs

Employment

• Many practice locations (home, hospital, clinic, etc.)

• Setting specialties (long-term care, public health)

• Staffing issues, nursing shortage

Non-physician Practitioners NPP

Distribution of Most Common NPPs, 2008 Survey

158348; 67%

70383; 30%

8000; 3%

2

NP'sPA'sCNM's

50%/50% split between Primary

and Specialty Care

Work predominantly in

Primary Care

Role and Value of NPPsLess 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

Allied Health Professionals

What is an Allied Health Professional?

60% of U.S. health care workforce

Certificate/degree in health care scienceDelivery of health or related servicesIdentify, evaluate, prevent disease/disorders

Dietary/nutrition

Rehabilitation

Health system management

Types of Allied Health Professionals

Technicians and Assistants

<2 years training

PT and OT assistants

Lab., rad., resp. techs

Technologists and Therapists

Advanced training

PT/DPT and OTs

Dietitians/nutritionists

Dispensing opticians

Speech/lang. pathologists

Social workers

Public Health Professionals and Core Disciplines

Physicians Researchers Lawyers Environme

nt-alistsSocial

Scientists

Epidemiology Biostatistics Health Svcs. Admin.

Health Ed./Beh. Science

Environmental Health

Health Services Administrators

Leadership, strategic direction, governing

boardsLead outpatient or nursing services,

department managers, logistics

and operationsAssistants to mid-level

managers, supervise small teams

BA, BS

MHA, MHSA,

MBA, MPH, MPA

Conclusion 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

Learning Objectives

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

At the end of this lecture, student should be able to: