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 FIRST-CONTACT 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-OF-THE-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 WELL-NESS 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 12th 2011, 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 TWO-THIRDS 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 TWO-DECADE 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 14th 2011, 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 24-25 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: POST-BACCALAUREATE

DEGREE

MASTERS OF OCCUPATIONAL THERAPY

LICENSURE REQUIREMENTS

MUST PASS A STATE-ADMINISTERED TEST.

EMPLOYMENT OPPORTUNITIES ARE NOW VERY GOOD

END OF LECTURE FOR SEPTEMBER 14th 2011

7TH PERIOD

Questions?

Discussion?