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Personnel in Health Care
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Presentation Objectives:
• Identifying the key professional Personnel involved in health care
S i i h l d i i i f h l h• Summarizing the roles and activities of health professionals
• Explaining the current market challenge for various health care personnel
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Factors Contributing to the Growth in Health Care & Health Care Professionals
Technology
Population Growth
Aging in the PopulationAging in the Population
Increased Access
Where the jobs are
http://www.bls.gov/oes/current/oes_alph.htm#H3
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Health Professionals
• Physicians• Nurses‐ RN, LN• Advanced Practice Nurse (APNs)• Physician Assistant (PA)• Nurse Practitioners (NPs)• Certified Nurse Midwives (CNMs)• Pharmacists• Laboratory Technicians• Other Aids
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• Bureau of Labor Statistics (www.bls.gov)– Personal and Home Care Aides
– Medical Assistants
– Physician Assistants
Fastest project growth (2010)
Physician Assistants
– Medical records and health information technicians
– Home Health Aides
– Fitness Trainers
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©Number of Jobs in US
Bureau of Labor Statistics, 2000
2,000,000
2,500,000
3,000,000
2,194,000
2,755,000
Selected Healthcare Professionals
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‐
500,000
1,000,000
1,500,000
Dietitions Pharmacists Physician Assistants
RNs Physicians Respiratory Therapists
49,000 217,000
58,000
598,000
83,000 56,000
270,000
89,000
705,000
112,000
2000 Level 2010 Projection
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Physicians
• Nature of work– Diagnostic, determination of treatment, examination, counsel to patients
• Classifications• Classifications– M.D. (doctor of medicine) – Allopathic
– D.O. (doctor of osteopathic medicine)
• A little trivia … doctor???
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Add approximately 20% to each category for estimate of current amount 8
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Solo Practice: - A doctor independently manages the practice
- Independently responsible
G P i
Solo and Group Practice
Group Practice:- A group of doctors manage the practice
- Share resources
- Joint collaboration in patient care delivery
- Shares related responsibilities and liabilities
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Solo Practitioner
Pros
o Decision Autonomy
o Complete oversight of business operations
o Total control over strategic
Pros
o Decision Autonomy
o Complete oversight of business operations
o Total control over strategic
Conso Reduced practice coverage for
time offo Loss of cost sharing o Financial insecurity if time off
is required
Conso Reduced practice coverage for
time offo Loss of cost sharing o Financial insecurity if time off
is requireddirection and practice future
o Consistent relationships with patients
o Opportunity to determine practice revenue
direction and practice future
o Consistent relationships with patients
o Opportunity to determine practice revenue
is requiredo Less support for expansiono More vulnerable to
competition
is requiredo Less support for expansiono More vulnerable to
competition
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Group Practitioner
ProsPotential for improved office efficienciesStable coverage for time off
ProsPotential for improved office efficienciesStable coverage for time off
ConsReduced independence in business decisionsComplex division of revenues and costs
ConsReduced independence in business decisionsComplex division of revenues and costsoff
Potential for improved cost sharing Work/Life balanceIncreased negotiating power with payers and others
offPotential for improved cost sharing Work/Life balanceIncreased negotiating power with payers and others
revenues and costsFor large practices:– Inefficient bureaucracies
may– Potential for reduction in
benefits from cost sharing opportunities
revenues and costsFor large practices:– Inefficient bureaucracies
may– Potential for reduction in
benefits from cost sharing opportunities
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Employed Physician
Pros
Financial security
Work/Life balance
Reduced administrative burden
Pros
Financial security
Work/Life balance
Reduced administrative burden
Cons
Less or little involvement in practice decision making
Possible bureaucratic
Cons
Less or little involvement in practice decision making
Possible bureaucraticburden
More time to focus on patient care, research, and teaching
burden
More time to focus on patient care, research, and teaching
Possible bureaucratic processes with larger organizations
Possible bureaucratic processes with larger organizations
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Where they locate …Surgical Spcialists and State Population
CA
12000
14000
16000
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WYDC
VTAKNDSDDEMTRI NHHI ID MENENMNVWV
VA
UTARKSMSIA
CTOR
OKSCKYCOAL
LAAZMN
MD
WITN
MOWAIN
MANCGA
NJMI
OH
PA
IL
FL
NY
TX
0
2000
4000
6000
8000
10000
0 10 20 30 40 50 60
State
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Academia
HMO
US Physician Distribution by Employment Type AMA‐2001
Employee38%
Self Employed
Solo27%
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8
Group Practice
State & Local Gov't
Private Hospital
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Self Employed Group35%
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Percentage Growth in FTE Physician Supply
(source – HHS)
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Female27%
Physician Gender Composition (2006)
Physicians by Gender
Female8%
Physician Gender Composition (1970)
Male73%
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Male92%
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Female Specialties
10%
12%
14%
16%
18%
20%19%
15.50%
11.30%
7 50%
Which specialties do female physicians select?
Source: Allied Physicians, Los Angeles Times17
0%
2%
4%
6%
8%
10% 7.50% 6.70%
4.10% 3.20%
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Decreasing reimbursements
Increasing cost of maintaining a practiceProfessional liability
Labor
Rent
Challenging Practice Environment
Rent
Supplies
Other infrastructure, e.g. billing costs, Hardware, Software, Telecom, etc.
Increasing administrative burdenRegulations
Contract provisions
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• Optometrist (OD)– vision correction
• Psychologist (PhD)l h l h li & h h
Other Independent Health Related Practice Types
– mental health counseling & psychotherapy
• Podiatrist (DPM)– diseases & deformities of the feet
• Chiropractor (DC)– literally, hand manipulation; Health of spine and nervous system
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Malpractice Insurance
A Brief Analysis
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© The New Professional Liability CrisisMalpractice Insurance Cost
Premiums rising sharply for the last three years for physicians
Premiums doubled in some specialties, especially OB GYNespecially OB‐GYN
Some physicians are dropping out of OB‐GYN
The beginning of an access to healthcare crisis?
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© An Example: Malpractice PremiumIncrease in Massachusetts
14%12.5%
9%
0%
6%
1998 1999 2000 2001 2002
ProMutual Rate Filings22
© Example: Average Premiums in Massachusetts ‐2002
$10200
$8,600
$8,428
$7,200
Ped
Ophth.
Internal Med.
Family Practice
$47,000
$30,246
$16,800
$12,400
$10,200
$84,566OB-GYN
Orth. Surg.
General Surg.
ENT
Anesth.
Ped.
ProMutual Rate Filings, 2002Orthopedic surgery: spine surgeryPediatricians: minor surgeryIM: no surgery 23
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AMA Watch List
WA
OR
NV OHWV
PA
NY
NJ
MA?
TXMS GA
FL
WV
In crisis
Problem signs
Currently OK
Source: American Medical Association (AMA) 25
© What to do about increasing malpractice insurance rates?
• Insurance Industry tries to shun high risk physicians
• Tort Reform aimed at reducing plaintiff’s awardsawards
• State‐run malpractice insurance
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Chiropractic Physicians
The Facts
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Chiropractic doctors or Chiropractorsdiagnose and treat patients' neuromuscular-skeletal disorders of the spine and other body joints by adjusting the spinal column or
Definition
joints by adjusting the spinal column or through other corrective manipulation.
Chiropractors are usually in private practice or in clinics with other health practitioners.
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What do they do?
• Duties are similar to M.D.’s: – Take patient's case history, conduct examination, and perform X‐rays and
other tests to diagnose patient's condition
• Diagnose neuromuscular‐skeletal disorders of the spinal column pelvis extremities and associatedspinal column, pelvis, extremities and associated tissues
• Treatment of health disorders in a natural manner
• Advise patients on corrective exercises, posture, lifestyle and nutrition
• Refer patients for medical care when appropriate.
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Structure, Education, Income
• 50,000 to 100,000 Chiropractors in U.S.
• Mostly Solo Practice
• Licenses are regulated at the state level
• 4‐year chiropractic college course at an accredited program
• Median Income: approximately $70,000
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Nurses
Definitions
Statistics
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What Do Nurses Do?What Do Nurses Do?
Assessment
Diagnosis
Planning of treatmentPlanning of treatment
Intervention
Evaluation of human response to health or illness
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More on what nurses do …
• Work mostly in hospital settings
• In addition to patient assessment and diagnosing: staff teaching, managing care, maintaining patient safety etcmaintaining patient safety, etc…
• Operate medical technologies and administer medications
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Licensed in the USA :: 2,558,874
Females :: 2,433,277 (95.1%)
Males :: 124,630 (4.9%)
Under 30 years old :: 228,289 (9%)
Licensed in the USA :: 2,558,874
Females :: 2,433,277 (95.1%)
Males :: 124,630 (4.9%)
Under 30 years old :: 228,289 (9%)
Registered Nurse Population
Under 30 years old :: 228,289 (9%)
30 - 39 years old :: 711,050 (27.8%)
40 - 49 years old :: 843,757 (33%)
50 - 59 years old :: 464,749 (18.2%)
60+ years old :: 293,800 (11.5%)
Under 30 years old :: 228,289 (9%)
30 - 39 years old :: 711,050 (27.8%)
40 - 49 years old :: 843,757 (33%)
50 - 59 years old :: 464,749 (18.2%)
60+ years old :: 293,800 (11.5%)
American Association of Critical Care Nurses 200234
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Primary Practice Setting
• Hospitals :: 45%
• Intensive Care bed unit :: 17%
• Telemetry/Step Down/PCU :: 6.8%
Source: AACCN 2002
• Emergency Department :: 7.8%
• Operating room :: 9 %
• Post Operative/Recovery :: 3.2%
• General/Specialty unit :: 35.1%
• Labor/Delivery room :: 6.9% 35
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Weekly range :: $395 - $1005
Average annual for all RNs :: $42,071
Average annual staff RN :: $38,567
Registered Nurse Full Time Salary
East Coast average annual staff RN :: $41,884
South average annual staff RN :: $37,109
Midwest average annual staff RN :: $35,601
West Coast average annual staff RN :: $44,781
Continued on next slide 36
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Average annual Supervisor :: $41,950
Average annual Instructor :: $42,407
Registered Nurse Full Time Salary…Registered Nurse Full Time Salary…
Average annual Head Nurse :: $46,262
Average annual Clinical Nurse Specialist :: $51,089
Average annual Nurse Practitioner/Midwife :: $55,014
Average annual Nurse Anesthetist :: $86,319
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Highest Nursing EducationHighest Nursing Education
Masters
Doctoral
6.50%
0.60%
Source: AACCN- 2002 38
0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00%
Associate Degree
Baccalaureate
Diploma
31.70%
28.80%
27.20%
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Characteristics of Registered Nurse Population: (HRSA‐2001)
Characteristic Value
RNs employed in nursing 2,201,813RNs per 100, 000 782
Source: Health Resources Services Administration 200139
Average age 45.2Average age at graduation 30.5Average Salary $46,782 Percent female 94.60%Percent male 5.40%
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© States with highest number of RNs per 100,000 (HRSA‐2001)
State RNs per 100,000District of Columbia 1,675Massachusetts 1,194South Dakota 1,128Rh d I l d 1 101
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Rhode Island 1,101North Dakota 1,096Iowa 1,060Maine 1,025Pennsylvania 1,010Missouri 960Nebraska 958
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States with lowest number of RNs per 100,000 (HRSA‐2001)
State RNs per 100,000Arkansas 701Georgia 683New Mexico 656Id h 636
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Idaho 636Oklahoma 635Arizona 628Texas 606Utah 592California 544Nevada 520
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45
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Full Time RNs
58.0
60.0
57.0
59.058.5 58.3
Full Time Employed RNs
Source: Dept. of Health & Human Services (HHS)47
48.0
50.0
52.0
54.0
56.0
1980 1984 1988 1992 1996 2000 2004
52.0 52.2
54.1
© Racial/Ethnic Characteristics of RN Population
Black7%
Hispanic4%
Asian3% American Indian
1%
Racial Characteristics
Source: HRSA-200148
White85%
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Chronic Shortages
• National Supply (1.89m) versus Demand (2m)– A 6% shortage
• Shortage projected to grow to 12%
• Factors driving demand include growing population and increased proportion of elderly
• What about supply?
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Florida Nursing Market
2002 Survey
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Florida Situation
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A relatively larger shortage
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The Vacancy Rate
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56
57
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Recruitment of Foreign Nurses
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Non‐Physician Practitioners
Who are they?
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o Nurse Practitioner
o Advanced Practice Nurse
o Certified Nurse Midwife (CNM)
o Physician Assistanto Surgery Assistanto Clinical Social WorkerCli i l P h l i
Who are they?
(CNM)
o Certified Registered Nurse Anesthetist (CRNA)
o Clinical Nurse Specialist (CNS)
o Clinical Psychologist (Ph.D.)
o Non‐clinical Psychologist
o PT, OT, Speech Pathologist
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Nurse Practitioner– NPs are RNs
Physician Assistant– Undergraduate degree
NP versus PA
Physician assistants are health care professionals licensed to practice medicine with physician supervision.
– Masters degree trained
– Certified by a nursing specialty organization
– Not possible for a non‐RN to be a NP
from an approved PA program.
– It is possible for an LVN, or RN to be a PA
62For useful Info on Pas: http://www.aapa.org/geninfo1.html
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What can they do?
Nurse Practitioner– Physician Services
– Defined by their Scope of Practice as stated in t t l BNE R l
Physician Assistant– Physician Services
– Defined by their Scope of Practice as stated in t t lstate law BNE Rules
221.12
– Limited prescriptive authority
state law
– Limited prescriptive authority
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Nurse Practitioner– In all settings
– Inpatient
O i
Physician Assistant– In all settings
– Inpatient
O i
Where can a non‐physician practitioner perform services?
– Outpatient
– SNF
– Home
– Nursing Home
– Outpatient
– SNF
– Home
– Nursing Home
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Show me the money!!!
In 2005
Average Base: $65,000
Average 1st Year: $56,000
Salary Range: $50,000 ‐ $105,000
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© Practice Characteristicsfor PAs who graduated in 2000
Other18%
Employer Type for PAs
Source: American Academy of Physician Assistants (AAPA) 2001 survey66
Single or multi‐specialy physian
office42%
Hospitals22%
Solo physian office18%
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Other Health Professionals
• Pharmacists– Knowledge of drugs and pharmaceuticals
– Patient Safety
– Monitor medication orders
b h i i• Laboratory Technicians– Detection, diagnosis, and treatment
– Bachelors Degree
• Aides– Promotion of health and healing
– Licensed at state level
– Typically employed by hospitals67
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Many of the fastest growing occupations are concentrated in the health services field. Factors contributing to continued growth in
Conclusion
this industry include the aging population, which will continue to require more services, and the increased use of innovative medical technology for intensive diagnosis and treatment.
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