Medical Science: History and Practice Lesson 2: The Practice of Medicine

1. Medical Science: History and Practice Lesson 2: The Practice of Medicine 2

2. Lesson Objectives Upon completion of this lesson, students should be able to … • Describe the difference between an internship and a residency in the training of physicians. • State which type of medical practice is addressed under the medical and surgical specialties. • Discuss ten allied health fields and the educational requirements for each of them. • Discuss the current trends in health care that are driving changes in medical practice.

3. Title of Doctor • Designates a person who holds a doctoral degree • Physicians are medical doctors or MDs • Practicing medicine requires a minimum of 9-10 years of education and training • Four-year college degree in premedical studies • Four years of medical school • 2-6 year internship depending on specialty area

4. Required Examinations for Physicians • State medical board examination • Upon passing the individual is licensed to practice medicine in that state • American Board of Medical Specialties • Upon passing the individual is board certified in a chosen specialty area To learn more about the American Board of Medical Specialties, click here or go to http://www.abms.org

5. Critical Thinking Question • What is the difference between a Doctor of Osteopathy (DO) and a Medical Doctor (MD)?

6. Doctor of Osteopathy • Learns the skill of manipulation therapy in schools of osteopathy • Places greater emphasis on the relationship between the musculoskeletal systems and the organs of the body • Usually able to perform the same procedures as a medical doctor Visit the American Academy of Osteopathy by clicking here or visiting http://www.academyofosteopathy.org

7. Others with Title of Doctor • DC – Doctor of Chiropractic • DMD – Doctor of Dental Medicine • DDS – Doctor of Dental Surgery • EdD – Doctor of Education • OD – Doctor of Optometry • PhD – Doctor of Philosophy • DPM – Doctor of Podiatric Medicine

8. Medical Practice Acts • Indicates who must be licensed to perform certain procedures • Establishes the requirements for licensure • Denotes duties associated with the license • Sets grounds on which a license can be revoked • Designates reports that must be made to the government • Specifies the penalties for practicing without a valid license

9. Ways a Medical License May be Granted • Examination • Offered by each state • Usually taken before the end of medical school • Federal Licensing Examination (FLEX) – official medical licensing exam in the U.S. • Upon passing the exam, a license is issued after an internship is completed

10. Ways a Medical License May be Granted • Examination • Passing the exam entitles one to set up private practice as a general practitioner • U.S. Medical Licensing Examination (USMLE) provides a single licensing exam for graduates from accredited programs

11. Ways a Medical License May be Granted • Endorsement • Means approval or sanction • Granted to applicants who have passed the National Board Medical Examination (NBME) • Most physicians in the U.S. are licensed by endorsement • If a medical school graduate is not licensed by endorsement they must pass the FLEX • Graduates of foreign medical schools must pass the same requirements as American graduates

12. Ways a Medical License May be Granted • Reciprocity • When one state accepts another state’s license • Allows the physician to practice in the state without having to take another examination

13. Re-Registration for Physicians • Required to maintain license • Required either annually or bi-annually • Physician is notified by mail when re-registration is required • Requirements of re-registration: • Payment of a fee • 75 hours of continuing medical education (CME) units in a three-year period

14. Causes for Suspension or Revoking of a Medical License • Unprofessional conduct • Commission of a crime • Personal incapacity to perform one’s duties

15. Health Care in the United States • Largest industry • Provides about 12.9 million jobs • Costs increasing faster than cost of living • About 14% of gross national product spent on health care • Heath care costs per year equal to about 1.5 trillion dollars

16. Health Care in the United States • Costs of employer-sponsored health care continues to increase • Only nation that does not provide some type of basic health care for all citizens

17. Factors Causing Increase in Health Care Costs in the U.S. • Expensive technological advances • Physician specialization • Breakdown of physician-patient relationships leading to the increase of lawsuits • Higher costs of medications • Older population needing more services • Longer life expectancy • Informed consumers demanding more tests and options

18. Factors Causing Increase in Health Care Costs in the U.S. • More uninsured rely on the emergency room for primary care • Uninsured having less or no access to preventive care leading to the need for treating more advanced illnesses or ailments • Social conditions such as: • Homelessness • Substance abuse • Poverty • Child abuse

19. Types of Medical Practices • Solo practice • Sole proprietorship • Partnership • Associate practice • Group practice • Professional corporation Let’s take a look at each one of these more closely!

20. Solo Practice • Main form of medical practice in early part of the twentieth century • Becoming less popular due to increase in costs, changes in practicing medicine, and legal environment • Physician practices alone and is responsible for all administrative decisions

21. Solo Practice • To provide care during off-duty times, physicians enter into agreements with other physicians • Office expenses can be shared if two solo practice physicians work out of the same building

22. Sole Proprietorship One physician responsible but other physicians may be employed Physician-owner pays all expenses and retains all assets Owner is responsible and liable for actions of all employees

23. Partnership • Legal agreement between two or more physicians to share in the business operation of a medical practice • Each partner is responsible for the actions of all partners

24. Associate Practice • Legal arrangement in which physicians share a facility and staff • Typically physicians do not share responsibility for legal actions of each other • Physicians act as if their practice is a sole proprietorship • Patients should understand that each physician in practice is not responsible for the other

25. Group Practice • Consists of three or more physicians who share the same facility and practice medicine together • A legal form of practice where all expenses, income, personnel, equipment, and records are shared

26. Group Practice • Specialties where groups are prevalent include anesthesiology, rehab and OB services, radiology, and pathology • Practice can be designed as an HMO or as an IPA

27. Professional Corporations • Managed by a board of directors • Created for legal and financial benefits • Physician-members become shareholders • The corporation can be sued but not the individual assets of the members

28. Professional Corporations • Benefits offered by corporations include: • Reimbursement for medical expenses • Profit sharing • Pension plans • Disability insurance

29. Common Medical Specialties • Allergy and immunology • Treats abnormal responses to acquired hypersensitivity to substances with medical methods including testing and desensitization • Anesthesiology • Administers both local and general drugs and provides respiratory and cardiovascular support during surgery • Bariatrics • Treats patients who are obese

30. Common Medical Specialties • Cardiology • Treats diseases and disorders of the heart and blood vessels • Dermatology • Treats injuries, growths, and infections relating to the skin, hair, and nails • Endocrinology • Treats diseases and disorders of the endocrine system

31. Emergency Medicine • Recognizes, prioritizes, and treats acute injuries, trauma, and illnesses • Supervises paramedic pre-hospital care

32. Common Medical Specialties • Family Practice • Treats the entire family regardless of age and sex • Gastroenterology • Diagnoses and treats illnesses of the gastro-intestinal system • Geriatric Medicine • Focused on the care of diseases and disorders of the elderly • Hematology • Studies blood and blood-forming tissues

33. Common Medical Specialties • Oncology • Study of cancer and cancer-related tumors • Primary Medicine (Internal Medicine) • Diagnoses and treats non-surgical problems in adult patients • Neurology • Treats non-surgical patients with disorders and diseases of the nervous system • Nephrology • Specializes in disorders and diseases of the kidneys

34. Obstetrics and Gynecology • Obstetrician • Provides pre-natal care up through the postpartum period • Gynecologist • Provides medical/surgical treatment of diseases/disorders of the female reproductive system

35. Common Medical Specialties • Ophthalmology • Opthalmologist: Treats disorders of the eye • Opthamology: Diagnosis and treatment of vision problems using both medical and surgical procedures • Orthopedics • Orthopedist: specializes in prevention and correction of disorders of the musculoskeletal system • Orthopedic surgeon: specializes in surgical procedures relating to this specialty

36. Otorhinolaryngology • Specializes in the medical and surgical treatment of ear, nose, and throat disorders • Terms: • Otology – study of the ear • Rhinology – study of the nose • Laryngology – study of the throat

37. Common Medical Specialties Pathology Specializes in diagnosing abnormal changes in tissues Forensic pathologist – expert in determining identity of a person based on evidence of body parts, dental records, and tissue samples Pediatrics Specializes in the development and care of children from birth to maturity To learn more about the field of pediatrics visit the American Academy of Pediatrics by clicking here or visiting http://www.aap.org

38. Common Medical Specialties • Physical and/or rehabilitative medicine • Specializes in treating patients with physical injuries and disabilities • Sports medicine • Treats athletes using preventive and diagnostic medicine • Psychiatry • Specializes in the diagnosis and treatment of patients with mental, behavioral, or emotional disorders

39. Common Medical Specialties • Pulmonology • Treats lung problems • Radiology • Specializes in the study of tissue and organs based on x-ray visualization • Rheumatology • Treats disorders and diseases characterized by inflammation of the joints such as arthritis • Urology • Treats problems with the urinary system and reproductive health initiatives for men

40. Surgery and Specialty Areas • Surgeons correct illness, trauma, and deformities through operative procedures • Specialties include: • Cardiovascular • Colorectal • Cosmetic/plastic surgery • Hand • Neurosurgery • Orthopedic • Oral (Periodontics, Orthodontics) • Thoracic

41. Health Care Institutions • Hospitals • Outpatient surgical centers • Urgent care centers • Nursing homes • Long-term-care institutions • Hospice

42. Hospitals • Largest employer in the U.S. • Key resource for health care in the U.S. • Deliver care for acute illnesses • Sites for major surgical procedures • Train and educate health care professionals • Conduct research • Provide education resources to the public • Size varies depending on needs of the community

43. The Joint Commisssion • The Joint Commission (formerly the Joint Commission on the Accreditation of Health Care Organizations (JCAHO)) • Private nonprofit organization • Encourages high standards of medical care • Institutions accredited by the Joint Commission must adhere to strict guidelines To learn more about Joint Commission accreditation click here or visit http://www.jointcommission.org

44. Categories of Hospitals • General hospital • Provides routine and specialized care such as intensive care units and emergency rooms • Range in size from 50 to several hundred beds • Usually found in most towns and communities • Teaching hospital • Provides same type of care as a general hospital • Generally located near a university medical school • Students, interns, and residents treat patients • More specialists may be on staff to educate and train interns and residents

45. Categories of Hospitals • Research hospital • Provides patient care and conducts research to combat disease • Examples include Veteran’s Affairs hospitals and Shriners hospitals • Specialty hospital • Provides specialized care for certain types of patients such as children, psychiatric patients, or burn victims

46. Emergency services Laboratory Radiology Oncology Nuclear medicine Psychiatry Pathology Immunology Respiratory therapy Physical therapy Occupational therapy Nursing Dietary Pharmacy Central supply Housekeeping Engineering Health information Social services General Departments in Hospitals

47. Medical Privileges • Refers to a physician's right to practice medicine in a particular hospital or other health care facility • Physicians can also gain “courtesy” or “visiting privileges” – provides the right to see a patient on a referral basis

48. Outpatient Surgical Centers • Facility where minor surgical procedures are performed • Also known as free-standing outpatient surgical centers • Surgeries performed at these centers generally require very little recovery time • Medical assistant tasks in this environment include: scheduling and preparing patients for surgery, receiving and admitting patients, assisting with some surgeries, and discharges

49. Urgent Care Centers • Offer quick care for non-emergent situations • In some managed care systems, these centers may be designated as a primary care facilities • Sites are popular for workers’ compensation cases and occupational medicine • Other types of care provided include: performing sports physicals, setting fractures, drawing blood levels, treating infections, and providing care beyond the usual physician office hours

50. Nursing Homes • Established in the nineteenth century • Long-term-care facilities that provides care to the elderly • Typically for-profit organizations