HEALTH SERVICE PROFESSIONALS

1. HEALTH SERVICE PROFESSIONALS • PHYSICIANS

2. PHYSICIANS PLAY A CENTRAL ROLE IN EVALUATING A PATIENT’S HEALTH CONDITION, DIAGNOSING ABNORMALITIES, AND PRESCRIBING TREATMENT.

3. SOME PHYSICIANS ARE ENGAGED IN MEDICAL EDUCATION AND RESEARCH TO FIND NEW AND BETTER WAYS TO CONTROL AND CURE HEALTH PROBLEMS.

4. A GROWING NUMBER ARE INVOLVED IN THE PREVENTION OF ILLNESS.

5. LICENSING • ALL STATES REQUIRE PHYSICIANS TO BE LICENSED IN ORDER TO PRACTICE.

6. SUCCESSFUL COMPLETION OF A LICENSING EXAMINATION AND COMPLETION OF A SUPERVISED INTERNSHIP/RESIDENCY PROGRAM.

7. REQUIREMENTS INCLUDE GRADUATION FROM AN ACCREDITED MEDICAL SCHOOL THAT AWARDS A DOCTOR OF MEDICINE (MD) OR DOCTOR OF OSTEOPATHIC MEDICINE (DO);

8. DOCTOR OF OSTEOPATHIC MEDICINE (DO)

9. 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.

10. DOCTOR OF MEDICINE (MD)

11. MEDICAL DOCTORS VIEW MEDICAL TREATMENT AS ACTIVE INTERVENTION TO PRODUCE A COUNTERACTING REACTION IN AN ATTEMPT TO NEUTRALIZE THE EFFECTS OF DISEASE. • (MEDICAL MODEL)

12. PHYSICIANS TRAINED IN FAMILY MEDICINE/GENERAL PRACTICE, GENERAL INTERNAL MEDICINE, AND GENERAL PEDIATRICS ARE CONSIDERED PRIMARY CARE PHYSICIANS OR GENERALISTS.

13. PHYSICIANS IN NON-PRIMARY CARE SPECIALITIES ARE REFERRED TO AS SPECIALISTS.

14. 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.

15. PRIMARY AND SPECIALITY CARE

16. 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.

17. IN A MANAGED CARE ENVIRONMENT WHERE HEALTH SERVICES ARE INTEGRATED, PRIMARY CARE PHYSICIANS SERVE AS GATEKEEPERS.

18. GATEKEEPERS SERVE AN IMPORTANT ROLE IN CONTROLLING COST, UTILIZATION, AND THE RATIONAL ALLOCATION OF RESOURCES.

19. IN THE GATEKEEPING MODEL, SPECIALITY CARE REQUIRES A REFERRAL FROM A PRIMARY CARE PHYSICIAN.

20. PRIMARY CARE PROVIDERS FOLLOW THROUGH THE COURSE OF TREATMENT AND COORDINATE VARIOUS ACTIVITIES INCLUDING INITIAL DIAGNOSIS, TREATMENT, REFERRAL, CONSULTATION, MONITORING, AND FOLLOW-UP.

21. PRIMARY CARE FOCUSES ON THE PERSON AS A WHOLE, WHEREAS SPECIALTY CARE CENTERS ON PARTICULAR DISEASES OR ORGAN SYSTEMS OF THE BODY.

22. PRIMARY CARE STUDENTS SPEND A SIGNIFICANT AMOUNT IN AMBULATORY CARE SETTINGS, FAMILIARIZING THEMSELVES WITH A VARIETY OF PATIENT CONDITIONS AND PROBLEMS.

23. STUDENTS IN MEDICAL SUBSPECIALTIES SPEND SIGNIFICANT TIME IN INPATIENT HOSPITALS, WHERE THEY ARE EXPOSED TO STATE-OF-THE-ART MEDICAL TECHNOLOGY.

24. SOME KEY ISSUES IN MEDICAL PRACTICE

25. 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.

26. THE DEVELOPMENT OF MANAGED CARE IS LIKELY TO SUBJECT PHYSICIANS TO GREATER CONSTRAINTS IN EXERCISING THEIR PROFESSIONAL JUDGEMENT.

27. MANAGED CARE ARRANGEMENTS GENERALLY LIMIT PAYMENTS TO PARTICIPATING PHYSICIANS THROUGH CAPITATION OR DISCOUNTED FEES.

28. ACCESS TO SPECIALISTS IS CONTROLLED BY GENERALISTS GATEKEEPERS WHO ARE PROVIDED INCENTIVES TO REDUCE INPATIENT CARE, X-RAYS, LABORATORY SERVICES, AND SPECIALISTS CONSULTATIONS.

29. HOSPITAL BASED TRAINING HAS PRODUCED TOO MANY SPECIALISTS. MEDICARE SPENDS $7 BILLION A YEAR ON RESIDENCY TRAINING.

30. NIH HAS FUNDED RESEARCH THUS CREATING A LARGE POOL OF PHYSICIAN RESEARCERS.

31. THERE ARE TOO MANY PHYSICIANS IN THE WORK FORCE ILL-PREPARED TO PRACTICE IN THE WELL-NESS ORIENTED, AMBULATORY-BASED ENVIRONMENT.

32. 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.

33. A SURPLUS OF PHYSICIANS LEADS TO UNNECESSARY INCREASES IN HEALTH CARE EXPENDITURES. A SHORTAGE ADVERSELY AFFECTS THE DELIVERY OF HEALTH SERVICES.

34. THERE IS A SURPLUS AT THE AGGREGATE, HOWEVER, PHYSICIAN SHORTAGES STILL EXIST IN CERTAIN PARTS OF THE COUNTRY.

35. 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.

39. Physician’s Salaries at the median

43. End of lecture for September 13th 2010, 6th Period • Questions? • Discussion?

44. NURSING

45. “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.

46. REFLECTS A 21.7% INCREASE OVER THE NUMBER OF RN’S THE NATION EMPLOYS TODAY.

47. THIS PROJECTED HIRING NEED WILL HAVE A MAJOR IMPACT ON HOSPITALS, WHICH EMPLOY ABOUT TWO-THIRDS OF ALL REGISTERED NURSES.

48. Nursing Salaries by Length of Service

49. 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%.

50. THE PRIMARY CONTRIBUTOR APPEARS TO BE A TWO-DECADE DECLINE IN YOUNG WOMEN CHOOSING NURSING AS A CAREER.