Health Service Professionals: Issues in Medical Practice

Learning Objectives Understand the reasons for maldistribution in the physician labor force

Issues in Medical Practices Involvement in Clinical Practice Guidelines Threat of Compromise Lopsided Medical Training Aggregate physician Oversupply Geographic Maldistribution Specialty Maldistribution International Medical Graduates (IMG)

Clinical Practice Guidelines Involvement in clinical practice guidelines Purpose is to align practices with research Due to increase in health care cost, the viability of the health care delivery system is under constant threat Physicians are constantly justifying cost over benefit

Finances and Training Threat of Compromise Lopsided Medical Training Physicians’ professional judgment compromised to meet managed care’s financial arrangements Lopsided Medical Training Too many specialists in a system that requires more primary care

Physician Oversupply Aggregate Physician Oversupply 173% increase from 1950 to 1990 Balanced Budget Act ’97 capped residency that Medicare would pay Payments >$7 billion per year, >$70,000 per resident Government does not mandate how these physicians will be trained Led to unnecessary health care expense Shortages exist in parts of the country

Maldistribution and Shortages Geographic Maldistribution Maldistribution = A surplus or shortage of physician types needed to maintain the health status of a population Shortages in rural and underserved areas (<50k) Shortages exist because: Less income to the physician Less professional interaction Little access to facilities and technology Less continuing education and professional growth Lower standards of living Fewer social and cultural diversities Less education for children

Specialty Maldistribution Imbalance between primary and specialty care. From 1979 to 1999: Number of primary care physicians increased 18% The number of specialists increased 118% In the US: Approximately 40.8% of physicians are generalists Approximately 59.2% are specialists In other countries, 25-50% are specialists

Reasons for Maldistribution Reasons for specialty maldistribution: 1) Medical technology 2) Reimbursement methods 3) Specialty-oriented medical education (See Table 4-6 page132) Specialists: Make more Better work hours More prestige Use high technology Intellectual challenge

Consequences of Maldistribution Consequences of having too many specialists: High volume of intensive, expense and invasive procedures Rising health care costs Number of surgeries increasing at two times the rate of population growth

International Graduates International Medical Graduates (IMG) Numbers steadily increasing ¼ of residency positions are filled by IMGs Move from rural to urban areas after graduation Not the solution to the maldistribution

Summary Current issues facing physicians and health care professionals include: Having to choose between appropriate treatment and cost Shortage of physicians in rural areas Maldistribution of physicians. Click Quiz 4 within Lesson 4 of the course to continue.