Component 1: Introduction to Health Care and Public Health in the U.S. Unit 3: Delivering Healthcare (Part 2) Lecture 2 Component Number 1 Component Name Introduction to Health Care and Public Health in the U.S. This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

Where Is Primary Care Delivered? Primary care clinic: Point of delivery A medical facility Usually, the conditions seen at a primary care clinic are not serious or life threatening “Gateway” to healthcare services Component 1 / Unit 3-2 Health IT Workforce Curriculum Version 2.0/Spring 2011

Primary Care Medical Specialties Family Practice General Internal Medicine Pediatrics Obstetrics and Gynecology (OB/GYN) Component 1 / Unit 3-2 Health IT Workforce Curriculum Version 2.0/Spring 2011

Health IT Workforce Curriculum Version 2.0/Spring 2011 Family Practice Family Practice (also known as Family medicine):  Provides health care for the individual and family Integrates biological, clinical and behavioral sciences The scope of family medicine is broad encompasses all ages, both sexes, each organ system and every disease entity American Board of Family Practice at https://www.theabfm.org/about/policy.aspx Component 1 / Unit 3-2 Health IT Workforce Curriculum Version 2.0/Spring 2011

General Internal Medicine Doctors of internal medicine also known as “internists” Focus on adult medicine Special study and training focusing on the prevention and treatment of adult diseases. http://www.acponline.org/patients_families/about_internal_medicine/ Component 1 / Unit 3-2 Health IT Workforce Curriculum Version 2.0/Spring 2011

Health IT Workforce Curriculum Version 2.0/Spring 2011 Pediatrics Pediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents The science of child care…includes planned preventive and curative care of children Achar S Textbook of Pediatrics, 3rd edition Component 1 / Unit 3-2 Health IT Workforce Curriculum Version 2.0/Spring 2011

Obstetrics and Gynecology Obstetrics – care of women during pregnancy and immediately after childbirth Gynecology – care of women who have problems of the female reproductive system Women’s health and GYN preventive care is an important facet of primary care Often the same clinician provides both OB and GYN services Component 1 / Unit 3-2 Health IT Workforce Curriculum Version 2.0/Spring 2011

Health IT Workforce Curriculum Version 2.0/Spring 2011 Specialty Care A specialty is a branch of medicine After completing medical school, physicians train in a specific field (their specialty) Some physicians undergo additional training (fellowships) after initial training in a more general field https://www.aamc.org/students/medstudents/cim/specialties/ Component 1 / Unit 3-2 Health IT Workforce Curriculum Version 2.0/Spring 2011

Examples of Specialties Dermatology Pathology Radiology Nuclear Medicine Psychiatry Emergency Medicine Preventive Medicine Component 1 / Unit 3-2 Health IT Workforce Curriculum Version 2.0/Spring 2011

Health IT Workforce Curriculum Version 2.0/Spring 2011 Specialty clinics Medical specialties Examples: Cardiology Immunology Gastroenterology Surgical specialties Orthopedic surgery Neurosurgery Plastic surgery Component 1 / Unit 3-2 Health IT Workforce Curriculum Version 2.0/Spring 2011

Delivery of Specialty Care Many surgical specialists see patients in outpatient clinics They perform surgeries in hospitals They may perform surgeries in outpatient surgical centers Component 1 / Unit 3-2 Health IT Workforce Curriculum Version 2.0/Spring 2011

Outpatient Surgical Centers Many surgeries or procedures are done in the hospital Some surgeries or procedures are done in outpatient (or ambulatory) surgical centers Surgery or procedures are performed in a non-hospital location Patients typically go home after a brief period of recovery (few hours) after the procedure /surgery Component 1 / Unit 3-2 Health IT Workforce Curriculum Version 2.0/Spring 2011

Health IT Workforce Curriculum Version 2.0/Spring 2011 Primary Care In Crisis? Increasing number of older patients with complex medical issues Imperfect coverage of preventive care services Emphasis on documentation Complex billing and compensation system Component 1 / Unit 3-2 Health IT Workforce Curriculum Version 2.0/Spring 2011

Health IT Workforce Curriculum Version 2.0/Spring 2011 Primary Care In Crisis? Decreasing number of physicians practicing primary care Supply-demand imbalance Greater dependence on after-hours care Increased cost of health care delivery Component 1 / Unit 3-2 Health IT Workforce Curriculum Version 2.0/Spring 2011

Why is Primary Care In Crisis? Few U.S. graduates enter family medicine Only a minority of first year internal medicine residents pursue careers in primary care More than 80 percent of graduating medical students carry educational debt Specialists are better compensated than primary care physicians Bodenheimer T. Primary Care -- Will It Survive? N Engl J Med 2006 355: 861-864 http://www.acponline.org/advocacy/events/state_of_healthcare/statehc06_1.pdf Karen E. Hauer, MD; Steven J. Durning, MD; et al., KE; Durning, SJ; Kernan, WN; Fagan, MJ; Mintz, M; O'Sullivan, PS; Battistone, M; Defer, T et al. (2008-09-10). "Factors Associated With Medical Students' Career Choices Regarding Internal Medicine". JAMA 300 (10): 1154–1164 Component 1 / Unit 3-2 Health IT Workforce Curriculum Version 2.0/Spring 2011

Why Don’t Physicians Want To Go Into Primary Care? A 2007 survey of graduating US medical students -- only 2% planned a career in general internal medicine Debt not as much a negative factor as the challenge of treating elderly and chronically ill patients with complex medical issues Practice environment and lifestyle also played a role Karen E. Hauer, MD; Steven J. Durning, MD; et al., KE; Durning, SJ; Kernan, WN; Fagan, MJ; Mintz, M; O'Sullivan, PS; Battistone, M; Defer, T et al. (2008-09-10). "Factors Associated With Medical Students' Career Choices Regarding Internal Medicine". JAMA 300 (10): 1154–1164 Component 1 / Unit 3-2 Health IT Workforce Curriculum Version 2.0/Spring 2011

Solving The Primary Care Crisis Health reform and federal stimulus funds Training Grants for training and educational innovation Recruitment Loan forgiveness and other financial inducements International Medical Graduates http://www.us-government-grants.net/article_info.php/articles_id/15 http://www.vcstar.com/news/2010/jun/16/health-reform-grants-expected-to-ease-primary/ Component 1 / Unit 3-2 Health IT Workforce Curriculum Version 2.0/Spring 2011