HSA 3111: Health Service Professionals 1 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida Topics Overview Statistics and Measures Physicians Physician Issues Other Providers Nursing Non-physician Providers Health Service Administrators (You?) “The U.S. healthcare industry is the largest and most powerful employer in the nation.” Text (p. 120)

HSA 3111: Health Service Professionals 2 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida Overview The chapter is filled largely with descriptive material about various healthcare professions The inferences are much more important –Look for incentives that shape current structures –Look for trends and how they may change structures directly or by changing incentives –How do trends affect patients and providers? –How will trends affect you in your career? The chapter short-changes the involvement of and impact on healthcare administrators

HSA 3111: Health Service Professionals 3 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida Statistics and Measures Healthcare represents 3% of the total labor force –16% of gross domestic product –Average HC worker much more productive in the labor market than the average worker* 7 of 10 fastest growing professions are in HC –Growth at 29% through 2010 –Growing population –Aging population HC labor among the most highly educated –What are implications of this fact? * There are huge caveats to this statement

HSA 3111: Health Service Professionals 4 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida Statistics and Measures (cont.) HC workers are in a variety of settings –Changing HC organizational structure changes labor needs –Changing demographics and disease patterns also affect HC labor needs Demand for HC labor related to funding for care –How might changing funding change demand? HC tasks are distributed among an increasingly varied group of professionals –Scope of roles and responsibilities is also dynamic

HSA 3111: Health Service Professionals 5 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida Statistics and Measures (cont.) 40% of HC professionals are employed by hospitals but the percentage of physicians is much lower –8% of physicians (after internship and residency) work in hospitals The supply of HC labor is marked by two imbalances –Primary vs. Specialty services –Geographic

HSA 3111: Health Service Professionals 6 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida Physicians Recall Chapter Three’s history of HC in the U.S. and the singular evolution of physician qualifications and roles We can identify two trends in HC workers related to the roles of physicians –Increased specialization among physicians –Increased divestiture of tasks formerly performed by physicians to other HC workers

HSA 3111: Health Service Professionals 7 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida Physicians (cont.) Two Trends (cont.) –Physicians remain the focal point of service for the hard cases –Significant organization is designed to Channel the hard cases to the right specialist Reduce the physician’s distractions –Other HC professionals now do many tasks formerly performed by physicians

HSA 3111: Health Service Professionals 8 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida Physicians (cont.) Increasing ratio of physicians to population –14.1/10,000 in 1950 to 27.0/10,000 by 2001 –Increases in non-physician providers increases coverage intensity Why do you think this is? –Growth of knowledge & effectiveness –Ability to pay Growth in Demand

HSA 3111: Health Service Professionals 9 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida Physicians (cont.) Specialization –Explosive growth in knowledge has resulted in too much for one person to know –Expensive specialized knowledge should not be wasted on routine tasks –Primary care providers becoming specialists in their own rights

HSA 3111: Health Service Professionals 10 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida Physicians (cont.) Primary Care –Typically first to treat and diagnose –Serve as gatekeepers in formalized managed care organizations –Have longer term relationship with patient –Sees whole patient Primary care issues All specialist issues –Requires ‘specialty’ training in being a generalist

HSA 3111: Health Service Professionals 11 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida Physicians (cont.) Hospitalists –Takes on role of primary care physician for hospitalized patients –May coordinate work of multiple specialists –Why does it make sense to create this specialty?

HSA 3111: Health Service Professionals 12 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida Physicians (cont.) Clinical Practice Guidelines –Wide variations in the way different physicians treat the same condition –Balance advanced available treatments with risk and cost Increased pressures in MCO MCO payment mechanisms also pressure physicians

HSA 3111: Health Service Professionals 13 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida Physicians (cont.) Clinical Practice Guidelines (cont.) –Standardize protocols for the same condition –Reduce physician’s discretion –Standardize costs and treatments –Reduce (and increase) exposure to liability –Recent news: Prostrate treatments CPR protocols

HSA 3111: Health Service Professionals 14 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida Physician Issues Physician oversupply –Some studies indicate that the U.S. will be oversupplied with physicians –Exacerbated by increasing treatments given by other providers (PAs, Nurse Practitioners, etc.) –Thought to increase healthcare costs (p. 130) I don’t see the mechanism for this –Federal government is restricting the paid support for residency training

HSA 3111: Health Service Professionals 15 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida Physician Issues (cont.) Overspecialization –In general specialized physicians earn more money than PCPs* –Sometimes have more predictable lifestyles –Often enjoy more prestige –Increased specialist use leads to increased invasive and costly procedures –Hospital-based internship and residency steers more physicians to specialty training –Shifts toward MCO** and preventive care are increasing the demand for PCP * Primary Care Physicians ** Managed Care Organizations

HSA 3111: Health Service Professionals 16 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida Physician Issues (cont.) Geographic Distribution –Other pressures steer physicians away from rural and poor areas Fewer insured (paying) patients Fewer professional growth opportunities Lower income Fewer cultural opportunities –Corresponding oversupply in urban areas –How can these distributions be affected?

HSA 3111: Health Service Professionals 17 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida Physician Issues (cont.) International Medical Graduates –Almost 25% of US physicians graduated from foreign medical schools –Quality differences are unclear –Distribution among specialties and geography is also unclear

HSA 3111: Health Service Professionals 18 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida Other Providers Dentists –Most are sole practitioners or in small groups –Employ related staff –Have business management as well as professional service responsibilities Pharmacists –Most are employees of other organizations –Taking on some health management responsibilities –Critical integration of services by multiple physicians

HSA 3111: Health Service Professionals 19 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida Other Providers (cont.) Optometrists, Chiropractors, Podiatrists, and Psychologists mimic many characteristics of dentists in terms of –Employment –Practice management All require licensing

HSA 3111: Health Service Professionals 20 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida Nursing Key profession for leveraging the physician’s time –Provide skilled medical services not at the level of the physician –Increased education for Nurse Practitioners increase range of tasks and further free physician time Nurses have an incredible variety of working conditions

HSA 3111: Health Service Professionals 21 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida Nursing (cont.) Expected shortfall of 340,000 nurses by 2020 –Lower pay –Difficult work conditions –Too few training programs Some programs established to increase number of nurses but funding remains an issue

HSA 3111: Health Service Professionals 22 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida Nonphysician Practitioners Physician Assistants, Nurse Practitioners, Certified Nurse Midwifes Sometimes referred to as physician extenders Work under the (sometimes loose) supervision of a physician Have differing treatment and prescription authority by specialty and state Differing educational requirments Patients often report increased satisfaction with NPs and PAs than with physicians –Why do you think?

HSA 3111: Health Service Professionals 23 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida Allied Health Professionals A dizzying variety of specialty professions not requiring an MD have developed –Often related to specific medical technologies –All have specific domain-related knowledge Some may practice independently –Speech Therapist –Occupational or Physical Therapist Some support a physician or other professional

HSA 3111: Health Service Professionals 24 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida Health Service Administrators These are the managers of health service organizations –Hospitals and clinics –Medical offices or groups Heavily business and process focused –Often have a holistic view of the organization, though not of specific medical techniques –Must anticipate changes –See the first new paragraph on p. 149 for a daunting description

HSA 3111: Health Service Professionals 25 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida Health Service Administrators (cont.) Senior HSAs must coordinate the work of and allocate resources to medical professionals, including physicians –Incredibly challenging work Many educational paths to the field –Specialty degrees –Business degrees Wide variety of work environments