Lecturer: Monika M. Wahi, MPH, CPH

Explain why health care professionals make up such a large proportion of the U.S. work force Name three types of allied health professionals Describe the role and value of non-physician practitioners List two differences between primary and specialty care Understand the role of dentists, pharmacists, and other doctoral-level health professionals At the end of this lecture, student should be able to:

U.S. health care industry is the largest employer in the U.S. – 13% of the U.S. labor force Over the years, services offered and types of health care professionals available are closely linked  Remember Market Justice? Likewise, the distribution of types of services and types of providers has evolved over time Current imbalances  Too many specialists, not enough generalists  Maldistribution of practitioners – oversupply of the wrong type of physicians  Roles for NPPs, PA’s, and nurse midwives increasing

Physicians Dentists Pharmacists Optometrists Chiropractors Psychologists Nurses Podiatrists NPPs Health Service Administrators Allied Health Professionals

Therapists Lab/Rad Technicians Social Workers Health Educators

Hospitals Nursing Care Facilities Migrant Health Centers Hospitals Community Health Centers Outpatient Facilities MCOs Insurance Firms Mental Health Centers Pharmaceutical Companies School Clinics Physicians’ Offices Laboratories Voluntary Health Agencies Professional Health Associations Colleges of Medicine Colleges of Allied Health Professions Research Institutions

From Table 4.1 (page 81)

From Table 4.2 (page 83)

MD’S Allopathic medicine Less likely to be generalists (1/3) Non-holistic approach DO’S Osteopathic medicine More likely to be generalists (>1/2) Holistic approach

First contact Gatekeeper Longitudinal Person as whole Generalist training Primary If needed Requires referral Episodic Disease/organ Specialty training Specialty

Too many specialists Not enough OB/GYN, Peds, IM, Gen/Fam Practice Shortage? Geographic maldistribution Specialty maldistribution

From Table 4.5 (page 92)

Largest Group of HC Professionals WWII beginnings Major caregivers of sick/injured patients Address physical, mental, emotional needs Levels of Nurses RNs require ADN, diploma, or BSN LPNs/LVNs state- level certification APNs are NPPs, include CNSs, CRNAs, NPs, and CNMs Employment Many practice locations (home, hospital, clinic, etc.) Setting specialties (long- term care, public health) Staffing issues, nursing shortage

50%/50% split between Primary and Specialty Care Work predominantly in Primary Care

Less training than MD/DO, but more than RNs Physician extenders – work closely with physicians Not entire range of primary care, and not complex cases – these given to physician Expansion of NPPs in 1960s in primary care; clients often more satisfied by NPPs than physicians Current issues: legal restrictions, financial barriers to reimbursement, shut out of decision/policy-making

60% of U.S. health care workforceCertificate/degree in health care scienceDelivery of health or related services Identify, evaluate, prevent disease/disorders Dietary/nutritionRehabilitationHealth system management

Technicians and Assistants <2 years trainingPT and OT assistantsLab., rad., resp. techs Technologists and Therapists Advanced trainingPT/DPT and OTsDietitians/nutritionistsDispensing opticiansSpeech/lang. pathologistsSocial workers

PhysiciansResearchersLawyers Environment- alists Social Scientists EpidemiologyBiostatistics Health Svcs. Admin. Health Ed./Beh. Science Environmental Health

Leadership, strategic direction, governing boards Lead outpatient or nursing services, department managers, logistics and operations Assistants to mid-level managers, supervise small teams BA, BS MHA, MHSA, MBA, MPH, MPA

As health care evolves, we are challenged with the maldistribution of physicians  NPPs are needed to help, but there are obstacles there as well  Strong role for nurses, and many career opportunities for nurses at different levels Other health care professionals have various levels of training, dx/tx authority, and roles  Dentists, public health professionals, health service administrators, pharmaceuticals

Explain why health care professionals make up such a large proportion of the U.S. work force Name three types of allied health professionals Describe the role and value of non-physician practitioners List two differences between primary and specialty care Understand the role of dentists, pharmacists, and other doctoral-level health professionals At the end of this lecture, student should be able to: