Component 1: Introduction to Health Care and Public Health in the U.S. Unit 3: Delivering Healthcare (Part 2) Focus On Primary Care

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 Health IT Workforce Curriculum Version 1.0/Fall 20102

Primary Care Medical Specialties Family Practice General Internal Medicine Pediatrics Obstetrics and Gynecology (OB/GYN) Component 1 / Unit 3 Health IT Workforce Curriculum Version 1.0/Fall 20103

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 Component 1 / Unit 3 Health IT Workforce Curriculum Version 1.0/Fall 20104

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. Component 1 / Unit 3 Health IT Workforce Curriculum Version 1.0/Fall 20105

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 Component 1 / Unit 3 Health IT Workforce Curriculum Version 1.0/Fall 20106

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 Health IT Workforce Curriculum Version 1.0/Fall 20107

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 Component 1 / Unit 3 Health IT Workforce Curriculum Version 1.0/Fall 20108

Examples of Specialties Dermatology Pathology Radiology Nuclear Medicine Psychiatry Emergency Medicine Preventive Medicine Component 1 / Unit 3 Health IT Workforce Curriculum Version 1.0/Fall 20109

Specialty clinics Medical specialties  Examples: ◦ Cardiology ◦ Immunology ◦ Gastroenterology Surgical specialties  Examples: ◦ Orthopedic surgery ◦ Neurosurgery ◦ Plastic surgery Component 1 / Unit 3 Health IT Workforce Curriculum Version 1.0/Fall

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 Health IT Workforce Curriculum Version 1.0/Fall

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 Health IT Workforce Curriculum Version 1.0/Fall

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 Health IT Workforce Curriculum Version 1.0/Fall

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 Health IT Workforce Curriculum Version 1.0/Fall

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 Component 1 / Unit 3 Health IT Workforce Curriculum Version 1.0/Fall

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 Component 1 / Unit 3 Health IT Workforce Curriculum Version 1.0/Fall

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 Component 1 / Unit 3 Health IT Workforce Curriculum Version 1.0/Fall