1. Health Service Professionals:
Issues in Medical Practice

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

3. 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)

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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.