1. Non-Physician Clinicians in the Health Care Workforce William J. Pettit, D.O. Associate Dean for Rural Health Oklahoma State University Center for Health Sciences

2. NPC’s in the Health Care Workforce 1

3. Definition of NPC ►Mid-level providers intended to work under the supervision of or in collaboration with a physician ►Others who work independently of physician in a certain medical area ►Lastly, those who practice as an independent alternative therapy

4. Access to Care ►Taber’s Medical Dictionary: “The right or ability of an individual to obtain medical and health care services” ►People without health care “access” for the notion of public health is best served by the broadest access to the healthcare workforce ►Efforts to provide health care by providers other than physicians ►In the face of rising health care costs consumers and employers are looking for cost saving options ●includes state and federal initiatives ●many NPC’s considered lower cost alternative

5. Scope of Practice ►Dependent on state law, therefore variable state to state what services can be provided ►Expansion of scope of practice by “legislation” not “education” ●Prescriptive, surgery, autonomy, are some of the issues

6. Non-Physician Clinicians in the Health Care Workforce 2

7. AOA – 2005 ►Education ►Licensure ►Relationship to Physicians ►Prescriptive Authority ►Reimbursement ►Legislative Agenda

8. Oklahoma Licensed NPC’s ►No Anesthesiology Assistants (legislation last year) (BA) ►Certified Registered Nurse Anesthetist (RN) ►Certified Registered Nurse Practitioner (RN) ►Physician Assistant (Prerequisite varies – usually BA) ►Optometrist (Prerequisites varies – usually BA) ►Pharmacist (Six year program to Pharm D) ►Psychologist (BA) ►Podiatrist (BA) ►Physical Therapist (Prerequisite varies – usually BA) ►Chiropractor (Prerequisite varies – usually BA)

9. Oklahoma NON Licensed NPC’s ►Acupuncture ►Naturopath ►Homeopath

10. Pre-Lecture Quiz 1.Psychology 2.Homeopath 3.Podiatry 4.Optometry 5.Nurse Practitioner 6.Chiropractors 7.Naturopath 8.Physical Therapy 9.Pharmacist 10.Physician Assistant Instructions: Chose the best answer from the list below for each of the following descriptions.

11. “…refer to themselves as doctors … or physicians, diagnose and treat patients whose health problems are associated with body’s muscular, nervous, and skeletal systems, especially the spine. …more than 90% …consider themselves as primary care practitioners and believe that they should be, are, the ‘primary care portal of entry’ for health care for their patients.” 1.Psychology 2.Homeopath 3.Podiatry 4.Optometry 5.Nurse Practitioner 6.Chiropractors 7.Naturopath 8.Physical Therapy 9.Pharmacist 10.Physician Assistant

12. “…advanced academic and clinical experience, which enables him or her to diagnose and manage most common and many chronic illnesses, either independently or as part of a health care team. Services provided…include but are not limited to ordering, conducting, and interpreting appropriate diagnostic and laboratory test, prescription of pharmacological agents and treatments and therapies. The type of training and certification required is dictated by state licensure laws and therefore vary from state to state.” 1.Psychology 2.Homeopath 3.Podiatry 4.Optometry 5.Nurse Practitioner 6.Chiropractors 7.Naturopath 8.Physical Therapy 9.Pharmacist 10.Physician Assistant

13. “…holistic approach to medicine that takes a wider view of illness, causes of disease and how people express their diseases individually. … refer to themselves as physicians …use natural remedies to assist the body in its natural tendency to heal itself. … based on three principles: the law of similars, the principle of minimum dose and prescription for the individual. Some … regard mental, emotional, physical and even spiritual illnesses as interconnected, remedies are prescribed on an individual basis, not merely for his/her disease…” 1.Psychology 2.Homeopath 3.Podiatry 4.Optometry 5.Nurse Practitioner 6.Chiropractors 7.Naturopath 8.Physical Therapy 9.Pharmacist 10.Physician Assistant

14. Non-Physicians in Health Care Workforce 3

15. 2008 Concept of PCMH ►“Primary care physicians play an integral role in coordinating a patient’s overall care.” ►AOA, AAFP, AAP, and ACP 2007 Seven Joint Principles: ●Personal Physician ●Physician Directed Medical Practice ●Whole-Person Orientation ●Coordinated and/or Integrated Care ●Quality and Safety ●Enhanced Access ●Better Payment Model

16. OHCA January 2009 ►PCMH – DO, MD, ARNP, PA, FQHC, RHC, HIS Facilities ►Networks – Hospital, Community Health Centers, Public Health Departments, Physicians, RHC’s, FQHC’s or other recognized safety net providers (OSU and OU)

17. Discussion ►Care/Case Management and the Physician ►Medical Informatics ●Electronic Health Records ●Health Information Technology ●Health Information Exchange ►Quality and Safety ►Health Promotion and Disease Prevention