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7/24/2019 Health Care USA Chapter 7
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Chapter 7
The Healthcare Workforce
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CHAPTER OBJECTIVES
Catalogue major health careprofessions, educational preparationand levels of credentialing
Understand roles & responsibilities ofprofessionals in the overall health caredelivery system
Highlight health care workforcepolicies, future expectations andimplications of the ACA
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Introduction HealthProfe!!ion! "#$
ne of largest U!"! employers# $%!million, $$!' U!"! workforce
())* occupations & professions# At+' of workforce, hospitals are majoremployers -.ig! /0$1
2ew vocations result from system
changes, 3!% 4 new jobs in nextdecade, more than any other industry
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Introduction HealthProfe!!ion! "%$
5mployment growth highest amonghealth plans, ambulatory clinics,home health, o6ces of practitioners
"peciali7ed positions result frommedical advances, but reduce8exibility & increases costs 9rowing acceptance of multi0skilled
professionals, esp! in hospitalscombining roles in related :elds!
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Credentialin&' Re&ulatin& HealthCare Profe!!ional! "#$
9overnment regulation necessary toprotect citi7ens from incompetent,unethical practitioners! "tates are
primary regulators# variations fromstate0to0state
3) occupations regulated by;
$! "tate licensure
(! Certi:cation
+!
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Credentialin&' Re&ulatin& HealthCare Profe!!ional! "%$
=he >downsides? of regulation
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State (icen!ure "#$
4ost restrictive type of regulation# restrictsentry into :elds of practice
"tate laws de:ne practice scope,
education and testing reuirements! Brevents use of professional titles without
meeting predetermined uali:cations
icensure boards; concern for settingstandards, assessing competence for entryto :elds of practice# power to censure,warn, revoke
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State (icen!ure) Shortco*in&!
Assesses only uali:cations on entryto :eld
Does little to assess continuingcompetence# only continuingeducation courses
ax discipline# rarely censure orrevoke licenses
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State+,ationalCerti-cation "tate or voluntary professional
organi7ations attest to education andperformance abilities, e!g! national
boards# Commission on Accreditation ofAllied Health 5ducation Brograms!
2o legal basis to prevent incompetent orimpaired practice# only probation or
revoking certi:cation
Bayers or employers insist on certi:cation!
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Re&i!tration
Eegun by various professions as ameans to network for jobs amongemployers, general public
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Ph.!ician! "#$
$+/ U!"! 4edical "chools
$/,+%0 ()$$ graduates
(% Colleges of steopathy,()) annual graduates
/' of all U!"! physicians -%+,)))1
4Ds, Ds share same privileges 4edical students 3F' female,
3+G' minority
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Ph.!ician! "%$
Bost0graduate training
4ost states reuire at least oneyear for licensing# professionalstandards reuire a minimum of +years of residency training topractice a specialty
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Ph.!ician! "/$
9ap of ,))) $styear residents :lled bygraduates of foreign medical schools %,))) foreign nationals enter U!"! practice per
year
(' of U!"! practicing physicians
3$+)) U!"! citi7ens attend foreign medicalschools & return to U!"! each year
+' of /)),))) practicing U!"! physiciansare primary care; nternal medicine#.amily practice# Bediatrics
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,ur!in& "#$
5arly U!"! 2ursing
.irst professional training program;$G%$, Bhiladelphia Iomen@s Hospital
Bre0II, + domains; public health,private duty, hospital
Bublic health elite; =E & infant care
$F(); /)' worked private duty, half inhomes and half for private patients inhospitals# few employed in hospitals
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,ur!in&) Po!t WWI
Hospital care & training emphasi7ed#hospital0based schools of nursingproliferated to provide sources of low0cost
labor# social & public health aspects weresubjugated to image as symbols ofnational sacri:ce & e6ciency, deferentialto physicians
2ursing leaders promoted high0ualitynursing schools, preferably associatedwith universities
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,ur!in&) Trainin& Education0R,!
( yr! associate degree
(0+ yr! hospital diploma programs Jnow defunct
0 yr! bachelor degree atuniversityKcollege
"peciali7ation followed medicinestarting in $F)s; Ey $F%)s, mastersand doctoral level preparation forteaching, advanced practice :elds#
clinical nurse specialists
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,ur!in&) E*plo.*ent Education Trend!0R,!
()$) report; + 4*
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,ur!in&) E*plo.*ent Education Trend!0R,!
3F)' receive basic education in aninstitution of higher education -oftenAD21 from community colleges
compared with ()' in $F%)# graduate0degreed nurses now comprise $+!(' ofall
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,ur!in&) E*plo.*ent Education Trend!0R,!
Hospital consolidations, :scalpressures created hospital nursingstressors; sicker patients, higher
nurse0to0patient ratios, supervision oflesser0skilled staM
Average
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icensed Bractical 2urses
Under supervision of
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2urse Bractitioners
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Clinical ,ur!e Speciali!t
Developed in response to highlyspeciali7ed medicine
.ocus on highly complex, sickestpatients
())* masters programs for specialistpreparation
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1enti!tr. "#$
5arly practice by barbers, blacksmiths & 4Ds
.irst school chartered in $G) with (0yearprogram# by $GG, (G schools, most privatelyowned# by $F)), most states reuired licensure
$F(%; Critical Carnegie report reorgani7ed dentaleducation!
II; recruits@ poor dental health raised publichealth awareness# "elective "ervice eliminatedall dental standards
$F)s; Bublic health dentistry est! by U of4ichigan# dental public health now a recogni7ed:eld with American Eoard of Dental Bublic Health
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1enti!tr. "%$
$FG; 2ational nstitute of Dental
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1enti!tr. "/$
"pecialties -G+' of $,))) are generalists1
$! Dental public health
(! 5ndodontics
+! ral & maxillofacial pathology! ral & maxillofacial radiology
! ral & maxillofacial surgery
%! rthodontics & dentofacial orthopedics
/! Bediatric dentistry
G! Beriodontics
F! Brosthodontics
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1enti!tr.) Trend!
cottage industry?
unaMected by managed care, healthreforms# most in solo practice serveonly paying patients# many low0
income are underserved# absent
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Phar*ac. "#$
Bractice dates to ancient times
Colonial U!"!; Hospital pharmacists wereapprentice 4Ds# separated in $/%
American Bharmaceutical Association founded$G(# now, G U!"! colleges of pharmacy
5mployment growing; aging population#increasing involvement in clinical decisions andphysicianKnurseKpatient counseling
$(/ accredited schools grant Bharm!D in % yearprograms# icense reuires internship & stateexam
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Phar*ac. "%$
3$(,))) graduatesKyr!# 3(/,))) active#employment demand will exceed supply through()()
Eoard of Bharmaceutical "pecialties certi:es
specialists in; nuclear, nutritional support,oncology, pharmacotherapy, psychiatric,ambulatory care, critical care, pediatric pharmacy
+' work in commercial community practice# (+'
in hospitals# +' work in government, forinsurers, for long0term care facilities, otherinstitutions!
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Podiatric 2edicine
Diagnoses, treats diseases, injuries of lowerleg and foot!
Brescribes drugs, lab tests, performs surgery
F accredited U!"! schools# yr!, post0baccalaureate education# many opt for +0years post0graduate training to achieveboard certi:cation in specialties; primarycare podiatric medicine, diabetic foot wound
care & footwear, limb preservation &salvage, or podiatric surgery
icensure reuired in all states
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Chiropractor!
=reat the whole body without drugs or surgery#believe spinal misalignment and nerve irritationinterferes with normal body functions
$ accredited programs, ( accredited institutions
Applicants reuire F) undergraduate credit hours All states reuire licensure (,))) current practitioners# projected increase
to %/,))) by ()() due to aging populationdemand
Achieve comparable results with 4Ds for backpain conditions!
4edicare and many private health plans@coverage
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Opto*etr.
Doctors of ptometry -Ds1 diagnose visionproblems, eye disease, prescribe treatment,:t eyeglasses, contact lenses
(), 0year colleges graduate $,+))Kyear# $yr! residencies for speciali7ation, e!g! familypractice, pediatric, geriatric, low0vision,cornea & contact lens, etc!
ver +,))) licensed practitioners "tate license reuires written & clinical
exams
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Health CareAd*ini!trator! rgani7e, direct, coordinate services
in hospitals, clinics, nursing facilities,physician practices
Eachelor, master and doctoralprograms# certi:cate, diplomas
/) schools have accredited masters@
programs 4ost employed in hospitals, clinics,
physician practices
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Allied Health Per!onnel
())* occupations supplementwork of physicians, dentists, otherhealth professionals within G)
allied health :elds .our categories
! aboratory technologists &
technicians! =herapeutic science practitioners
! Eehavioral scientists
O! "upport services
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I3 (a4orator. Technolo&i!t! Technician!
"tate licensed# rapid growth & diversity#2ational Accrediting Agency for Clinicalaboratory "ciences accredits G$programs# ++),)))*, L )' hospital
employed! Analy7e body 8uids, tissues, cells,
chemical contents, bacterial growth,match blood for transfusions
=echnologists; bachelor degrees=echnicians; associate degrees
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Radiolo&ic Technolo&.
"upervised by physician radiologists# Noint
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,uclear 2edicineTechnolo&. $0 year hospital certi:cate programs for
radiologic technologists,
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II3 Therapeutic SciencePractitioner!
$! Bhysical =herapists
(! ccupational =herapists
+! "peech anguage Bathologists
! Bhysician Assistants
h i l h i
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#3Ph.!ical Therapi!t!"PT!$
"tate license# doctoral degrees thenorm# ($$ accredited programs
2umerous specialties
9raduate accredited colleges#complete internship
=reat injuries, disabilities, improve
function# collaborative role 5mployment; Hospitals, rehab
centers, nursing homes, privatepractice
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%3 Occupational Therapi!t!"OT!$
Oarious regulation in all states, rangingfrom license to registration
4asters degree reuired# doctoral degreesoMered!
Assist recovery from injuries to recoverliving skills, work abilities# plan educational,vocational, recreational activities
5mployment; Hospitals, nursing homes,community mental health, adult day careprograms, rehabilitation facilities
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/3 Speech (an&ua&ePatholo&i!t!
All states regulate# 4aster@s degree in speechlanguage or audiology reuired for license in(/ states
(+ colleges & universities oMer programs
5valuate, treat patients of all ages withcommunicative, swallowing disorders
5mployment; Hospitals, long term carefacilities, schoolsKuniversities -3)'1, clinics
5xpanding employment for aged populationand children with communication disorders
5 Ph i i A i
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53Ph.!ician A!!i!tant!"PA!$
$F%$; Duke University initiated formilitary corpsmen, medics
All states grant treatment privileges
4any specialties# diagnose, givetherapy, counsel, prescribe drugs &refer under 4D supervision
$% programs; many oMer masters
degrees, some oMer baccalaureatedegrees# a few associate degrees
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Social Worker!
Eachelor@s degree reuired# master@sdegree often the employment standard
G) accredited bachelor@s, (G) master@s
programs# $)) doctoral programs preparefor advanced practice andKor research
Counsel patients, families on personal,economic, social problems of illness,
disability# arrange community resources 9rowing demand in gerontology,
substance abuse, mental health :elds
R h 4ilit ti
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Reha4ilitationCoun!elor! Eachelor@sK4aster@s degree reuired
for state license or certi:cation
Brovide counsel, emotional support,
rehabilitation therapy# test abilities,skills levels, interests & psychologicalstate
Develop training plans to maximi7efunctioning & prepare foremployment!
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IV3 Support Ser6ice!) HealthInfor*ation Ad*ini!trator!
Eachelor@s degree in health informationadministration is entry0level reuirement
4edical record administration in hospitals,
other health facilities# maintain systemsto store & retrieve of patient data for:nancial, legal and research purposes
Brojected major future increase in
employment# A
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Alternati6e Therapi!t! "#$
4edical science has fostered public@sinterest in >alternative? approaches
>A group of diverse medical and healthcare systems, practices and products that
are not presently considered a part ofconventional medicine!?
Complimentary 4edicine; adds tomainstream medicine
Alternative; outside the mainstream 2H Center for Complementary and
Alternative 4edicine est! in $FFG# 3 +G'of American use forms of CA4# P + EexpendituresKyear
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Alternati6e Therapi!t! "%$
,ational Center for Co*pli*entar.and Alternati6e 2edicine ",CCA2$"urveys to estimate extent of use nternational study of traditional
medicines "tudies of medicinal herbs "tudies of unusual therapies, e!g!
telepathic healing
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actor! that In8uence 1e*andfor Health Per!onnel "#$
4edical, scienti:c advances that increaselongevity, chronic care needs and survivalof traumatic events
Bhysician supply; almost all otherproviders depend on physician support
=echnologic advances increase specialists& eliminate other classes of workers, e!g!
laboratory automation Home care increases with aging
population# reforms shift more care to
community settings# workforce demand
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actor! that In8uence 1e*andfor Health Per!onnel "%$
Corporati7ation of health care Hospital consolidationsKmergers# vertical
integration into care continuums
Bhysician practice arrangementchanges; solo0Lgroup0L hospitalemployment
2ew provider organi7ations, e!g! ACs
users? by ( 4*
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Healthcare Workforce I!!ue! the ACA "#$
Association of Academic Health Centersde:ned workforce issues in $FF; central tohealth reforms;
Adeuacy of supply# geographic distribution#underrepresented minorities# future uality &relevance of professional schools@ programs#costs of education# competency testing# re0de:ning roles as technology changes# faculty
supply
2ational Health Care Iorkforce Commission
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Healthcare Workforce I!!ue! the ACA "%$
ACA responses to issues with federal supportfor;
oans and scholarships for targeted
professions in underserved areas Cultural competency training
4inority recruitment
Brimary care residency training
.QHC expansions
Community mental health & primary careintegration
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The uture) Co*ple9itie! of ,ationalHealth Care Workforce Plannin&
Until today, no national comprehensiveplanning
"takeholders with diMerent, con8icting prioritiesin education, training, regulation, :nancing etc!
Absence of uniform national & state dataseverely confounds future predictions of need
Demographics, consumer demands, new
disease knowledge, delivery & reimbursementreforms will reuire workforce role changes &adaptations
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