Health Care USA Chapter 7

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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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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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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Health Care USA Chapter 7