HSA 3111: Health Service Professionals 1 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida

HSA 3111: Health Service Professionals

1Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest

Topics

• Overview• Statistics and Measures• Physicians• Physician Issues• Other Providers• Nursing• Non-physician Providers• Health Service Administrators (You?)

“The U.S. healthcare industry is the largest and most powerful employer in the nation.”

Text (p. 120)



Overview

• The chapter is filled largely with descriptive material about various healthcare professions

• The inferences are much more important– Look for incentives that shape current structures– Look for trends and how they may change

structures directly or by changing incentives– How do trends affect patients and providers?– How will trends affect you in your career?

• The chapter short-changes the involvement of and impact on healthcare administrators



Statistics and Measures

• Healthcare represents 3% of the total labor force– 16% of gross domestic product– Average HC worker much more productive in the

labor market than the average worker*• 7 of 10 fastest growing professions are in HC

– Growth at 29% through 2010– Growing population– Aging population

• HC labor among the most highly educated– What are implications of this fact?

* There are huge caveats to this statement



Statistics and Measures (cont.)

• HC workers are in a variety of settings– Changing HC organizational structure changes

labor needs– Changing demographics and disease patterns

also affect HC labor needs• Demand for HC labor related to funding for care

– How might changing funding change demand?• HC tasks are distributed among an increasingly

varied group of professionals– Scope of roles and responsibilities is also dynamic



Statistics and Measures (cont.)

• 40% of HC professionals are employed by hospitals but the percentage of physicians is much lower– 8% of physicians (after internship and residency)

work in hospitals• The supply of HC labor is marked by two

imbalances– Primary vs. Specialty services– Geographic



Physicians

• Recall Chapter Three’s history of HC in the U.S. and the singular evolution of physician qualifications and roles

• We can identify two trends in HC workers related to the roles of physicians– Increased specialization among physicians– Increased divestiture of tasks formerly performed

by physicians to other HC workers



Physicians (cont.)

• Two Trends (cont.)– Physicians remain the focal point of service for the

hard cases– Significant organization is designed to

• Channel the hard cases to the right specialist• Reduce the physician’s distractions

– Other HC professionals now do many tasks formerly performed by physicians



Physicians (cont.)

• Increasing ratio of physicians to population– 14.1/10,000 in 1950 to 27.0/10,000 by 2001– Increases in non-physician providers increases

coverage intensity• Why do you think this is?

– Growth of knowledge & effectiveness

– Ability to payGrowth in Demand



Physicians (cont.)

• Specialization– Explosive growth in knowledge has resulted in too

much for one person to know– Expensive specialized knowledge should not be

wasted on routine tasks– Primary care providers becoming specialists in

their own rights



Physicians (cont.)

• Primary Care– Typically first to treat and diagnose– Serve as gatekeepers in formalized managed care

organizations– Have longer term relationship with patient– Sees whole patient

• Primary care issues• All specialist issues

– Requires ‘specialty’ training in being a generalist



Physicians (cont.)

• Hospitalists– Takes on role of primary care physician for

hospitalized patients– May coordinate work of multiple specialists– Why does it make sense to create this specialty?



Physicians (cont.)

• Clinical Practice Guidelines– Wide variations in the way different physicians

treat the same condition– Balance advanced available treatments with risk

and cost• Increased pressures in MCO• MCO payment mechanisms also pressure

physicians



Physicians (cont.)

• Clinical Practice Guidelines (cont.)– Standardize protocols for the same condition– Reduce physician’s discretion– Standardize costs and treatments– Reduce (and increase) exposure to liability– Recent news:

• Prostrate treatments• CPR protocols



Physician Issues

• Physician oversupply– Some studies indicate that the U.S. will be

oversupplied with physicians– Exacerbated by increasing treatments given by

other providers (PAs, Nurse Practitioners, etc.)– Thought to increase healthcare costs (p. 130)

• I don’t see the mechanism for this– Federal government is restricting the paid support

for residency training



Physician Issues (cont.)

• Overspecialization– In general specialized physicians earn more

money than PCPs* – Sometimes have more predictable lifestyles– Often enjoy more prestige– Increased specialist use leads to increased

invasive and costly procedures– Hospital-based internship and residency steers

more physicians to specialty training– Shifts toward MCO** and preventive care are

increasing the demand for PCP* Primary Care Physicians ** Managed Care Organizations




• Geographic Distribution– Other pressures steer physicians away from rural

and poor areas• Fewer insured (paying) patients• Fewer professional growth opportunities• Lower income• Fewer cultural opportunities

– Corresponding oversupply in urban areas– How can these distributions be affected?




• International Medical Graduates– Almost 25% of US physicians graduated from

foreign medical schools– Quality differences are unclear– Distribution among specialties and geography is

also unclear



Other Providers

• Dentists– Most are sole practitioners or in small groups– Employ related staff– Have business management as well as

professional service responsibilities• Pharmacists

– Most are employees of other organizations– Taking on some health management

responsibilities– Critical integration of services by multiple

physicians



Other Providers (cont.)

• Optometrists, Chiropractors, Podiatrists, and Psychologists mimic many characteristics of dentists in terms of – Employment– Practice management

• All require licensing



Nursing

• Key profession for leveraging the physician’s time– Provide skilled medical services not at the level of

the physician– Increased education for Nurse Practitioners

increase range of tasks and further free physician time

• Nurses have an incredible variety of working conditions



Nursing (cont.)

• Expected shortfall of 340,000 nurses by 2020– Lower pay– Difficult work conditions– Too few training programs

• Some programs established to increase number of nurses but funding remains an issue



Nonphysician Practitioners

• Physician Assistants, Nurse Practitioners, Certified Nurse Midwifes

• Sometimes referred to as physician extenders • Work under the (sometimes loose) supervision of

a physician• Have differing treatment and prescription

authority by specialty and state• Differing educational requirments • Patients often report increased satisfaction with

NPs and PAs than with physicians– Why do you think?



Allied Health Professionals

• A dizzying variety of specialty professions not requiring an MD have developed– Often related to specific medical technologies– All have specific domain-related knowledge

• Some may practice independently– Speech Therapist– Occupational or Physical Therapist

• Some support a physician or other professional



Health Service Administrators

• These are the managers of health service organizations– Hospitals and clinics– Medical offices or groups

• Heavily business and process focused– Often have a holistic view of the organization,

though not of specific medical techniques– Must anticipate changes– See the first new paragraph on p. 149 for a

daunting description



Health Service Administrators (cont.)

• Senior HSAs must coordinate the work of and allocate resources to medical professionals, including physicians– Incredibly challenging work

• Many educational paths to the field– Specialty degrees– Business degrees

• Wide variety of work environments

Documents

HSA 3111: Health Service Professionals 1 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida