HCA 701: Survey of the U.S. Healthcare System

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HCA 701 Survey of the U.S. Healthcare System

• Physicians and Ambulatory Care

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RESOURCES NEEDED TO MAINTAIN A HEALTH CARE
DELIVERY SYSTEM
Financing
Health Care Delivery System
Technology Supplies
Healthcare Professionals
Facilities
Source Williams and Torrens, Introduction to
Health Services, 2002
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Healthcare Professionals

• Healthcare is a major employer
• It has a rapidly growing labor sector
• Professionals
• Non-professionals and technicians
• Non-institutional workers
• Rapid growth due to
• Technology growth and specialization
• Health insurance coverage
• Aging population
• Emergence of hospitals

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Types of Healthcare Worker Certification

• Licensure state or legal designation
• Certification and registration
• Independent and dependent professions
• Independents practice without physician
  supervision (e.g., doctors, dentists)
• Dependents need physician supervision (most
  nurses, CNAs)

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Ambulatory Care

• Personal health care given to the patient in an
  non-hospital or institutional setting
• Types of settings
• Physician owned private practice
• Managed care clinic settings
• Community health care settings
• Urgent care facilities
• Shift to ambulatory care due to several factors
• Medicare PPS
• Managed care
• Improved technology

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Patient Visits per 100 persons by Ambulatory
Service Type, 1993-94 and 1999-2000
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Physician Authority

• Based on modern science and scientific knowledge.
• Physicians become the intermediaries between
  science and private experience
• Authority signifies the presence of status and
  quality
• Requires legitimacy and dependence.
• Legitimacy acceptance by subordinates
• Dependence bad things can happen if we dont
  obey
• Types of Physician Authority
• Social Authority
• Cultural Authority
• Professional Authority

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The Evolution of the Physician in the U.S.

• Allopathic
• Homeopathy
• Osteopathic
• Chiropractic

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Physicians

• Comprised of two types by practice
• Primary care physicians short supply in U.S.
• Family Practice, Internal medicine, OB/GYN,
  Pediatricians
• Specialists Surplus in U.S.
• Specialize in specific areas

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Physician Surplus or Shortage?

• Rapid growth of physicians, esp. specialists,
  during 1980-95 due to
• Massive federal outlays
• Influx of International Medical Graduates (IMGs)
• Distribution of physicians gives appearance of
  shortage
• Not enough primary care providers
• Medical underserved areas in rural communities
  and inner cities
• Malpractice and the impact on physicians

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Physicians NV vs. US
Physicians Type Nevada U.S.
Physician generalists per 100,000 population 21 30
Physician specialists per 100,000 142 206
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Changing Role of the Physician

• More employed physicians
• By managed care organizations and hospitals (the
  emergence of the Hospitalist)
• Large group practices emerged with the growth of
  managed care
• Emphasis away from specialty areas to managed
  care
• More female physicians

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Physicians who would recommend the practice of
medicine
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For physicians who wouldnt recommend medical
profession
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Distribution of Physicians by Specialty 1980,
1986, 1995, 2000 (In thousands

• 1980 1986 1995 2000 Pct.
  Change
• Specialty No./ No./ No./
  No./ 1986-2000
• All specialties 414/100 521/100 630/100
  684/100 31.4
• Primary Care 159/38.5 179/34.4 205/32.5
  219/32.0 22.2
• Other Medical
• Specialties 25/6.2 62/12.0 83/13.2
  94/13.7 50.2
• Surgical Specialties 110/26.7 134/25.7
  158/25.2 170/24.9 27.0
• All other specialties 118/28.5 144/27.8
  183/29.1 201/29.4 38.9

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Physician Medical Education

• Undergraduate medical curriculum
• Most emphasize the acute care setting
• Increase in women and minorities
• Graduate medical education
• Major increases in residencies
• Shifts in the organization of medical schools
• Must compete for patients
• Shift to managed care by med school hospitals
• Trends medical education in for-profit hospitals
• Flexnor Report

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Will doctors meet demand in a bio-terror event
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Nurses

• Typifies the concern of healthcare nursing is
  concerned with human response to health problems
• Historic factors that shaped nursing as a career
• Occupation to support physicians
• Emergence of hospitals as community institutions
• Acceptable female occupations, primarily white
  females
• Linked to religious orders

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Understanding the Nursing Shortage

• Changes in occupational opportunities for women
  since 1970s
• Majority of RNs are 50 years of age or married
  with children at home
• Low salaries pay compression
• Burnout
• Lack of clinical career ladder
• Active vs. Inactive about 1/3 of nurses not
  working fulltime