Essay Instructions: Module 4 - Human Resources: Health Care Personnel and the Changing Practice of Medicine
Human Resources: Health Care Personnel and the Changing Practice of Medicine
Welcome to Module 4 of Health Care Systems.
Module 4 presents an overview of the greatest resources within the hospital organization----people! As medical education evolves into specialty and subspecialty practice, this affects the future of medical practice. Additionally, changes within other major health care professions impact the ever-changing landscape of the hospital environment.
Objectives:
After completing this module, students should be able to:
Assess the origins and impact of geographic maldistribution of physicians and disproportion in supply of medical generalists and specialists
Evaluate the influence of managed care on the practice of medicine and physician relationships with hospitals and insurers
Differentiate among major health care professions in terms of educational preparation, credentials, and roles in the health care service
Analyze the factors that influence demand for various healthcare providers and workforce issues that divide them
Debate ethical issues faced by health care providers as a result of the rapidly changing health care environment and advances in technologic capabilities.
Readings:
Sultz, H. A., & Young, K. A. (2011). Health Care USA: Understanding its organization and delivery (7th ed.). Boston: Jones & Bartlett. (Chapters 5 and 6).
PowerPoint Lectures:
Chapter 5: Medical Education and the Changing Practice of Medicine
Chapter 6: Health Care Personnel
Terms to Know:
Flexner Report
American Medical Association
Academic Health Center
Medical specialty boards
Residency program
Clinical practice guidelines
"Clinics without walls"
Physician-hospital organizations (PHO)
International medical school graduates (IMGs)
Hospitalist
Physician pay-for-performance
Allopathic medical schools
Nurse practitioners (NPs)
Opticians/optometrists/ophthalmologists
Certification
Licensure
Alternative therapies
Corporatization of health care
Maldistribution of health care manpower
Speech-language pathologist
Chiropractic medicine
Podiatry
Module Summary:
Module 4 provided an overview of the growth and change in medical education from the colonial apprentice system to today's high technology, specialty-oriented instruction in the basic sciences and clinical fields. The evolution of specialty and subspecialty practice was discussed, as was the funding of graduate medical education. The changes in the practice of medicine and physician relationships with hospitals and insures following the introduction of managed care were also reviewed. More recent developments such as clinical practice guidelines, physician report cards, Internet usage, and new ethical issues were explored.
Additionally, this module defined the major health care professions, with particular emphasis on their educational preparation, credentials, numbers, and roles in the health service system. The factors that influence demand for the various health cares providers and the workforce issues that divide them were also reviewed. The module included a discussion of the development of health work-force policy and some expectations for the future.
Despite unending speculation about the evolving structure of health care services, there has been little fundamental change in the way health professionals are organized and the way they interact with each other. For physicians, the number and variety of contractual arrangements has increased significantly, as has the oversight from intermediaries in terms of utilization review. But there has been little change in the way most physician's practice medicine. Furthermore, physicians remain the central figures in American health care with non-physician providers poised to play a more critical part in the delivery of health care services but as yet unable to significantly penetrate the system. Although nurse practitioners (NP)s, physicians' assistants (PA)s, and other health care providers may possess skills that appear to be well suited to the demands of an environment with a greater focus on cost containment and managing health behaviors, their roles have been limited by their small numbers and the still significant clout of the medical profession. However, changes in the relative supply for new provider, changes in the relative of new providers and their emerging roles may alter the landscape more drastically over the next 10 to 15 years than has occurred in the past 30 years. These changes in many ways will determine how quickly and in what ways new service delivery forms develop in the future.
Major Themes of Module 4
Chapter 5: Medical Education and the Changing Practice of Medicine
1. Historical development of medical education, colonial times to the present
2. The Flexner Report and the reformation of American medical schools: entrance requirements, curricula content and post-graduate training requirements
3. Evolution of the academic medical center: the medical school-university teaching complex
4. The development of specialty medical education and training programs; the development and functions of specialty credentialing societies and boards
5. The scope, diversity, and organization of medical specialties
6. The origins and impact of geographic mal-distribution of physicians and disproportion in supply of medical generalists and specialists
7. Medical education’s skewed emphasis on curative rather than preventive care.
8. The impact of evolving market forces on the relationships between physicians and hospitals and the scrutiny of medical care costs, quality, and outcomes.
9. The specialized, high technology nature of education, research, and clinical service in academic medical centers make them the most expensive of America’s health care system. Nevertheless, academic medical centers are under increasing pressure to cut back on high-cost activities or face major deficits and possible extinction.
10. Decreases in Medicare’s subsidies to teaching hospitals contained in the Balanced Budget Act of 1997 had major implications for graduate medical education. By scaling back subsidies for graduate medical education and by encouraging beneficiaries to enroll in managed care plans, Medicare and Medicaid reduced both annual revenues and the number of patients receiving care at academic health centers.
11. New ethical issues reflect the practice dilemmas faced by physicians working in the rapidly changing health care environment.
12. The dependence on International Medical Graduates (IMGs) to fill the residency positions of most hospitals in the United States remains a continuing concern.
13. Steeply rising costs of medical liability insurance are a growing concern for practicing physicians, medical schools, and teaching hospitals. As a result, physicians are leaving high premium states, choosing to retire early, or reducing high-risk aspects of their practice to decrease their insurance costs.
14. The fastest growing field of physician practice, the “hospitalist” has evolved outside of the system of control over specialty training; the number of hospitalists is expected to increase to 30,000 by the end of 2010; hospitalists are physicians whose sole responsibility is attending hospitalized patients. They serve as proxies for patients’ primary care physicians and have no specific qualifications, though most are trained in internal medicine or pediatrics.
Chapter 6: Health Care Personnel
The broad array of health care occupations and professions that constitute the health care workforce and the settings in which they work; numbering 13.8 million people, health care workers constitute 10% of the total U.S. workforce.
The licensure, certification, registration, and other credentialing systems designed to protect the public from incompetent or unethical practitioners.
The education, functions, and supply of physicians, nurses, nurse practitioners, dentists, pharmacists, podiatrists, chiropractors, optometrists, health care administrators, and various allied health practitioners.
The growing interest in and professional acceptance of alternative and complementary therapists.
The influence of health care reforms on the health care workforce.
The current health care workforce policy issues as defined by the Association of Academic Health Centers.
New technology, shorter hospital stays, and increased numbers of aged will spur employment of home care nurses, therapists, and aides. More employment opportunities will also occur in primary care clinics, health plans, ambulatory centers, and physicians’ offices; there will be severe shortages of health care personnel, especially in direct care-giving positions in the next decade.
The mix of skills and number of personnel ebb and flow with the discovery and application of new service modalities and institutional adjustments to financial pressures.
Fewer nurses taking care of more severely ill patients during shorter hospital stays and the need to supervise non-professional personnel has increased nursing workloads, lowered morale, and raised serious concerns about the quality of care. As a result, many competent nurses have left hospital employment. This, coupled with the aging of the existing nurse workforce, portends a growing shortage of clinical nurses that will seriously affect nurse recruitment and nurse staffing patterns in hospitals.
An aging population and technological advances will have significant effects on the health care industry over the next decade. A significant percentage of all wage and salary jobs created after 2010 will be concentrated in the health care industry.
