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Health Services Workforce. Chapter 8 Tracey Lynn Koehlmoos, PhD, MHA. Roemer Model. Where are we now? Resource Production Workforce and hospitals Research and technology Where have we been? Organization of Programs Management Economic Support. Health Services Workforce.

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health services workforce

Health Services Workforce

Chapter 8

Tracey Lynn Koehlmoos, PhD, MHA

HSCI 678 Intro to US Healthcare System

roemer model
Roemer Model
  • Where are we now?
  • Resource Production
    • Workforce and hospitals
    • Research and technology
  • Where have we been?
    • Organization of Programs
    • Management
    • Economic Support
health services workforce3
Health Services Workforce
  • Largest Industry in the US
  • 11.9 million workers and growing!
  • MDs: receive 20% of all personal health expenditures, control 75% of health expenditures
  • Nurses, 2 million plus, largest group
  • Many more allied professionals
physicians
Physicians
  • Leadership/entry role in health system
  • Historical autonomy
  • Challenges
    • Doctor as businessman
    • Reduced fees
    • Insurers seek cost containment
    • Utilization review
  • But first…
medical history 101
Medical History 101
  • US medical profession followed Brits.
  • Apprenticeships, no standardized programs
  • 1846—AMA founded, licensing & training
    • More standardization
    • More science and research
the flexner report
The Flexner Report
  • 1910 by Abraham Flexner and AMA
  • Visited 131 US and Canadian med schools
  • Found wide variation in all aspects
  • Recommended only 31 should stay open
  • Johns Hopkins, ideal model
  • Closed all but 2 Black medical schools
med school today
Med School Today
  • About 126 schools for MDs
  • 12 Osteopathy programs
  • 4 year program
  • 17,000 new physicians each year
  • Rigorous standards
  • Costly (with great variation)
  • 50% or more Med School revenue from provision of services
graduate medical education
Graduate Medical Education
  • GME, 3-7 year residencies for specialty
  • Residents receive stipends
  • Each GME costs Fed $70K
  • Medicare and Medicaid, largest payers of GME
  • No centralized controlling authority
  • # Residencies > # Medical Graduates
who fills the remaining slots
Who fills the remaining slots?
  • International Medical Graduates (IMGs)
  • Formerly known as FMGs

1: to provide foreign MDs with training

2: Inexpensive labor for teaching hospitals

3: Augment supply of US physicians

IMGs will work in places US physicians will not:

Inner City

Mental Hospitals

Prisons

supply and demand
Supply and Demand
  • 813,770 Physicians in US (2000)
  • 2/3 Specialists
  • Inadequate distribution of providers
  • Demand, hard to predict
  • Supply, easier to control
    • Number of Medical School Slots
    • Number of IMGs based on policy
specialists v generalists
Specialists v. Generalists
  • Generalists: FP’s, Internal Medicine
  • 2/3 of physicians are specialists/subspec.
  • No emphasis on producing more FPs
  • No quick fix
  • Managed Care emphasizes the Primary Care Provider (Generalist)—but the idea has not caught on in the US
physician summary
Physician Summary
  • No easy way to predict demand
  • There may be an oversupply
    • True in some areas and specialties
    • Undersupply in other areas and generalists
  • Specialist receive higher reimbursement and more prestige than Generalist
  • Generalists are the hub of Managed Care-sort of…
allied health providers
Allied Health Providers
  • Laboratory Personnel
  • PT and OT and RT
  • Radiology Technicians
  • Dietitians/Nutritionists
  • Clinical Psychologists
  • Speech Pathologist and Audiologists
  • Medical Records administrators
  • Medical Social Workers
midlevel practitioners
Midlevel Practitioners
  • Physician Assistants (PAs)
    • Post-Vietnam, medical corpsmen
    • 20-36 months training
    • Primary care role good for Managed Care
    • 55% associated with specialist practices
    • Issues of professional territorialism
    • Licensure restriction
midlevel practitioners16
Midlevel Practitioners
  • Advance Practice Nurses (APNs)
  • Nurse Mid-Wives (4,000)
  • Nurse Practitioners (58,500)
  • No national standard
  • Require physician oversight
  • No direct reimbursement to APNs
nurses
Nurses
  • Largest group in the medical workforce
  • More than 2 million active nurses
  • 2/3 work in hospitals
  • Five levels of nurse education
    • CNA—on the job, no certificate
    • LPN—12 month program (state license)
    • RN—hospital diploma, AA, BA (state license)
    • APN—Midwife, ARNP
    • Clinical specialist—MS (also PhD, ND)
nursing shortage
Nursing Shortage
  • US-wide, expected to worsen
  • Aging nurse workforce (43 average age)
  • By 2010, 20% below requirements
  • Reality of Nursing:
    • High entry salary, relatively low increase
    • Work environment complaints
    • Cultural change in US
pharmacists and dentists
Pharmacists and Dentists
  • Pharmacists: 200,000+
    • 5-6 years of training
    • Dependent on MDs to write prescriptions
    • Increase in elderly patients, increase in internet and mail order prescriptions
  • Dentists: 170,000
    • No dependence on physicians!
    • Have successfully treated decay
    • Must find other areas to concur including MC
health service administrators
Health Service Administrators
  • Highly trained business people and managers (60,000)
  • Masters prepared (MHA, MBA, MS)
  • Flexibility and leadership
    • Strategic planning and marketing
    • Stay current on technology and policies
    • Accounting and financial management
    • Clinical management and physical plant
workforce summary
Workforce Summary
  • Largest segment of the US workforce
  • More women becoming physicians, PAs
  • Aging of the nursing workforce
  • Racial and Ethnic disparities in all areas
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