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Today’s Topic: Health Care Professionals. Objectives for today. Describe the evolution of the medical profession and medical practices Discuss the supply of physicians in the United States Discuss the other major health care professionals. Rise of the medical profession.

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Today’s Topic: Health Care Professionals

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Today s topic health care professionals

Today’s Topic:Health Care Professionals

Objectives for today

Objectives for today

  • Describe the evolution of the medical profession and medical practices

  • Discuss the supply of physicians in the United States

  • Discuss the other major health care professionals

Rise of the medical profession

Rise of the medical profession

  • Medicine is the most powerful profession (at least in America)

  • How have MDs achieved more power than architects, engineers, or even managers?

Docs haven t always been so dominant from starr

Docs haven’t always been so dominant (from Starr)

  • Romans

    • Physicians frequently slaves, freedmen, or foreigners

  • 18th c. England

    • Only persons beneath physicians were surgeons and apothecaries

  • 19th c. America

    • Surgeons in same social class as barbers

What about the rest of the world

What about the rest of the world?

  • Medical profession not as powerful in other highly developed nations

  • Former Soviet Union - $ comparable to factory workers

  • Japan - managers make more $

  • United Kingdom - $ salaries much lower than U.S. docs

The rise of the medical profession

The Rise of the Medical Profession

General characteristics of a profession:

  • Self-regulating

  • Unique body of knowledge

  • High level of training

  • Service orientation

  • Code of ethics

Authority of medical profession from starr

Authority of medical profession (from Starr)

  • The authority of MDs differentiates them from other professions

  • Authority is the ability to control others’ behaviors

  • 2 roots of authority

    • Dependence

    • Legitimacy

Derivations of dependence

Derivations of dependence

  • Knowledge, competence of a professional

  • Belief that bad consequences will occur if one does not obey professional

  • Unique reasons we are dependent upon medical profession

    • They have scientific knowledge

    • They make decisions for us

Derivations of legitimacy

Derivations of legitimacy

  • Acceptance that you should obey

  • Based on...

    • Rational, scientific grounds

    • Affirmation by peer group

    • Judgement/advice is meant to do good

  • When legitimacy is in doubt, dependence almost usually still exists

Cultural and social authority

Cultural and social authority

  • Social authority: Giving of commands (e.g. when parent tells you what to do; when boss tells you what to do)

  • Cultural authority: Our views of reality which affect our reactions to commands from others.

Consolidation of medical authority

Consolidation of medical authority

  • Greater cohesion

  • Referrals to specialists

  • Changes in pre-industrial America

  • Better transportation

  • Telephones

  • Differentiation of labor

Consolidation continued

Consolidation (continued)

  • Standardization of medial education

    • In mid to late 19th c., a lot of sects within medicine

    • Homeopaths: thought disease could be cured/caused by drugs; thought that disease caused by a suppressed itch.

    • Eclectics: thought herbal medicine was best treatment.

Consolidation continued1

Consolidation (continued)

  • First medical school at Univ. of Pennsylvania in 1765

    • Doctors only went to school for four years

  • Abraham Flexner’s report

    • Recommended closure of many medical schools

  • Now, over 100 medical schools in U.S.

    • Doctors have 8 years of undergraduate education

Medical authority and conversion into economic power

Medical authority and conversion into economic power

  • AMA: established in 1846.

  • Hospitals and drug companies dependent upon physicians as gatekeepers

  • Doctors against national health insurance, prepaid group practices, and company employment

Physician income

Physician income

Measuring supply

Measuring supply

  • No. of physicians per 100,000 enrollees

  • No. of physicians per 10,000 residents

  • Supply/pop. ratios do not account for..

    • Physician productivity

    • Health of the population

    • Physicians who travel around to provide care

No of excess physicians from wennberg

No. of excess physicians (from Wennberg)

Consequences of increased supply

Consequences of increased supply

  • Increased competition, shift in employment

    • Solo practice, fee for service

    • Group practice, capitation

  • HMOs

    • Staff model

    • Group model

    • Network model

    • IPA

Rural urban distribution of m d s

Rural/urban distribution of M.D.s

  • While there is an oversupply overall, too few physicians in many rural counties

Strategies to increase rural supply

Strategies to increase rural supply

  • Medical schools have increased output from 1965 to now

    • Assume that graduates will go to rural areas

  • Oversupply, competition in urban areas could drive some to rural areas

  • Training in rural areas

Strategies to increase rural supply1

Strategies to increase rural supply

  • National Health Services Corp.

    • Indenture program

    • Physicians often leave after their time is completed

  • Oversupply, competition in urban areas could drive some to rural areas

  • Training in rural areas

International medical graduates

International medical graduates

  • Supply has increased in 1990s

  • Why?

    • Some specialties need more docs

    • Rural locations

    • Teaching hospitals

Osteophathic medicine

Osteophathic medicine

  • Osteopathy is similar to allopathic medicine

    • Reimbursed by Medicaid, Medicare, & most private insurance

  • Tends to stress joint manipulation and diet more than allopathic

Physician assistants pas and nurse practitioners nps

Physician Assistants (PAs) and Nurse Practitioners (NPs)

  • PAs work under supervision of physicians

    • can diagnose, manage, treat common diseases

  • NPs have a similar role

    • Midwives, family NPs, psych. NPs

    • Emphasize prevention, counseling

Rise of nursing

Rise of nursing

  • Early 1900’s,

    • Nurses tended to be social derelicts, past prostitutes (Rosenberg’s The Care of Strangers)

  • Today, a respected and large (the largest) health care profession

Professionalization of nursing

Professionalization of nursing

  • Led by Florence Nightingale

    • Argued that only women are caring enough to be nurses

    • Physicians agreed with this

      • they didn’t want nurses involved in technical aspects

Nurse training in early 20 c

Nurse training in early 20 c.

  • Nurse training was a good deal

    • Free room and board

    • Usually sponsored by hospitals (as is still the case in Japan)

    • Hospitals got cheap labor in return

Hospital health administration

Hospital & Health Administration

  • Relatively young “profession”

  • Is it even a profession?

  • Demand, education accompanied hospital growth

Hha education

HHA Education

  • 1st master’s degree program

    • University of Chicago, 1934

  • 1st Ph.D. degree program

    • University of Iowa, 1950

  • MHA predominant degree, # MBA programs increasing

Public health education

Public health education

  • Educational cores

    • Epidemiology

    • Health behavior and promotion

    • Environmental health and toxicology

    • Health management and policy

    • Biostatistics

  • Primary degree: MPH

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