Introduction to Healthcare and Public Health in the US

1. Introduction to Healthcare and Public Health in the US Delivering Healthcare (Part 2) Lecture b This material (Comp1_Unit3b) was developed by Oregon Health and Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

2. Delivering Healthcare (Part 2)Objectives • Describe the organization of clinical healthcare delivery in the outpatient setting, and the organization of outpatient healthcare (Lectures a-c) • Describe the organization of ancillary healthcare delivery in the outpatient setting (Lecture d) • Discuss the role of different healthcare providers, with an emphasis on the delivery of care in an interdisciplinary setting (Lecture e) Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 2

3. Where Is Primary Care Delivered? • Primary care clinic: • Point of delivery • A medical facility • Usually, the conditions seen at a primary care clinic are not serious or life threatening • “Gateway” to healthcare services Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 3

4. Primary Care Medical Specialties • Family Practice • General Internal Medicine • Pediatrics • Obstetrics and Gynecology (OB/GYN) Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 4

5. Family Practice • Family Practice (also known as Family medicine):  • Provides healthcare for the individual and family • Integrates biological, clinical and behavioral sciences • The scope of family medicine is broad • encompasses all ages, both sexes, each organ system and every disease entity Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 5

6. General Internal Medicine • Doctors of internal medicine also known as “internists” • Focus on adult medicine • Special study and training focusing on the prevention and treatment of adult diseases. Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 6

7. Pediatrics • Is the branch of medicine that deals with the medical care of infants, children, and adolescents • Focuses on diagnosing, treating and preventing diseases that affect children Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 7

8. Obstetrics and Gynecology • Obstetrics – care of women during pregnancy and immediately after childbirth • Gynecology – care of the female reproductive system • Women’s health and GYN preventive care are an important facet of primary care • Often the same clinician provides both OB and GYN services Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 8

9. Specialty Care • A specialty is a branch of medicine • After completing medical school, physicians train in a specific field (their specialty) • Some physicians undergo additional training (fellowships) after initial training in a more general field Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 9

10. Examples of Specialties • Dermatology • Pathology • Radiology • Nuclear Medicine • Psychiatry • Emergency Medicine • Preventive Medicine Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 10

11. Specialty clinics • Medical specialties • Examples: • Cardiology • Immunology • Gastroenterology • Surgical specialties • Examples: • Orthopedic surgery • Neurosurgery • Plastic surgery Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 11

12. Delivery of Specialty Care • Many surgical specialists see patients in outpatient clinics • They perform surgeries in hospitals • They may perform surgeries in outpatient surgical centers Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 12

13. Outpatient Surgical Centers • Many surgeries or procedures are done in the hospital • Some surgeries or procedures are done in outpatient (or ambulatory) surgical centers • Surgery or procedures are performed in a non-hospital location • Patients typically go home after a brief period of recovery (few hours), following the procedure /surgery Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 13

14. Primary Care In Crisis? • Increasing number of older patients with complex medical issues • Imperfect coverage of preventive care services • Emphasis on documentation • Complex billing and compensation system Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 14

15. Primary Care In Crisis? • Decreasing number of physicians practicing primary care • Supply-demand imbalance • Greater dependence on after-hours care • Increased cost of healthcare delivery Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 15

16. Why is Primary Care In Crisis? • Fewer US graduates enter family medicine • Only a minority of first year internal medicine residents pursue careers in primary care • More than 80 percent of graduating medical students carry educational debt • Specialists are better compensated than primary care physicians Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 16

17. Why Don’t Physicians Want To Go Into Primary Care? • A 2007 survey of graduating US medical students: only 2% planned a career in general internal medicine • Debt not as much of a negative factor as the challenge of treating elderly and chronically ill patients with complex medical issues • Practice environment and lifestyle also played a role Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 17

18. Solving The Primary Care Crisis • Health reform and federal stimulus funds • Training • Grants for training and educational innovation • International Medical Graduates • Recruitment • Loan forgiveness and other financial inducements Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 18

19. Delivering Healthcare (Part 2)Summary – Lecture b • Primary care locations • Primary care specialties • Outpatient specialty care • The primary care crisis Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 19

20. Delivering Healthcare (Part 2)References – Lecture b References American Board of Family Practice at https://www.theabfm.org/about/policy.aspx http://www.acponline.org/patients_families/about_internal_medicine/ https://www.aamc.org/students/medstudents/cim/specialties/ Bodenheimer T. Primary Care -- Will It Survive? N Engl J Med 2006 355: 861-864 http://www.acponline.org/advocacy/events/state_of_healthcare/statehc06_1.pdf Karen E. Hauer, MD; Steven J. Durning, MD; et al., KE; Durning, SJ; Kernan, WN; Fagan, MJ; Mintz, M; O'Sullivan, PS; Battistone, M; Defer, T et al. (2008-09-10). "Factors Associated With Medical Students' Career Choices Regarding Internal Medicine". JAMA 300 (10): 1154–1164 http://www.us-government-grants.net/article_info.php/articles_id/15 http://www.vcstar.com/news/2010/jun/16/health-reform-grants-expected-to-ease-primary/ Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 20