2 pages
Chapter 9
Health Professionals and the Health Workforce
Learning Objectives (1 of 2)
Describe roles that education and credentialing play in the development of health professions, such as medicine and nursing
Describe the continuum of public health education and identify educational pathways for becoming a public health professional
Identify recent changes in the education of physicians
Describe the educational options in nursing and the growing role that nurses play in healthcare delivery
Learning Objectives (2 of 2)
Identify components of prevention and public health that are recommended for inclusion in clinical education
Explain the concept of primary care and differentiate it from secondary and tertiary care
Identify a range of mechanisms used to compensate clinical health professionals and explain their advantages and disadvantages
Vignette 1 (1 of 2)
Upon your arrival at the hospital, the nurse specialist examines you and consults with the radiologists, the gastroenterologist, and the general surgeon.
Your medication is reviewed by the pharmacist and your meals by the clinical nutritionist.
Throughout the hospitalization, you are followed by a hospitalist.
Vignette 1 (2 of 2)
Once you get back home, the home care team comes to see you regularly for the first 2 weeks, and the certified physician assistant (PA) and the doctor of nursing practice (DNP) see you in the office.
You realize that health care is no longer just about doctors and nurses.
You ask yourself: What roles do all of these health professionals play in the healthcare system?
Vignette 2 (1 of 2)
Jenna decides that she wants to become a doctor and see patients and practice medicine.
“I thought there was only one kind of doctor who could diagnose disease and prescribe medicine,” she mentions at a career counseling meeting.
“Not so, anymore,” says her advisor. “There are allopathic and osteopathic physicians. In addition, there are nurse practitioners (NPs) who are authorized to diagnose and prescribe medications, and there are PAs who do the same under a physician’s supervision.”
Vignette 2 (2 of 2)
“The universe of ‘doctors’ now includes doctors of nursing practice, as well as other doctoral degree professionals, such as pharmacists, occupational therapists, and physical therapists.”
Understanding careers in health care can be as difficult for students as it is for patients, Jenna thinks to herself.
Now she understands why her advisor asked: “What do you mean by ‘practice’? What do you mean by ‘doctor’?”
Vignette 3 (1 of 2)
Sarah was about to begin medical school and was expecting 2 years of “preclinical” classroom lectures focusing on the basic sciences, followed by the study of clinical diseases.
Then, as she had heard from her physician father, she expected 2 years of clinical hospital “rotations” and electives investigating specialties.
She is surprised to find that medical school has changed.
Vignette 3 (2 of 2)
There are small-group, problem-based learning (PBL) sessions where she needs to be able to locate and read the research literature. There is contact with patients and their problems right from the beginning. There is increasingly a 4-year approach instead of a preclinical and clinical approach to medical education.
She wonders: Are these changes for the better? What else needs to be done to improve medical education?
Vignette 4 (1 of 2)
You are interested in clinical care, as well as public health. I need to make a choice, you think to yourself.
“Not necessarily,” your advisor says. “There are many ways to combine clinical care with public health.”
After a little investigation, you find out that undergraduate public health education is increasingly seen as preparation for clinical education, and clinical prevention and population health are increasingly becoming part of clinical care.
Vignette 4 (2 of 2)
In addition, many careers, from health administration, to health policy, to health education, to clinical research, combine the individual orientation of clinical care with the population perspective of public health.
So what is the best pathway to a public health career for you?
Questions-to-Ask (1 of 2)
What do we mean by a health professional?
How do education and training serve to define health professions?
What are the educational options within public health?
What is the education and training process for physicians?
What is the education and training process for nursing?
Questions-to-Ask (2 of 2)
What roles do physicians, nurses, and other clinical health professions play in public health?
What is meant by primary, secondary, and tertiary care?
How are clinical health professionals rewarded and compensated for their services?
How can we ensure the system has the right number of healthcare professionals?
What Do We Mean by a Health Professional?
Clinical health professionals include:
Physicians, nurses, dentists, pharmacists, optometrists, clinical psychologists, physician assistants, and health services administrators
Allied health practitioners include:
Graduate-trained professionals, such as physical therapists and medical social workers
Technical specialists, often with an associate’s degree, such as dental assistants and laboratory technicians
How Do Education and Training Serve to Define Health Professions?
Accreditation
A process of setting standards for educational and training institutions and enforcing these standards using a regularly scheduled institutional self-study and an outside review
Defines and enforces educational expectations
Credentialing
An individual, not the institution, is evaluated
Process of verifying that an individual has the desired or required qualifications to practice a profession
Often in the form of certification, where successful completion of formal exams leads to recognition
Defines specialties and subspecialties within a profession
Usually a prerequisite for licensure
How Do Education and Training Serve to Define Health Professions?
Licensure
State governmental function
Usually required for practice of a health profession
May include residency requirements, a legal background check, continuing education requirements, etc.
What Are the Educational Options Within Public Health?
Public health education includes degree programs at community colleges and 4-year colleges as well as at the master’s and doctoral level.
Articulation of these degrees to ensure development of career ladders is underway
A large and growing number of options are available to combine public health with other professions
Combined or joint degrees with medicine, nursing, law, social work, international affairs, etc.
What is the Education and Training Process for Physicians? (1 of 2)
Undergraduate coursework and MCAT examination
Medical school
MD (allopathic) & DO (osteopathic) degree options
Years 1 & 2: Basic science and preclinical training
Part 1 of National Boards of Medical Examiners
Years 3 & 4: Hospital-based clinical rotations in specialty areas
Part 2 of National Boards of Medical Examiners
What is the Education and Training Process for Physicians? (2 of 2)
Residency training
“Internship”
Part 3 of National Boards of Medical Examiners taken after the first year
Maximum standard for residents is 80 hours/week
Fellowship
Routine part of specialization
Table 9.1: Selected Physician Specialties of Medicine (1 of 3)
Anesthesiology
Emergency medicine
Family medicine
Internal medicine
Obstetrics and gynecology
Orthopaedic surgery
Otolaryngology
Table 9.1: Selected Physician Specialties of Medicine (2 of 3)
Anatomic pathology
Clinical pathology
Pediatrics
Physical medicine and rehabilitation
Plastic surgery
Aerospace medicine
Occupational medicine
Public health and general preventive medicine
Table 9.1: Selected Physician Specialties of Medicine (3 of 3)
Psychiatry
Neurology
Child neurology
Diagnostic radiology
Radiation oncology
Radiologic physics
Surgery
Urology
What is the Education and Training Process for Nursing? (1 of 2)
Registered nurses (RN)
Responsible for hospital-based services
Requires a state license that may require a bachelor of science in nursing (BSN) degree
Doctorate in nursing practice (DNP)
Licensed practical nurses (LPN)
Provide a range of services under direction of RNs
1–2 year associate’s degree
What is the Education and Training Process for Nursing? (2 of 2)
Certified Nursing Assistants (CNA)
Allowed to perform only the basic care of patients
Short certification program
Little formal specialization within nursing
Nurse midwifes and nurse anesthetists
More specialization to be seen in the future
New and Expanding Roles for Nurses
Infection control
Health navigation
Nurse case management
Patient safety
Health information system implementation
Disaster and emergency management
What Roles Can Clinical Health Professionals Play in Public Health?
Pharmacists provide education about drugs for patients and practitioners and control prescription drug abuse
Dentists and dental assistants prevent dental and gum disease and provide early detection of oral cancers
Primary care specialists, nurses, and physician assistants are the front lines of clinical prevention
Screening, behavioral counseling, immunization, preventive medication
What is Meant by Primary, Secondary, and Tertiary Care?
Primary care
First contact providers who handle the majority of common problems for which patients seek care
Secondary care
Specialty care provided by clinicians who focus on a small number of organ systems or type of service
Tertiary care
Subspecialty care defined by type of institution is it delivered at and the type of problem addressed
Table 9.2: Ideals and Realities of Primary Care—the 6 Cs
Data from Institute of Medicine. Defining Primary Care: An Interim Report. Washington DC: National Academies Press; 1994.
How Are Clinical Health Professionals Rewarded and Compensated for their Services?
Compensation depends on:
Site where care is delivered
Nature of the patient’s insurance
Type of institution in which the professional works or is employed
Table 9.3: Method of Financial Compensation to Providers of Health Services (1 of 2)
Table 9.3: Method of Financial Compensation to Providers of Health Services (2 of 2)
How Can We Ensure the System Has the Right Number of Healthcare Professionals? (1 of 2)
Financial compensation is the fundamental market mechanism for regulating the supply of most professionals
Mechanism has not worked well in health professions
Demand for positions in medical schools far exceeds the supply
Much of the control over the number of professionals who are trained has been made by the profession itself through policies that control the number and size of accredited degree-granting institutions
How Can We Ensure the System Has the Right Number of Healthcare Professionals? (2 of 2)