This chapter discusses the various types of healthcare providers in the United States, including physicians, nurses, and other roles. It outlines the history and education/licensing requirements for physicians and how they typically practice medicine. It also describes the different levels of nurses, from registered nurses to advanced practice nurses. The chapter addresses current and projected nursing shortages in the US healthcare system. It provides an overview of the complex mix of health personnel and some gaps and issues around distribution of providers across geographic areas.

1. Chapter 3
People Who Provide Healthcare
Dr. Mandato

2. Physicians
 1775-New Englanders were apprentice-
trained
 Some had under grad degrees, but mostly
just needed to stand the site of blood
 3-6 yr apprenticeship “doctor’s boy”
 Bloodletting, tooth-pulling and wound
dressing
 Medical license granted by the states
 3-year residency, medical licensure exam
for citizen or resident alien

3. Private Medical Practice
 Primary mode-private practice
 Fee for service
 Malpractice requirements
 Stipulations of admitting privileges for
hospitals
 Laws of state dictate what physicians may
do to or for patients
 Growing trend toward group practices
versus physician ownership (p. 79)

4. Patterns of Practice
Primary Care-2 main functions:
1. Provide most care-gatekeeper
2. Control use of hospital or specialist care
 Hospitalist: physicians who see patients
soley on an inpatient basis

5. Patterns of Practice
Medical Specialization:
 Narrow range of knowledge and skills
 Incentive based on knowledge/technology
explosion and financial incentives
 Advantages and disadvantages

6. Medical Education
 136 fully accredited allopathic medical
schools, 26 DO medical schools
 ACGME: Accreditation Council for
Graduate Medical education
 IMG-international medical graduate

7. Physician Workforce Projections
 Utilization of health services is generally higher in those
areas that have more physicians
 We do engage in forecasting despite what we have said
about a lack of planning
 We consider trends in healthcare usage
 Adequacy of the future supply of physicians has been
analyzed regularly
 PSM-Physician Supply Model-demographic utilization-based
computerized system to forecast the supply and
specialization of areas for 18 medical specialties required
to meet a high quality of physician services
 Supply of primary care physicians is growing slightly faster
than demand, could help with the current undersupply of
primary care physicians
 Shortage of specialists

8. Nursing
 Nursing-the protection, promotion and
optimization of health, abilities,
prevention of illness/injury, alleviation of
suffering through the diagnosis and
treatment of, human response and
advocacy in the care of individuals,
families, communities and populations

9. Nursing
Essential features of professional nursing are considered to
be:
 Provision of a caring relationship that facilitates health and
healing
 Attention to the range of human experiences and
responses to health and illness within the physical and
social environments
 Integration of objective data with knowledge gained from
an appreciation of the patient’s or group’s subjective
experience
 Application of scientific knowledge to the process of
diagnosis and treatment through judgment and critical
thinking
 Advancement of professional knowledge through scholarly
inquiry
 Influence on social and public policy to promote social
justice

10. Nursing
Categories:
 RN-registered nurse-highest level of
education/most responsibility-ADN or BSN
and exam
 LPN-licensed practical nurse-12-18 month
program and must pass an exam
 Nurse Aide-variable-certain program offerings
 APRN-advanced practice registered nurses-
Masters Level
 MSN-Master of science in nursing-reparation
for leadership roles and APRNs

11. Nursing
Reasons for Nursing Shortages:
 Low salaries
 Limited chances for increases
 Poor working conditions
 Poor professional image and greater working
opportunities for women
 Doctor-nurse relationship
 Healthcare sector growing in jobs-2011-
despite job losses
 Nurse-to-patient ratio
 Long working hours

12. Nursing
Reasons for Nursing Shortages:
 Low salaries
 Limited chances for increases
 Poor working conditions
 Poor professional image and greater working
opportunities for women
 Doctor-nurse relationship
 Healthcare sector growing in jobs-2011-
despite job losses
 Nurse-to-patient ratio
 Long working hours

13. Nursing
Nursing Shortages:
1950s-led to LPN
1990-Managed Care helped ease shortage
2001-overall healthcare worker shortages
Nursing in Expanded Roles:
-30k in 1990 to 140,000 in 2011-APRNS
-growth of the APRN profession linked to: decline of docs
choosing primary care, APRNs in many cases can fill the need
-can perform physical exams, diagnose and treat common
health problems, prescribe medications from a specified list.
Order and interpret x-rays and provide pre-natal care.
Gynecological exams and administer immunizations
-PAs-see p. 101

14. Health Personnel
 Complex in US
 Highly developed and many patients
benefit from
 Gaps and overlaps
 Maldistribution by geographic area
 Differing levels of patient access

15. Primary Care
Primary Care:
 Primary care and ambulatory care go together
 Means by which two goals of a health services
system-optimization of health and equity in
distributing resources-are balanced. Basic level
of care provided equally to everyone…(p. 105)
 COPC-community-oriented primary care-a
defined population’s health problems are
systematically identified and addressed
 Gatekeepers-to monitor, regulate, and control
use of medical and related services
 P. 108-list of functions-family practitioners,
APRNS can provide same care/equal in quality

16. Healthcare Employment
 Expected to make up larger portion of total US
employment by 2014-10% in 2014
 Home healthcare and offices of health
practitioners expected to grow faster than all
other healthcare settings
 # of PAs expected to rise by 50%. Mas-50%,
home health aides-56%, PA assistants-44%. PTs-
37%
 Nursing-expected to grow the greatest number
of new jobs
 Health services occupations-leading source of
jobs for Americans in the coming years because
of projected growth in healthcare