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This 5 page Class Notes was uploaded by Gabriela Saint-Louis on Sunday March 22, 2015. The Class Notes belongs to 1101 at George Washington University taught by Tamara Henry in Spring2015. Since its upload, it has received 160 views.
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Date Created: 03/22/15
Chapter 9 Health Professionals and the Health Workforce De ning a quotHealth Professionalquot clinical health professions include physicians nurses dentists pharmacists optometrists psychologists podiatrists and chiropractors amp 0 Nurse practitioners physician assistants health services administrators and allied health practitioners 0 Allied Health practitioners a broad category in its own rights ranging from graduate degreetrained professionals such as physical therapists occupational therapists and medical social workers to technical specialists often with an associate s degree such as dental assistants sonographers and laboratory technicians EducationTraining 0 Education and training central to the development and de nition of most health professions education implies that a student is pursuing a degree or certi cate from an accredited educational institution Training often organized and directed outside of educational institutions Hospitals health departments and large group practices often have the responsibility of training hew health professionals Accredita ancredentialing 0 implies a process of setting standards for educational and training institutions and enforcing these standards using a regularly scheduled institutional selfstudy and n outside review 0 used by most health professions to de ne and enforce educational expectations 0 Credentialing implies that the individual rather than the institution is evaluated Generic term indicating a process of verifying that an individual has the desirable or required quali cations to practice a profession Often takes the form of Certi cation a professionled process in which applicants who have completed the required educational process take an examination successful completion of formal examinations leads to recognition in the form of certi cation Educational options within Public Health many public health roles require graduate degrees that focus on disciplines including epidemiology biostatistics environmental sciences health administration and policy and social and behavioral sciences joint degrees 0 combinations with law social work international affairs 0 combined or joint degrees often allow students to reduce the total number of credit hours required to satisfy the requirement for the two degrees public health professionals today include those who specialize in a wide range of disciplines and work in a variety of settings from governmental public health to notforpro t and forpro t institutions as well as in educational and health care institutions formal certi cation as a public health specialist has only been available since 2008 when the rst certifying examination was given 0 examination covers the ve areas expected for a professional master39s degree such as a MPH biostatistics epidemiology environmental health sciences social and behavioral sciences and health policy and management Education and training process for physicians physicians are a central part of what is called the practice of medicine two categories a Allopathic graduate with an MD degree 0 Osteopathic graduate from osteopathic medical schools and receive a DO degree Most medical schools now require primary are experiences along with traditional specialty rotations Residency fellowship Education and Training process for Nursino the laroest of the health professions Nursing profession dates from the middle of the 18005 when it began to be organized as a profession in England Florence Nightingale is often associated with the founding of nursing as a profession In the US the nursing profession grew out of the Civil War and the essential role played by women in this con ict who performed with we would today call nursing functions Different types of nursing o LPN Licensed Practical Nurses provide a range of services often under thee direction of registered nurses LPNquots educational requirements vary widely from state to state ranging from one year of education after high school to a twoyear associates degree 0 CNA certi ed nursing assistants or nursing aides have usually completed a shortterm certi cation program and are allowed to perform only basic care of patients 0 RN Registered Nurses considered central to the nursing profession and are usually responsible for hospitalbased services Each state de ned its own requirements for RN licensure Move toward integrating nursing into the formal degree system has resulted in nurses with associate s degrees Bachelor of Science in nursing BSN degrees as well as graduate degrees Nurse midwives and nurse anesthetists are two traditional specializations within nursing Roles phvsicians nurses and other clinical health professions plav in public health Primary Secondary and Tertiary Care o Primary Care traditionally refers to the rst contact providers of care who are prepared to handle the greater majority 0 common problems for which patients seek care widely seen as the foundation of a healthcare system Traditionay primary care was considered the domain of physicians today a range of health professions are involved in primary as well as secondary and tertiary care Term quotmedical homequot is becoming widely used suggesting that primary care ins increasingly viewed as a team effort only 13 of physicians in the US practice primary care Affordable Care Ac has encouraged the use of nurse practitioners as part of primary care by providing greater ability for them to bill directly for services without going through a physicians Primary care is a key to healthcare system because it is where most care is delivered and is often the entry point for subsequent specialty care 0 Secondary Care Often refers to specialty care provided by clinicians who focus on one or a small number of organ systems or on a speci c type of service such as obstetrics and gynecology or anesthesiology o Tertiary Care Subspecialty care usually de ned in terms of the type of institution in which it is delivered often academic o specialized health centers May also be de ned in terms of the type of problem that is addressed such as trauma centers burn centers or neonatal intensive care units Compensation and reward of clinical health professionals for services Compensati Meaning Examples Advantages Disadvantag on method es Feefor Clinician paid Physicians Reward May Service for each often paid for linked encourage covered medical visits directly to delivery of service and work unnecessary procedure performed as well as but may not encourages necessary be paid for ef ciency of services counseling for delivery of prevention services Capitation Clinicians are Primary care Discourages May paid a set physicians in unnecessary discourage amount per health plans are may necessary time period may be paid a encourage care may for each set amount preventive encourage patient for per patient care allows referral to whom they per month are for specialists are expected to predictable unless responsible provide all budgeting specialty care regardless of primary care is nancially level of use of services discouraged services Episode of Institution or Medicare pays Encourages May Care clinician is for hospital rapid and encourage paid a set care based on ef cient discharge amount for diagnosis delivery of prior to ability providing related care to provide comprehensiv groups selfcare e services DRGs such as allowing a hosp al de ned treatment number of based on the days per patients condition diagnosis Salary Set amount Governmental May allow May per time facilities focus on discourage period generally pay quality ef ciency clinicians on a seniority based salary Pay for Compensation Additional Links income Dif cult to performanc adjusted compensation with quality measure e quotP4Pquot based on for adherence providing quality measures of t evidence strong outcomes the quality of based incentive for may be care guidelines quality related to delivered New P4P factors being outside instituted as clinician39s part of control Medicare reimburseme nt Ensurino svstem has the rioht number of healthcare professionals Financial compensation is the fundamental market mechanism for regulating the supply of most professionals 0 O O has not generally worked well in the health professions demand for positions in medical schools for instance 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 degreegranting institutions
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