1. science
2. medicine

Chapter 9
Health Professionals and
the Health Workforce
Slide Show developed by:
Richard C. Krejci, Ph.D.
Professor of Public Health
Columbia College 3.30.15
What are the Major Entities in the Health
Care System?
Healthcare System
Health
Professionals
Healthcare
Institutions
Healthcare
Financing
Chapters 9, 10, and 11
Learning Objectives
 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
Learning Objectives
 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
Key Questions
• 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
optimal number of Health Professionals?
Careers in the Health Workforce
Jenna decides that after college she wants to become a
doctor and practice medicine, thinking there was only one
kind of doctor who could diagnose disease and prescribe
medicine. Not so any more, says her advisor. There are
allopathic and osteopathic physicians. In addition there are
nurse practitioners who are often authorized to diagnose and
prescribe medication as well as physician assistants who do
the same under a physician’s supervision. Doctors now
include doctors of nursing practice as well as others with
doctoral degrees such as pharmacists and physical
therapists. Understanding careers in health care can be as
difficult for students as it is for patients, you think to yourself.
Now she understands why her advisor asked: “What do you
mean by practice? What do you mean by doctor?”
Public Health Education
You are interested in clinical work 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 & population
health is increasingly becoming part of clinical care. In
addition, many careers from health administration to
health policy to clinical research combine the individual
orientation of clinical care with the population
perspective of public health. So what’s the best pathway
to public health for you?
Key Chapter Concepts
• Primary Care
• Secondary Care
• Tertiary Care
• Accreditation
• Credentialing
• Certification
• Licensure
→ First contact
→ Seeing a specialist
→ Referral to institution
→ Process for structure, processes,
& outcomes
→ Verify qualifications
→ Competence measured by a
written/skills evaluation
→ Legal document granted by the
government
Specifics of Primary,
Secondary, and Tertiary Care
• Primary care
– First contact providers who handle the majority of
common problems for which patients seek care
(handout)
• 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 it is
delivered at and the type of problem addressed
Types of Physicians
• Allergist Allergy specialist
• Anesthesiologist Physician who administers anesthetic during
surgery.
• Cardiologist Heart specialist.
• Dermatologist Skin specialist.
• Endocrinologist Specialist in glandular disorders.
• Gastroenterologist Specialist in the disorders of the digestive tract.
• Hematologist blood specialists
• Oncologist cancer specialist.
• Medical Internist Physician practicing nonsurgical, adult medicine.
• Nephrologist Kidney specialist.
• Neurologist Specialist in disorders of brain and nervous system.
More Physicians
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•
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•
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Obstetrician/Gynecologist Physician dealing with childbirth and women’s
diseases.
Ophthalmologist Eye specialist.
Orthopedic Surgeon Specialist who performs surgery on bones and joints.
Otolaryngologist Specialist in the treatment of ear, nose, and throat.
Otogist Ear specialist.
Pathologist Specialist in the cause of death.
Pediatrician Specialist in the treatment of children.
Plastic Surgeon Specialist the treatment of skin and soft tissues deformities.
Podiatrist Foot specialist.
Psychiatrist Physician specializing in the treatment of mental illness.
Radiologist Specialist in the use of x-ray and radium therapy.
Rheumatologist Specialist in disorders involving connective tissue such as
joints and muscles.
Thoracic Surgeon Specialist in surgery on the chest and lungs.
Vascular Surgeon Specialist in surgery on the heart and blood vessels.
Urologist Specialist in the treatment of the urinary tract.
Types of Dental Specialists
• Endodontist Specializes in the prevention, diagnosis,
and treatment of diseases and injuries that affect the root
of the tooth and related tissues.
• Oral Surgeon Specializes in the surgical removal of teeth
and the surgical correction of mouth disorders.
• Orthodontist Specializes in the development, prevention,
and correction of irregularities of the teeth.
• Pedodontist Specializes in the treatment of children’s
dental problems.
• Periodontist Specializes in the treatment and prevention
of gum disease.
Technical Personnel
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Medical Assistants
Medical Technologists
Occupational Therapy Assistants
Physical Therapy Assistants
Dispensing Opticians
Optical Technicians
Dietitians
Social Workers
Health Coaching
• Evolving concept on Patient-centered care
• Nurses, health educators, social workers,
community health workers
• Behavior-based intervention
• Moving away from traditional patient
directives
• Continuous communication
and reinforcement is the “key”
Selected Specialties and SubSpecialties of Medicine
General Certificate(s)
Subspecialty Certificates
American Board of Allergy and Immunology
Allergy and Immunology
American Board of Anesthesiology
Anesthesiology
Critical Care Medicine
Hospice and Palliative Medicine1
Pain Medicine
American Board of Colon and Rectal Surgery
Colon and Rectal Surgery
Selected Specialties and Sub-Specialties of
Medicine
General Certificate(s)
Subspecialty Certificates
American Board of Dermatology
Dermatology
Clinical and Laboratory Dermatological Immunology
Dermatopathology
Pediatric Dermatology
American Board of Emergency Medicine
Emergency Medicine
Hospice and Palliative Medicine1
Medical Toxicology
Pediatric Emergency Medicine
Sports Medicine
Undersea and Hyperbaric Medicine
American Board of Family Medicine
Family Medicine
Adolescent Medicine
Geriatric Medicine
Hospice and Palliative Medicine1
Sleep Medicine
Sports Medicine
Selected Specialties and Sub-Specialties of
Medicine
General Certificate(s)
Subspecialty Certificates
American Board of Internal Medicine
Internal Medicine
Adolescent Medicine
Cardiovascular Disease
Clinical Cardiac Electrophysiology
Critical Care Medicine
Endocrinology, Diabetes and Metabolism
Gastroenterology
Geriatric Medicine
Hematology
Hospice and Palliative Medicine1
Infectious Disease
Interventional Cardiology
Medical Oncology
Nephrology
Pulmonary Disease
Rheumatology
Sleep Medicine
Sports Medicine
Transplant Hepatology
Selected Specialties and SubSpecialties of Medicine
General Certificate(s)
Subspecialty Certificates
American Board of Medical Genetics
Clinical Biochemical
Genetics
Clinical Cytogenetics
Clinical Genetics (MD)
Clinical Molecular
Genetics
PhD Medical Genetics
Medical Biochemical Genetics4
Molecular Genetic Pathology
American Board of Neurological Surgery
Neurological Surgery
American Board of Nuclear Medicine
Nuclear Medicine
Selected Specialties and SubSpecialties of Medicine
General Certificate(s)
Subspecialty Certificates
American Board of Obstetrics and Gynecology
Obstetrics and Gynecology
Critical Care Medicine
Gynecologic Oncology
Hospice and Palliative Medicine1
Maternal and Fetal Medicine
Reproductive Endocrinology/Infertility
American Board of Ophthalmology
Ophthalmology
American Board of Orthopaedic Surgery
Orthopaedic Surgery
Orthopaedic Sports Medicine
Surgery of the Hand
Selected Specialties and Sub-Specialties of
Medicine
General Certificate(s)
Subspecialty Certificates
American Board of Otolaryngology
Otolaryngology
Neurotology
Pediatric Otolaryngology
Plastic Surgery Within the Head and Neck
Sleep Medicine
American Board of Pathology
Anatomic Pathology and Clinical
Pathology
Pathology - Anatomic
Pathology - Clinical
Blood Banking/Transfusion Medicine
Chemical Pathology
Cytopathology
Dermatopathology
Forensic Pathology
Hematology
Medical Microbiology
Molecular Genetic Pathology
Neuropathology
Pediatric Pathology
Selected Specialties and Sub-Specialties of Medicine
General Certificate(s)
Subspecialty Certificates
American Board of Pediatrics
Pediatrics
Adolescent Medicine
Child Abuse Pediatrics2
Developmental-Behavioral Pediatrics
Hospice and Palliative Medicine1
Medical Toxicology
Neonatal-Perinatal Medicine
Neurodevelopmental Disabilities
Pediatric Cardiology
Pediatric Critical Care Medicine
Pediatric Emergency Medicine
Pediatric Endocrinology
Pediatric Gastroenterology
Pediatric Hematology-Oncology
Pediatric Infectious Diseases
Pediatric Nephrology
Pediatric Pulmonology
Pediatric Rheumatology
Pediatric Transplant Hepatology
Sleep Medicine
Sports Medicine
Selected Specialties and SubSpecialties of Medicine
General Certificate(s)
Subspecialty Certificates
American Board of Physical Medicine and Rehabilitation
Physical Medicine and
Rehabilitation
Hospice and Palliative Medicine1
Neuromuscular Medicine3
Pain Medicine
Pediatric Rehabilitation Medicine
Spinal Cord Injury Medicine
Sports Medicine
American Board of Plastic Surgery
Plastic Surgery
Plastic Surgery Within the Head and Neck
Surgery of the Hand
Selected Specialties and SubSpecialties of Medicine
General Certificate(s)
Subspecialty Certificates
American Board of Preventive Medicine
Aerospace Medicine
Occupational Medicine
Public Health and General
Preventive Medicine
Medical Toxicology
Undersea and Hyperbaric Medicine
Selected Specialties and SubSpecialties of Medicine
General Certificate(s)
Subspecialty Certificates
American Board of Psychiatry and Neurology
Psychiatry
Neurology
Neurology with Special
Qualifications in
Child Neurology
Addiction Psychiatry
Child and Adolescent Psychiatry
Clinical Neurophysiology
Forensic Psychiatry
Geriatric Psychiatry
Hospice and Palliative Medicine1
Neurodevelopmental Disabilities
Neuromuscular Medicine3
Pain Medicine
Psychosomatic Medicine
Sleep Medicine
Vascular Neurology
Selected Specialties and SubSpecialties of Medicine
General Certificate(s)
Subspecialty Certificates
American Board of Radiology
Diagnostic Radiology
Radiation Oncology
Radiologic Physics
Hospice and Palliative Medicine1
Neuroradiology
Nuclear Radiology
Pediatric Radiology
Vascular and Interventional Radiology
American Board of Surgery
Surgery
Vascular Surgery
Hospice and Palliative Medicine1
Pediatric Surgery
Surgery of the Hand
Surgical Critical Care
Selected Specialties and SubSpecialties of Medicine
General Certificate(s)
Subspecialty Certificates
American Board of Thoracic Surgery
Thoracic Surgery
Congenital Cardiac Surgery4
American Board of Urology
Urology
Pediatric Urology
What are the 6 C’s of Ideals and
Realities of Primary Care?
Primary care ideals
Contact
The point of first contact with the health
care system—the entry point
Realities
Patients enter the health care
systems through many
disconnected points including:
ER, specialists, urgent care
centers, nontraditional
practitioners, etc.
Ideals and Realities of Primary Care
Primary care ideals
Comprehensive
Realities
Primary care intends to be able Rapid increase in possible
to diagnose and treat the great treatments and high-volume
majority of problems
practices increase proportion
of patient problems that are
referred to specialists
Ideals and Realities of Primary Care
Coordinated
Primary care ideals
Realities
Primary care intends to be the
focal point for diagnosis and
treatment with coordination
through referral to specialists
for consultation and feedback
Primary care physicians
increasingly being replaced by
"hospitalists," who are full time
in the hospital and provide
care for inpatients and direct
patient access to specialists
Ideals and Realities of Primary Care
Primary care ideals
Continuity
Realities
Patient followed over many Patients increasingly
years—continuous care
required or encouraged to
provision
change
physicians/providers for
insurance purposes
Ideals and Realities of Primary Care
Caring
Primary care ideals
Realities
Individualized care based on
individual relationships
Primary care increasingly
becoming an administrative
entity without long-term
individual relationship
Ideals and Realities of Primary Care
Community
Primary care ideals
Realities
Primary care designed to
connect the individual patient
with community resources and
community requirements
(required examinations,
reportable diseases,
vaccinations, driver’s licenses,
etc.)
Health care professionals and
public health have long history
of distant and—at times—
contentious relationships
How Are Clinical Health Professionals
Rewarded and Compensated for Their
Services?
• Compensation depends on three primary
factors:
1. Site where care is delivered
2. Nature of the patient’s insurance
3. Type of institution in which the professional works or
is employed
Methods of Financial Compensation to
Providers of Health Services
Compensation
Method
Fee-for-service
Meaning
Examples
Clinician paid
Physicians
for each
often paid for
covered service medical visits
and procedure,
but may not be
paid for
counseling for
prevention
Advantages
Disadvantages
Reward linked
directly to work
Performed
May encourage
delivery of
unnecessary, as
well as
Necessary
services
Encourages
efficiency of
delivery of
services
Methods of Financial Compensation to
Providers of Health Services
Compensation
Method
Capitation
Meaning
Clinician is
paid a set
amount per
time period for
each patient for
whom they are
responsible,
regardless of
level of use of
services
Examples
Advantages
Primary care
physicians in
health plans
may be paid a
set amount per
patient per
month and are
expected to
provide all
primary care
services
Discourages
Unnecessary
care, may
encourage
preventive care,
allows for
predictable
budgeting
Disadvantages
May
discourage
necessary care,
may encourage
referral to
specialists
unless specialty
care is
financially
discouraged
Methods of Financial Compensation to
Providers of Health Services
Compensation
method
Meaning
Episode of
Care
Institution or
clinician is paid
a set amount
for providing
comprehensive
services, such
as hospital
treatment based
on the patient’s
diagnosis
Examples
Medicare pays
for hospital
care based on
Diagnosis
Related Groups
(DRGs)
allowing
defined number
of days per
condition
Advantages
Encourages
rapid and
efficient
delivery of care
Disadvantages
May encourage
discharge prior
to ability to
provide selfcare
Methods of Financial Compensation to
Providers of Health Services
Compensation
method
Salary
Meaning
Examples
Set amount per Governmental
time period
facilities
generally pay
clinicians on a
seniority-based
salary
Advantages
Disadvantages
May allow
focus on
quality
May discourage
efficiency
Methods of Financial Compensation to
Providers of Health Services
Compensation
method
Pay for
Performance
“P4P”
Meaning
Compensation
adjusted based
on measures of
the quality of
care delivered
Examples
Additional
Compensation
for adherence
to evidence
Based
guidelines
Advantages
Links income
with quality
Providing
Strong
incentive for
quality
Disadvantages
Difficult to
measure quality
Outcomes
maybe related
to factors
Outside
clinician’s
control
Addressing the Current Nursing
Shortage in America
• Causes
–
–
–
–
–
Lack of technology training
Higher patient loads
Gender bias (female dominated industry)
Restrictions on entry to schools of nursing
Shortage of qualified nursing faculty
• Efforts
–
–
–
–
Better compensation
Increased education opportunities
Increased applicant pool
Raising job status
The End
Slide show was developed by:
Richard C. Krejci, Ph.D.
Professor of Public Health
Columbia College of SC
All Rights Reserved
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