Healthcare Occupations and Services in the United States, Exams of Advanced Education

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MHA 707 EXAM 2 BOST-with 100% verified solutions 2024-2025 Tutor verified Community-based care self and ambulatory care Hospital based care inpatient acute care Postacute care long-term care, ambulatory rehab centers, long term care hospitals Self-care (80-95% of health problems stop here) OTC meds, vitamins and supplements and change of habits Ambulatory healthcare medical services performed without admission to a hospital or other health care facility for an overnight stay Freq settings for ambulatory care physician offices, emergency departments, and hospital outpatient clinics Emerging and expanding ambulatory HC telehealth, physician home visits, retail pharmacies, diagnostic imaging and laboratory centers, ambulatory surgery centers, and urgent care centers Most freq reasons for visits general medical exam, routine prenatal, post op, medication, cough, well baby exams, hypertension, knee symptoms, and pre-op visit Majority of OVs in NE >65 and female Majority of ED visits occur in NFP 70.9% How many ED visits are taught IN hospitals? around 15% in 2016, how many patients are insured the majority. 85% were private ins, Medicaid and Medicare. Only 8.4% had no ins. ED functions related to providing highly technical resources for acutely ill persons life threatening, prompt hospitalizations, and serve as secondary private physician's office. ED functions related to restricted access to HC cannot reach private physician, reg clinic is not open or available, geographically isolated, or have no ins so no place to go when sick. Top 3 reasons for visits to ED abdominal pains, chest pain, or fever What are the three major categories of ownership and control? Government, non-government NP, and non-government FP Community hospital (85%) All nonfederal, short-term general, and special hospitals whose facilities and services are available to the public (gyno, ENT, rehab, orthopedic, and short term general hospitals are considered community hospitals) Community Hospital- % of beds NFP- 68.2% FP- 17.8% and State/local- 14% Community hospital- % of annual admissions NFP- 72.3% FP-15.8% and state/local- 11.9% Postacute care defined to restore patient health and mobility and to provide continuing care for people with chronic conditions who can no longer live at home or without assistance. Other postacute care settings include -long-term care acute hospitals (LTACHS) -other specialty hospitals -ambulatory rehab facilities Long-term postacute care encompasses a range of supportive, rehab, nursing and palliative services provided to people- young to old- whose capacity to perform daily activities is restricted due to chronic disease or disability. 5 major sectors of long-term care (postacute) adult day services, home health, hospice, nursing homes, and residential care facilities. In 2016, majority of home health agencies were FP centers (i.e. hospice, nursing homes etc) In 2016, the minority of adult day services centers were for profit (FP) In 2016, majority of nursing homes and residential care communities and minority adult day service centers were chain-affiliated Adult day services centers 4600 adult day services centers and 286,300 participants (safe, professional care settings for adults who need supervision outside the home during the day) Home health agencies provided to individuals and families in their place of residence to promote, maintain, or restore health or to maximize the level of independence while minimizing the effects of disability and illness, including terminal illness. Hospitals without walls (Home health) advnaces in technology allow dozens of complex illnesses, once treated almost exclusively in the hospital, to be treated at home. Hospice 4300 hospices and 1,426,000 patients received services in 2015. Defined as a program of palliative and supportive care services that provides physical, psychological, social and spiritual care for dying persons, their families and other loved ones (usually life expectancy is <6mo) Nursing homes 15,600 homes and 1,347,600 residents. Provide a wide range of health and personal care services- focusing on medical care more than most assisted living facilities. (rehab, physical, occupational and speech) Residential care communities 28,900 res. care communities and 811,500 residents served. Provide level of care and supervision for people unable to live by themselves but who do not need 24-hour nursing care. Horizontal persons with only a HS diploma or equivalent, trained to assist, are carry out basic patient care, and their training can lead to more skilled and well- paying jobs. HC Occupations amount to a large and increasing portion of employed US persons In 2018, about 13 million people, or 8.5% of all civilians employed in nonagricultural occupations and in 2002, about 9 million, or 6.8% The Bureau of Labor Statistics has 2 major categories of HC workers practitioners and tech occupations and HC support Occupations. Major categories of HC occupations do NOT include •Medical and Health Services Managers (n = 372,670) •Health Educators (n = 58,780) •Postsecondary Health Teachers (n = 255,190), Postsecondary Health Specialties Teachers (n = 199,480), and Community Health Workers (n = 56,130) How many people in 2018 were employed in "practitioners and technical occupations" 9 million (virtually all of these careers require licensure or certificate) Largest occupations (practitioner and technical) 78% total. •Registered nurses (n = 2,951,960) •Health practitioner support technologists and technicians (n = 801,590) •Licensed practical and licensed vocational nurses (n = 701,690) •Therapists (n = 687,790)—occupational, physical, radiation, respiratory, exercise + Largest Occupation (practitioner and technical cont.) •Physicians and surgeons (n = 826,000 ) •Diagnostic-related technologists and technicians (n = 390,630) •Pharmacists (n = 309,550) •Medical records and health information technicians (n = 208,650) •Nurse practitioners (n = 179,650) •Physician assistants (n = 114,710) How many people are in HC Support Occupations? 4 million- 77% total Largest in HC Support category •Nursing assistants (n = 1,450,960) •Home health aides (n = 797,670) •Medical assistants (n = 673,660) •Physical therapist assistants and aides (n = 141,510) Doctor salary range $75,000- $900,000 NP average about how much of a DR? half RN wages rising steadily LPNs make about __% 60% of what an RN makes HC support occupations compare? ave. salary of TX school teacher = $57,000 Outpatient care centers 43% increase Home health care services 26% increase What percent of the entire US workforce is comprised of Women? 46.9% •Most health care occupations are above 70% •Pharmacy- the lowest percentage (63.4%) •Not the largest health care occupation •However, physicians' authority, autonomy, and leadership within the health care system transcend their numbers Family and General Practitioners—117,000 General Internists—79,000 General surgeons—24,000 Anesthesiologists—31,000 Pediatricians—57,000 Obstetricians and Gynecologists—34,000 Floating in space 440,000 In 2019, 154 fully accredited allopathic medical schools in the United States Allopathic (MD) medical schools in the United States and Canada accredited by a voluntary agency—Liaison Committee on Medical Education (LCME) •Comprised of representatives from the AMA and the Association of American Medical Colleges (AAMC) and their Canadian counterparts In 2019, 35 osteopathic (DO) medical schools DO schools accredited by the American Osteopathic Association (AOA) Most medical schools are attached to a university •Invariably a separate college with its own dean (or the equivalent) •Sometimes loosely linked with other health professional schools in a health sciences center •About 60% of the medical schools are part of state public universities and remainder private •All the medical schools receive substantial, although primarily indirect, financial support from the federal government Physician training regimen is long •Entry to U.S. medical schools usually requires a university bachelor's degree •"Undergraduate" medical education lasts another four years •"Graduate Medical Education" (GME) includes the residency experience, which last many years depending upon the specialty Admission to medical school is selective For the class entering in 2018-2019, there were 52,757 applicants •21,622 found places (matriculants), a ratio of about 2.4:1 (1978 3.2:1) The ratio of full-time faculty to students is very high, much higher than in virtually any other branch of education Number of medical school faculty actually exceeds the number of students by a ratio of close to 1.77:1 (most faculty don't teach full-time; research is a critical activity) Medical school applicants for 2018-2019 •51% were women •47% were white, 21% were Asian, 8% African American, and 6% Hispanic or Latino Medical school graduates for 2017-2018 •47% were women (%-age of women eclipsed men in 2019) •56% were white, 21% Asian, 5.7% African American, and 5.4% Hispanic or Latino •This profile of graduates is similar to the matriculants for 2018-2019, but with a lower percent of women and a higher proportion of whites and a lower percent of African Americans and Hispanics. The proportion of women in medicine has been increasing since the 1960s. •In 1965, women comprised less than 10% of applicants, matriculants, and graduates •This percent began rising steeply in 1970 •By 1990, it was about 40% •From 1990 to 2009, women were about 48% of applicants, matriculants, and graduates The record for increasing the admission rates for African Americans does not match that for women 1970s to 1990- African American admissions remained unchanged at about 6% 1995- increased to 9% 2000- decreased to 7.5%, 2006-decreased to 6.6% 2014- 6.3% -Hispanic admissions remained around 4% and Asian Americans accounted for close to one-fifth of all admissions relationship with patients is usually long-term, stress patient communication and encourage patients to be partners in HC, serve as their patients' advocate, and assist them in utilizing the system ("Gatekeeper" in Managed Care) *(Rise of the "Hospitalist")* Physician satisfaction- The Profession has changed quite substantially in the last 50 years Less autonomous as physician practices are incorporated into HC systems, More physicians are salaried (employed), Greater oversight of physicians by health care payers like CMS and the insurance companies, and Most physicians feel their societal esteem falling (still one of most trusted professions) ** Most studies have found physician dissatisfaction growing A 2017 physician satisfaction survey conducted by the Physicians Foundation found: •80% of physicians reported being overextended or are at capacity, with no time to see additional patients (burnout = 42% in 2020; highest in Gen X) •48% of physicians said their time with patients is always or often limited •46.8% of physicians plan to accelerate their retirement plans •Only 6% of physicians said ICD-10 has increased efficiency in their practices About 40,000 doctors are in only in administration, research or teaching 20,000 doctors are federally-employed (most in military) Doctors per 10,000 population US, 1965 14.5 US, 1980 20 US, 2012 28.3 Mass 44 (highest) Idaho 18 (lowest) About ¼ U.S. physicians trained outside U.S. (IMGs) Projected physician shortfall = 47,000 to 122,000 by 2032 Primary Care shortfall 21,000 to 55,000 by 2032 Specialty physician shortfall 25,000- 66,000 by 2032 Demographics population growth and aging are primary drivers of shortfall. Achieving population health goals goals (↓obesity, smoking, BP, cholesterol, glucose) would increase demand by 34,000 FTEs; Also achieving universal access Ø2:5 currently active physicians will be >65 y.o. within next decade Trend towards fewer weekly hours worked per physician; > younger; > female equates with 21,000 fewer active physicians by 2032 Within nursing, Registered Nurses (RNs) are the largest category In 2018, 2.95 million active RNs, up from 2.2 million in 2001 Nursing includes advanced practice nursing (APN) occupations Nurse Practitioner (n = 179,650) *growing rapidly •Nurse Anesthetist, CRNA (n = 43,520) •Nurse Midwife, CNM (n = 6,250) The importance and influence of nursing and nurses on the delivery of health care cannot be overestimated. Advanced practice degree (Master's Degree usually) Nurse Practitioner (NP) •Clinical Nurse Specialist •Certified Registered Nurse Anesthetist (CRNA) •Certified Nurse Midwife (CNM) •Women's Health Nurse Practitioner (WHNP) •Family Nurse Practitioner (FNP) State nursing board establishes licensing; scope of practice set by state medical board (some states don't require physician supervision) •Give patients medicines and treatments •Evaluate a patient's response to medicines and treatments •Consult with doctors and other healthcare professionals, as needed •Counsel and teach patients and their families how to stay healthy or manage their illnesses or injuries •Conduct research (usually clinical research) Majority of RNs work? General medical and surgical hospitals (1,698,700) Majority of NPs work? Offices of physicians (84,720) One issue for job satisfaction and retention among nurses is hours worked •The working hours of RNs in hospitals have changed •Use of extended work shifts and overtime has escalated (shortage) Another issue is the nurse-to-patient ratio •In 1999, California became the first and only state—at this point—to set a maximum nurse-to-patient ratio •14 states have followed with laws or regulations •CA, CT, IL, MA, MN, NV, NJ, NY, OH, OR, RI, TX, VT, and WA **tends to be an unpopular policy among hospital administrators Another issue is that of worker protection through unions for nurses •In 2006, the National Labor Relations Board exempted some RNs from union membership ("supervisory duties"; can't unionize or strike) •board adopted a broad definition of supervisor •Workers considered supervisors if they oversaw another employee and could be held accountable for that subordinate's performance •Workers considered supervisors if supervisory duties were only 10% to 15% of their work •Dissenting members, "Today's decision threatens to create a new class of workers under federal labor law: workers who have neither the genuine prerogatives of management, nor the statutory rights of ordinary employees" The health profession of physician assistant (PA) developed in the United States since the Vietnam War (1965-1973) •Returning Vietnam-veteran medical corpsmen were among the first PAs •Although there is an overlap between PAs and NPs (and scope of practice debates), the PA profession has become an established health services profession in the United States. In 2019, there were more than 250 accredited PA programs •Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) has accredited PA programs since 2001. •Most programs offered through medical schools, teaching hospitals, or schools of the allied health professions in 4-year colleges PAs role involves •Approaching •Analyzing health status data •Formulating, implementing, and monitoring an individualized treatment or management plan •Instructing and counseling patients regarding compliance •Performing routine procedures By the mid-1990s, it was estimated that PAs could perform 80% of the primary functions of a primary-care physician practice and would be widely accepted by patients. From its beginnings, the PA profession was conceived as an extension of the profession of medicine •Unlike nursing, it was not meant to be another separate profession •In each state, PA licensure is provided for under the Medical Practice Act rather than under a separate law •Although about 72% of PAs are women, in the beginning it was predominantly male. This status is reflected in the AAPA definition of a PA Physician assistants are health care professionals licensed to practice medicine with physician supervision PA practice Practice settings for physician assistants, 2018 Offices of physicians- 55% Hospitals; state, local, and private- 26 Outpatient care centers- 8 Educational services; state, local, and private- 3 Employment services- 2 Orphan Drug ACT 1983 grants special tax treatment and sometimes offers federal grant money to fund research. Orphan drugs for cancer generate the largest profits DEA Drug Schedule I no accepted medical use and a high potentional for abuse and therefore may not be prescribed or dispensed DEA Drug Schedule II-V carying controls on their manufacture, distribution, and sales DEA Drugs unscheduled NO DEA restrictions FDA does not proactively control vitamins and supplements (American's spent $34B in 2019) New Drug Application NDA process that includes animal testing, progressively larger human trials, review of the drug's labeling, and an inspection of the facilities where the drug would be manufactured Drugs must be made available OTC if consumers can use it safely and effectively without professional guidance per package labelling (GRASE) How long can the development of a new drug take to receive FDA Approval? up to 15 years and patents usually last 20 years from the date of filling. Preclinical human cells lines, animals or the targeted pathogen/cancer Phase 0 Pharmacokinetics (PK), sub-therapeutic doses, 10 subjects Phase I safety profile; 20-100 subjects; potential clinical efficacy? (70% make it through Phase I) Phase II side effects; 100-300 subjects; clinical efficacy w/dosage ranges (about 1/3 of drugs make it through Phase II) Phase III Larger trial to verify preliminary assumptions; 30 - thousands of subjects; (about 25% of drugs make it through Phase III) Phase IV post-marketing surveillance (individual incidents reported) Operation Warp Speed (May 2020 - Feb 2021) A public-private partnership to develop and make COVID-19 vaccines available quickly and in large quantities (initially, $10B from Trump Admin) Clinical chief (OP. warp speed) Moncef Slaoui (formerly GSK Chief of Vaccines) Logistics Chief (Op. Warp speed) Gen. Gustav Perna, US Army Preliminary evidence used to fund 6/20+ promising vaccine candidates Phases I, II and III often run simultaneously to cut development time Safety analyses were not sacrificed Final candidates received "advance orders" to ensure profitability (ex: $2B to Pfizer) Intellectual property (IP) protections (ex: patents) and market exclusivity Medical equipment (e.g., an MRI system) is expected to be used multiple times over its life Conventional medical devices are products that are easy to manufacture with relatively few barriers for entry for new companies and relatively little product differentiation (e.g., an IV pole) High tech medical devices typically require significant investment in research and development to design, often resulting in patents, and greater regulatory scrutiny from the FDA (e.g., a pacemaker, surgical instruments and implants) FDA approved - Class I includes elastic bandages, handheld surgical instruments, etc. -Manufacturers simply need to register the device before bringing to market (pre-approval is not required) FDA Approval- Class II includes surgical drapes, infusion pumps, etc. -Pre-approval is required but manufactures only need to demonstrate that the medical device is substantially equivalent to a device already on the market FDA Approval- Class III includes heart valves, implanted pacemakers, etc. -Devices are generally required to demonstrate that they are safe and effective before they may be marketed though evaluations typically not as rigorous as drug studies Most medical devices are purchased by? health care providers—hospitals in particular—and represent an input to the health care delivery system rather than a product purchased directly. Sales cycles to large organizations like hospitals are typically long with multiple gating steps. Providers typically look for coverage by third-party payers like Medicare or managed care organizations (which often look to Medicare) for new products. Who do Hospitals often look to for negotiate prices and set terms? GPO-especially for conventional medical products. This true of medications (via formularies) as well Who must be convinced to select or switch to a new product? Providers or committees Provides an incentive to keep costs down The cost of a drug or medical device may be included in the global payment that a hospital receives, particularly common with Medicare/Medicaid (CMS) Physician preference items (PPI) are devices for which physicians express strong preferences but don't generally bear the cost of their choice Implantable medical devices (IMD) such as pacemakers, artificial hip joints, etc. are an important category of PPI and can be a significant component of the total cost for high-cost medical procedures, such as surgical procedures Hospitals typically bear the acquisition costs of IMD and historically have accommodated physician preferences especially when physicians can control where their patients are admitted Who are often the final customers of medical devices in general? Physicians (manufacturers often seek their input) The nature of high-technology Class III devices is that? competition is already limited and devices not completely interchangeable making it difficult for purchasers to negotiate prices Overall, the United States spending on medical devices was estimated? between $125 and $172 billion in 2013 and the industry employed an estimated 330,000-365,000 people across an estimated 5,300-5,600 companies System of checks and balances the Constitution spells out "checks" on the powers of each branch, exercised by the other two Judicial review •Not found in the Constitution •Established early in the 19th century by the third Chief Justice of the Supreme Court, John Marshall, and his colleagues on the bench •Has become an accepted part of the U.S. constitutional system only because the other two branches have granted the Court that authority At the tertiary level of government (local) the boundaries between the branches at times become blurred Legislatures create the laws that establish the means to safeguard the public's health •For example, assurance of pure water supply and protecting health of workers in their places of employment Legislatures also enact the legal framework within which the health care delivery system functions Although a state legislature creates the licensing law for physicians the executive branch administers it, the judicial system determines the guilt or innocence of a person charged with "practicing medicine without a license Judicial system also plays a vital role in safeguarding the public's health enforces sanitary protection and pollution control legislation, with criminal sanctions if necessary Judicial system handles disputes arising from the provision of health services (civil law) through the process of malpractice litigation Judicial system adjudicates contract cases arising from health care system disputes disputes between providers or patients, on one side, and a third-party payer on the other Judicial system protects the rights of? individuals under the due process and equal protection clauses of the Fifth and Fourteenth Amendments to the Constitution. Government in HC (executive branch) •Oversees the delivery of health care services •Drafts and enforces provider/payer regulations •Administers health care financing programs Government in HC (legislature) •creates the programs or regulatory authority •The courts that settle disputes arising under the laws and adjudicates violations of them Provision of Personal Health Services- At the federal level? personal health services are provided, for the most part, to categories of persons, for example: (i.e. Members of the uniformed services, their families and Native Americans) State Government provides personal health services to? Persons who have specific diseases (i.e. people with mental illness and TB) Generally for the poor? Local governments' personal health services are stratified by class Governments at all levels provide health services for prisoners and those in poverty (ex: FQHCs, State vaccination programs, local public health centers) Government participates in financing in three ways 1. pays directly and indirectly for the operation of its own programs Health Resources and Services Administration (HRSA) Provides health care to people who are geographically isolated, and/or economically or medically vulnerable by funding health centers in underserved areas through its Bureau of Primary Health Care Indian Health Service (IHS) Provides physical, mental, social, and spiritual health services to American Indians and Alaska Natives National Institutes of Health (NIH) Responsible for supporting and carrying out biomedical research with primary focus on basic biomedical research at the organ-system, tissue, cellular, and subcellular levels Substance Abuse and Mental Health Services Administration (SAMHSA) Lead agency within DHHS to advance the behavioral health of the nation Centers for Medicare & Medicaid Services (CMS) Administers Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and the Basic Health Program a unit within the CDC. National Center for Health Statistics (NCHS) NCHS compiles statistical information that can guide actions and policies to improve health in the United States. (A "unique public resource for health information—a critical element of public health and health policy") Through the NCHS, the CDC collects and publishes data that are critical to the health care system including: •Birth, death, marriage, and divorce (vital) statistics •Data about population health, health behavior, and use of health services local health department (LHD) is a unit of either state or local government focusing exclusively on a smaller geographic area, usually well-defined and considered by virtually any observer to be "local" in nature—a county, city, town, parish, or village. If the LHD does not provide a service either directly or through contract it does not necessarily indicate that those services are not publicly available within a jurisdiction. In small and rural communities, a health care organization is often the major employer, and as a result, is vital to the community's economic viability. In some distressed communities, where manufacturing and related industries have declined, health care organizations have become a significant source of employment, especially for women. health care organizations have become a significant source of employment, especially for women.