Health Care USA Ch.7

National Center for Complementary and Integrative Health (NCCIH)

-international studies of traditional medicines and herbs -studies of nonconventional therapies (ex: Chinese medicine)

4 categories of allied health professions

-laboratory technologists and technicians -therapeutic science practitioners -behavioral scientists -support services

general practitioner (GP)

-most states require at least one year of post-graduate training for licensure -rare because most insurance companies require full residency plus board certification to get listed on their approved provider lists

criticisms of state-level licensing system

-not being sufficiently responsive to patient complaints -emphasizing practitioners' right to practice -not providing harder sanctions -not sufficiently involving the community of patients in the process

Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN)

-works under the direct supervision or an RN or MD -2yr associate degree -2-3yr hospital diploma program -state licensure required -hospital positions decreasing; nursing homes, residential care positions increasing

technologists and technicians: radiologic

1-4yrs training; bachelor's and associate degrees; obtains radiographs, ultrasound, CT scans, MRI scans, PET scans

What are the two essential functions of licensing boards?

1. Determine who may begin practicing in their state by insuring that applicants hold the appropriate credentials, are not under sanction by any other state medical licensing board, and do not have a criminal record 2. Investigate allegations of malpractice and physician impairment and then impose appropriate sanctions and/or required treatment and/or supervision

Four mechanisms that regulate healthcare occupations

1. state licensure 2. Professional certification 3. Maintenance of certification 4. Registration

technologists and technicians: nuclear medicine

1yr hospital certification training for professionals meeting federal standards on use of radioactive drugs and detection equipment; voluntary professional certification and registration

registered nurses (RN)

4-5yr bachelor degree state licensure required

registration

A mechanism to facilitate contacts and relationships among members of a profession, potential employers, or the public. It ranges from simple listings or registries of persons offering a service to national registration programs of professional or occupational groups that require educational and testing qualifications. Most are voluntary and therefore do not include parameters for competence or disciplinary actions

physical therapy

DPT; state license; specialties to treat injuries, disabilities to improve function; collaborative role with MDs and other rehab professions

podiatric medicine

Diagnoses & treats diseases & injuries of lower leg & foot. Doctor of Podiatric Medicine (DPM).

dentistry

Doctor of Dental Surgery (DDS), Doctor of Dental Medicine (DDM), Doctor fo Medical Dentistry (DMD)

optometry

Doctor of Optometry examines patients' eyes to diagnose vision problems and eye disease, prescribes drugs for treatment, and prescribes and fits eyeglasses and contact lenses

What can medical licensing boards do?

Have board authority to mandate treatment for addiction, require supervision to practice, impose practice limitation up to and including partial or total suspension of licensure, make recommendations to the state's attorney general for prosecution if a practitioners behavior is believed to be criminal

opthamologist

MD, eye diseases and surgery

medical assistants

Perform routine administrative duties (answering phone, completing insurance forms, scheduling appointments, taking medical histories, measuring vital signs, assisting the physician in treatment). 1yr training from vocational/technical schools or associate's degree

international medical graduates (IMGs)

Physicians trained in medical schools outside the United States who fill the annual shortfall in U.S. medical school graduates required to staff hospitals. Responsibility for evaluating credentials of IMGs entering the United States' residency programs lies with the Educational Commission for Foreign Medical Graduates.

residency training

Prepares a physician to practice a medical specialty. 3-8 years qualifies a physician for certification in 1 of 24 medical specialty boards

Nurse Practitioner (NP)

RNs with advanced education and clinical experience; provide primary and specialty care; allowed to prescribe medicine in most states; can specialize

ABIM requirements

To sit for the next recertification exam, the MOC program required a physician to complete a certain number of medical knowledge self-assessment modules produced by the ABIM and perform practice-improvement activities on a specified time line

25%

What percentage of the US physician workforce is made up of IMGs?

It is intended to restrict entry or practice in certain occupations and to prevent the use of professional titles by those without predetermined qualifications

Why is licensure the most restrictive of the four mechanisms of regulation?

Physician Assistant (PA)

Works under the supervision of physicians; require state licensure; can diagnose, prescribe drugs, counsel, and refer to specialists

physician supply

all non-MD providers depend on physician support

Clinical Nurse Specialist (CNS)

an APRN who is an expert clinician in a specialized area of practice; required to have an RN and either a master's or doctorate degree (PhD or DPN) in nursing

alternative therapy

any of various health care practices that do not follow generally accepted medical methods; complementary and alternative medicines

social workers

bachelor's degree required for state licensure/certification; master's degree for management positions; doctoral programs for advanced practice/research; counsel clients, families on personal, economic, social problems of illness, disability and coordinating community resources in mental health, substance abuse

health information administrators

bachelor's degree; maintain systems to store and retrieve patient data for financial, legal and research purpose Registered Health Information Administrators (RHIA) Electronic Health Record (EHR)

rehabilitation counselors

bachelor's/master's degree; counsel, provide emotional support, test work abilities and skill levels; assess psychological state; develop training plans to maximize function and prepare for employment

integrative medicine

complementary and conventional medicine offered by the same practitioner in a coordinated manner

American Board of Internal Medicine (ABIM)

created a continuous MOC program that is synchronized with an every-10-year recertification board exam

expansion of home care

for aging population, reforms shift more care to community settings

Collaborative Practice Act (CPA)

identifies scope of practice for PA or NP

technologic advances

increase need for specialists

Changing nature of disease, disability, and treatment

increasing longevity, chronic care needs, increased survival of traumatic events

physicians

long term training required: -Undergraduate bachelors degree -Medical school: MD -Post graduate: 1-6yr residencies for specialization -More post grad: 1-3yr fellowships for sub-specialization

occupational therapy

master's degree; doctorates offered; state license; assist recovery from illness, injuries with life skills, work abilities, educational, vocational plans

speech language pathologist

masters degree in SPL or Audiology for license; evaluate, treat all ages for communication, swallowing disorders

complementary medicines

nonstandard treatments that you use along with standard ones

pharmacy

pharmacy programs 6yrs grant a Doctor of Pharmacy (PharmD); additional degrees needed for those going into laboratory or research experience to prepare for research positions which pharmaceutical companies or for teaching at a university

healthcare administrators

plan, direct, coordinate, and supervise delivery of healthcare and manage the operation of healthcare facilities

certification

regulating process under which a professional organization, such as a national board, attests to the educational achievements and performance abilities of persons in a healthcare field of practice; usually not state-based

state licensure

state law defines scope of practice to be regulated and the education and testing requirements that must be met to engage in a particular profession's practice

technologists and technicians: laboratory

state licensed; analyze fluids, tissues, cells for chemical contents, bacteria, match for blood transfusions technologists: bachelor's degree technicians: associate degree

allied health personnel

support, complement, or supplement the professional functions of physicians, dentists, or health professionals in delivering health care to patients, and they assist in environmental health control, health promotion, and disease prevention

What does having certification mean?

the individual has obtained advanced or specialized training in a particular area or practice consistent with an established body of metrics; allows the public, employers, and third-party payers to determine which practitioners are appropriately qualified in their specialty or occupation

Maintenance of Certification (MOC)

traditionally entailed simple requirements from a state licensing board or professional certifying organization on the number of hours of continuing education (CE) credits a practitioner should obtain per year

chiropractors

treat the whole body without the use of drugs or surgery; spinal misalignment and nerve irritation interferes with normal body functions; Doctor of Chiropractic Degree; medicare and many private health plans cover this

alternative medicines

used in place of mainstream medicine; natural or homeopathic sources, massage, aromatherapy, acupuncture

optometrist

vision problems