1. Introduction to Healthcare and Public Health in the US Delivering Healthcare (Part 2) Lecture b This material (Comp1_Unit3b) was developed by Oregon Health and Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

2. Delivering Healthcare (Part 2) Objectives Describe the organization of clinical healthcare delivery in the outpatient setting, and the organization of outpatient healthcare (Lectures a-c) Describe the organization of ancillary healthcare delivery in the outpatient setting (Lecture d) Discuss the role of different healthcare providers, with an emphasis on the delivery of care in an interdisciplinary setting (Lecture e) Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 2

3. Where Is Primary Care Delivered? Primary care clinic: –Point of delivery –A medical facility Usually, the conditions seen at a primary care clinic are not serious or life threatening “Gateway” to healthcare services Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 3

4. Primary Care Medical Specialties Family Practice General Internal Medicine Pediatrics Obstetrics and Gynecology (OB/GYN) Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 4

5. Family Practice Family Practice (also known as Family medicine): –Provides healthcare for the individual and family –Integrates biological, clinical and behavioral sciences –The scope of family medicine is broad encompasses all ages, both sexes, each organ system and every disease entity Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 5

6. General Internal Medicine Doctors of internal medicine also known as “internists” Focus on adult medicine Special study and training focusing on the prevention and treatment of adult diseases. Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 6

7. Pediatrics Is the branch of medicine that deals with the medical care of infants, children, and adolescents Focuses on diagnosing, treating and preventing diseases that affect children Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 7

8. Obstetrics and Gynecology Obstetrics – care of women during pregnancy and immediately after childbirth Gynecology – care of the female reproductive system Women’s health and GYN preventive care are an important facet of primary care Often the same clinician provides both OB and GYN services Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 8

9. Specialty Care A specialty is a branch of medicine After completing medical school, physicians train in a specific field (their specialty) Some physicians undergo additional training (fellowships) after initial training in a more general field Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 9

10. Examples of Specialties Dermatology Pathology Radiology Nuclear Medicine Psychiatry Emergency Medicine Preventive Medicine Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 10

11. Specialty clinics Medical specialties Examples: –Cardiology –Immunology –Gastroenterology Surgical specialties Examples: –Orthopedic surgery –Neurosurgery –Plastic surgery Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 11

12. Delivery of Specialty Care Many surgical specialists see patients in outpatient clinics They perform surgeries in hospitals They may perform surgeries in outpatient surgical centers Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 12

13. Outpatient Surgical Centers Many surgeries or procedures are done in the hospital Some surgeries or procedures are done in outpatient (or ambulatory) surgical centers –Surgery or procedures are performed in a non-hospital location –Patients typically go home after a brief period of recovery (few hours), following the procedure /surgery Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 13

14. Primary Care In Crisis? Increasing number of older patients with complex medical issues Imperfect coverage of preventive care services Emphasis on documentation Complex billing and compensation system Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 14

15. Primary Care In Crisis? Decreasing number of physicians practicing primary care Supply-demand imbalance Greater dependence on after-hours care Increased cost of healthcare delivery Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 15

16. Why is Primary Care In Crisis? Fewer US graduates enter family medicine Only a minority of first year internal medicine residents pursue careers in primary care More than 80 percent of graduating medical students carry educational debt Specialists are better compensated than primary care physicians Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 16

17. Why Don’t Physicians Want To Go Into Primary Care? A 2007 survey of graduating US medical students: only 2% planned a career in general internal medicine Debt not as much of a negative factor as the challenge of treating elderly and chronically ill patients with complex medical issues Practice environment and lifestyle also played a role Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 17

18. Solving The Primary Care Crisis Health reform and federal stimulus funds Training Grants for training and educational innovation International Medical Graduates Recruitment Loan forgiveness and other financial inducements Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 18

19. Delivering Healthcare (Part 2) Summary – Lecture b Primary care locations Primary care specialties Outpatient specialty care The primary care crisis Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 19

20. Delivering Healthcare (Part 2) References – Lecture b References American Board of Family Practice at https://www.theabfm.org/about/policy.aspxhttps://www.theabfm.org/about/policy.aspx http://www.acponline.org/patients_families/about_internal_medicine/ https://www.aamc.org/students/medstudents/cim/specialties/ Bodenheimer T. Primary Care -- Will It Survive? N Engl J Med 2006 355: 861-864 http://www.acponline.org/advocacy/events/state_of_healthcare/statehc06_1.pdf Karen E. Hauer, MD; Steven J. Durning, MD; et al., KE; Durning, SJ; Kernan, WN; Fagan, MJ; Mintz, M; O'Sullivan, PS; Battistone, M; Defer, T et al. (2008-09-10). "Factors Associated With Medical Students' Career Choices Regarding Internal Medicine". JAMA 300 (10): 1154–1164 http://www.us-government-grants.net/article_info.php/articles_id/15 http://www.vcstar.com/news/2010/jun/16/health-reform-grants-expected-to-ease-primary/ Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture b 20