1. Health Care Professionals
Chapter 12
Health Care Professionals

2. Table 12.1 Health Care Sector as a Proportion of All Employed Persons, Selected Years
1970
1990
2003
Employment in health sector (thousands)
4,246
9,447
13,615
Total number of persons employed (thousands)
76,805
117,914
137,736
Health sector as a proportion of all occupations
5.5%
8.0%
9.9%
Total resident U.S. population
(millions)
203.2
248.7
290.8
Number of health personnel per 100,000 population
2,090
3,799
4,682

3. Factors Contributing to the Increased Supply of Health Care Professionals
Technological growth
Specialization
Health insurance coverage
Aging population
Emergence of ambulatory clinics
Array of post-hospitalization venues

4. Physician Supply
Between 1965 and 2005, there was a 218 percent increase in the supply of active physicians.
In 2005, there were approximately 845,684 active nonfederal physicians, including osteopaths.

5. Factors Influencing the Supply of Physicians
Movement away from managed care
Increase in the number of female physicians
Lifestyle preferences
Population growth
Increase in average lifespan

6. International Medical Graduates (IMGs)
By the early 1970s
IMGs accounted for more than 40 percent of new physician licentiates
30 percent filled residency positions
20 percent were active physicians in the United States

7. International Medical Graduates (IMGs)
In 2005, there were 204,369 IMGs in the United States
Accounted for 24 percent of the total active nonfederal physician population.

8. Factors Contributing to Supply of IMGs
Specialties, geographic locations, and employment settings avoided by U.S. medical graduates.
Surplus of residency positions in teaching hospitals.
Increased market penetration of managed care plans in urban areas.

9. Table 12.3 Number of Active Physicians and Percentage Distribution by Specialty, Selected Years
1980
2002
Specialty
Number
Percent
Percent Change
All
435,264
100%
768,498
76.6%
Primary Care
170,705
39.2%
286,294
37.3%
67.7%
Medical
25,328
5.8%
57,579
7.5%
127.3%
Surgical
72,050
16.6%
104,871
13.6%
45.6%
Other
167,181
38.4%
319,754
41.6%
91.3%

10. Reference Table 12.3
Primary care specialties have grown substantially.
Growth in medical specialties has increased over this period, reaching to more than 120 percent.
Percentage of primary care physicians in any given year has remained fairly constant.

11. Reference Table 12.3
Sources of growth in primary care specialties have come from IMGs and women.
In 1980, IMGs constituted 18 percent of all primary care physicians.
In 2003, they accounted for 29.2 percent.

12. Reference Table 12.3
In 1980
Women constituted 13.1 percent of all primary care physicians
In 2002, they accounted for 33.5 percent

13. Geographic Distribution of Physicians
Rural areas and inner-city locations continue to experience physician shortages.
Rural areas with no nearby cities still have fewer than 100 physicians per 100,000 civilians.

14. Geographic Distribution of Physicians
Nonmetro places with less than 2,500 inhabitants have experienced no improvement in physician availability in 60 years.

15. Efforts to Improve the Unequal Distribution of Physicians
Federal efforts to improve the distribution of physicians include loan forgiveness and extensive support for the development of family practice training programs.
At the state level, there have been efforts to improve physician distribution through the authority of Offices of Rural Health.

16. Osteopathy
Osteopaths traditionally emphasize the importance of the musculoskeletal system on general health.
Osteopaths are licensed to practice medicine and perform surgery in all states.
In 2005, there was a total of 50,532 osteopaths in the Unites States.

17. Dentists Majority of dentists are in general practice.
Approximately,14 percent of all dentists are specialists.
Orthodontists comprise roughly 33 percent of all dental specialists.
Oral surgeons constitute 25 percent of the specialist population.

18. Total Population (Thousands) Active Dentists per 100,000 population
Table 12.5 Total and Active Dentists and Dentist/Population Ratios: Selected Years
Number of Dentists
Year
Total
Active
Total Population (Thousands)
Active Dentists per 100,000 population
1960
105,200
90,120
182,287
49.4
1980
147,280
126,240
228,831
55.2
2000
168,000
276,740
60.7

19. Reference Table 12.5
In 2000
Approximately 168,000 active dentists practicing in the United States.
The earlier increases in the number of dentists can be attributed to federal legislation passed in the early 1960s and 1970s that attempted to remedy the perceived shortage.

20. Reference Table 12.5 Between 2000-2001
There were 55 dental schools and 4,327 first-year dental students in the United States.

21. Public Health Professionals
Administration of health agencies
Planning and evaluating prevention, screening, and health education programs
Surveillance and control of environmental hazards and pollutants
Incidence and prevalence of disease in populations

22. New Roles for Public Health Professionals
Role in managed care
Monitor disease incidence
Prevalence and outcome
Develop, implement, and monitor programs of prevention
Bioterrorism surveillance and prevention

23. Nurses
RNs are the largest group of licensed health care professionals in the United States.
In 2000, an estimated 81.7 percent of RNs were employed in nursing.
Despite an overall increase in the number of nurses employed in nursing, a shortage still exists.

24. Factors Contributing to the Nursing Shortage
Decline in nursing school enrollments
Aging of the RN workforce
Nurses not employed in nursing
Decline in relative earnings
Emergence of alternative job opportunities

25. Pharmacists In the 1980s and 1990s
Pharmacists expanded their role to include drug production education and to act as experts on the effects of specific drugs, drug interactions, and generic drug substitutions.

26. Pharmacists In the early twenty-first century
Role was further expanded to include selecting, monitoring, and evaluating appropriate drug regimens
Providing information to patients and health care professionals
Preventing medication errors

27. Physicians’ Assistants
Qualified by academic and practical training to provide patient services under supervision of a licensed physician.
May diagnose, manage, and treat common illnesses, provide preventive services, and respond to emergency situations.
May prescribe certain classes of medications.

28. Advanced Practice Nurses
Basic nursing education
Basic licensure
Graduate degree in nursing
Experience in a specialized area
Professional certification from a national certifying body
An APN license, if required

29. Seven Core Competencies
Direct clinical practice
Expert guidance and coaching of patients, families, and other care providers
Consultation
Research skills
Clinical and professional leadership
Collaboration
Ethical decision-making skills

30. Issues in PA and NP Use Legal restrictions concerning practice
Reimbursement policies
Relationships with physicians