Other Members of the Health Care Team
We started with physicians because then have the power. We concluded with nurses because they have the numbers. We have not done justice to the dozens of other health professionals working in hospitals, ambulatory care and community health. It is important to understand the roles of these other team members as a health care consumer, and for your own career development.
Now that we have briefly explored the world of medical doctors who work in various settings, here are a few other health professionals that are also integral members of the American health care team. Due to the great depth and volume of health care provider information that is beyond the scope of this course, only general information is provided here, with some helpful links for further exploration. These include dentists, pharmacists, other doctoral-level professionals, and a special section on nursing and the growing shortages that are facing this and other health care professions today.
Dentists
Dentists are the major providers of dental care and must have graduated from accredited dental schools that award a Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DMD) degree and successful completion of both written and practical examinations. Specialties recognized by the American Dental Association (ADA) include orthodontics, oral and maxillofacial surgery, oral pathology, pediatric dentistry, prosthodontics, periodontics, endodontics, and public health dentistry. For more information on this profession, go to the American Dental Association.
Pharmacists
Pharmacists dispense medicines prescribed by physicians, dentists, and podiatrists and provide consultation on the proper selection and use of medicines. They too must have graduated from an accredited pharmacy program that awards a Bachelor of Pharmacy or Doctor of Pharmacy (PharmD) degree, successful completion of state board examinations, and practical experience or completion of a supervised internship.
The role of pharmacists has expanded from the preparation and dispensing of prescriptions to include:
- Drug product education
- Serving as experts on specific drugs, drug interaction, and generic drug substitution
Optometrists
(OD degree)—vision correction
American Optometric Association
Psychologists
(PhD) or (PsyD) degree—mental health counseling and psychotherapy
American Psychological Association
Podiatrists
(DPM)—diseases and deformities of the feet
American Podiatric Medical Association
Chiropractors
(DC)—the art of manipulation and joint mobilization, rooted in the belief that the health of the spinal column and nervous system is central to well-being.
American Chiropractic Association
Physical Therapists (PT)
(DPT)—See more information under the "Allied Health" segment
American Physical Therapy Association
Occupational Therapists (OT)
(OTD)—See more information under the "Allied Health" segment
American Occupational Therapy Association
Speech-Language Pathologists (MS/PhD)
See more information under the "Allied Health" segment
American Speech-Language-Hearing Association
As seen above, many nurses, PTs, OTs, and SLPs also receive PhDs and professional doctorates today, though most can be certified to practice clinically with a Bachelor's or Master's degree.
Child Life Specialists
One last shout out will be for Child Life Specialists. Before I became a nurse I had been a volunteer in hospital playrooms and taken related coursework.
Hospital Specialists Help Remind The Sickest Kids They're Still Kids
NPR, June 2012
Paying Providers
After payment for hospitals, payment for providers (most of them physicians) is the largest health expenditure in the US. When you stop and think about it, physicians make the decisions which drive the cost for most of the system (treatments, tests).
How physicians are paid makes a difference. Each method of payment has a purpose or intended consequence. Methods of payment also create financial incentives, and some of these incentives may have negative effects on access, quality, and cost. Look at the table below. For each method of payment you have been given the intended consequence and an example. Your task is to match each method of payment to a potential negative affect.
|
Intention |
Unintended Consequences |
Example |
|
|
Fee for Service |
Compensates providers according to efforts and resources used |
Increases unnecessary treatments and procedurees to increase volume |
Traditional Medicare (Part B) pays providers using RBRVS |
|
Per Illness Episode |
One fee covers procedures and follow up visits; decreases unnecessary visits |
Provider minimizes post-procedure visits |
Surgeons payment is for the procedure and post-operative care |
|
Capitation |
Allows provider to direct resources toward mazimizing patient health |
Providers may skimp on care maximize their profits |
Medicare Part C plans (Medicare Advantage) |
|
Salary |
Remove financial incentives for over and under treatment |
No incentive to work hard or more efficiently or to be cost-donscious |
Veterans Health Administration |
|
Pay for Performance (P4P) |
Bonus for meeting quality or efficiency benchmarks established by payor OR assign a penalty for failing to meet benchmarks. Aligns provider goals with those of the payor. |
Providers concentrate on benchmarks to the exclusion of other important care elements. May also penalize providers with many complex apatients. |
ACO shared savings bonuses for primary care performance from ACA |