CHAPTER 4
Health Services Professionals
NEGATIVE CONSEQUENCES OF SPECIALTY MALDISTRIBUTION
1. High volume of intensive, expensive, and invasive medical services (overuse of medical
3. Specialist services have less impact in improving overall health status.
4. Problems with access to care by the underserved.
OTHER DOCTORAL-LEVEL PROFESSIONALS
Optometrist (OD)—vision correction
Psychologist (PhD)—mental health counseling and psychotherapy
Podiatrist (DPM)—diseases and deformities of the feet
NURSES
• Constitute the largest group of healthcare professionals.
• Two basic levels of licensed nurses:
1. RN—three avenues of RN education/preparation:
2. LPN (LVN)—1 to 2 years at a community college
Impact of decline in hospital stay: Growth of other settings such as home health and nursing
homes, which has led to a growth in nursing employment in these settings.
Other growth areas for RNs:
1. Clinical nurse specialists—Work in hospitals (vs. home health, clinics, or nursing homes).
Specialize in fields such as cardiac care, oncology, neonatal care, psychiatric care.
2. Certified Registered Nurse Anesthetists—Trained to manage anesthesia during surgery.
NONPHYSICIAN PRACTITIONERS (NPPS)
NPPs practice in areas similar to those in which physicians practice, but they do not have MD or
DO degrees, and they mainly practice in primary care settings. Their practice results in improved
access to primary care. Care rendered is often equivalent in quality to that provided by
physicians, and is cost effective. Patients generally express a greater degree of satisfaction with
ALLIED HEALTH PROFESSIONALS
Need created by the growth of technology and specialization in medicine. They function in roles
that are complementary to those of physicians and nurses.
Two main categories:
technicians, dental hygienists, etc.
HEALTH SERVICES ADMINISTRATORS
• Organize, coordinate, and manage the delivery of healthcare services.
• Provide leadership, direction, and strategic planning in health services organizations.
• Challenges faced:
• changes in financing and reimbursement
GLOBAL TREND IN HEALTHCARE PROFESSIONALS
• Many countries (particularly in in sub-Saharan Africa) face a health workforce shortage, meaning
that each country has less than 23 health workers per 10,000 people.
• In Europe and in the US, the number of doctors is insufficient to accommodate the growing needs
ACA Takeaway
• To alleviate the shortage of primary care providers, ACA invests $230 million to increase the
TERMINOLOGY
• Advanced practice nurses (APNs)—Nurses who have education and clinical training beyond
that required for an RN. The four areas of specialization in nursing include clinical nurse
specialist (CNS), certified registered nurse anesthetist (CRNA), nurse practitioner (NP), and
certified nurse midwife (CNM). NPs and CNMs are also categorized as nonphysician
practitioners.
body is a self-healing organism.
• Comorbidity—Refers to the condition when patients have multiple health problems.
• Dental assistants—Work for dentists in the preparation, examination, and treatment of patients.
While dental assistants do not have to be licensed to work, there are formal training programs
available that offer a certificate or diploma.
and general pediatrics in the United States. They are considered primary care providers.
• Hospitalist: A physician who specializes in the care of hospitalized patients.
• Licensed practical nurses (LPNs)—Called licensed vocational nurses (LVNs) in some states,
care for patients under the direction of physicians and registered nurses.
They must complete a state-approved program in practical nursing and a national written
(CNMs).
• Nurse practitioners—Advanced practice nurses (APNs) who have completed a program of
study leading to competence as RNs in an expanded role. NPs are trained to practice
independently of physicians, and can often substitute for primary care physicians.
• Occupational therapists (OTs)—Help people of all ages improve their ability to perform tasks
other healthcare professionals and with patients to achieve the desired therapeutic outcomes.
• Pharmacists—Dispense medicines prescribed by physicians, dentists, and podiatrists, and
provide consultation on the proper selection and use of medicines. All states require a license to
practice pharmacy. The role of pharmacists has expanded over the last two decades to include
drug product education and serving as experts on specific drugs, drug interactions, and generic
• Primary care—First-contact care or the portal to the healthcare system. Primary care focuses on
the person as a whole. It seeks to balance the multiple requirements for which a patient’s
condition may call and refers patients to appropriate specialty care when needed. Primary care
should incorporate continuity, comprehensiveness, and coordination with other levels of care.
• Psychologists—Non-physicians who are trained to provide mental health care using counseling
board-certified specialist. Common specialties include anesthesiology, cardiology, dermatology,
family medicine, internal medicine, neurology, obstetrics and gynecology, ophthalmology,
pathology, pediatrics, psychiatry, radiology, and surgery.
REVIEW QUESTIONS
1. Describe the major types of health services professionals (physicians, nurses, dentists,
pharmacists, physician assistants, nurse practitioners, certified nurse midwives),
including their roles, training, practice requirements, and practice settings.
The major roles of physicians are to diagnose diseases and treat patients. Physicians must be
licensed to practice. The licensure requirements include graduation from an accredited medical
such as health maintenance organizations (HMOs). Nurses are the major caregivers of sick and
injured patients, serving their physical, mental, and emotional needs. All states require nurses to
be licensed to practice as RNs. The licensure requirements include graduation from an approved
nursing program that awards an associate degree (ADN), diploma, or bachelor’s degree (BSN),
and successful completion of a national examination. ADN programs take about 2 years and are
degree and successful completion of both written and practical examinations. Most dentists
practice in private offices as solo or group practitioners. Some dentists work in dental clinics in
private companies, retail stores, franchised dental outlets, or HMOs. The federal government also
employs dentists, mainly in the hospitals and clinics of the Department of Veterans Affairs and
the US Public Health Service. The major roles of pharmacists are to dispense medicines
pharmaceutical manufacturing companies.
Physician assistants are licensed to perform medical procedures under the supervision of a
physician. The supervising physician may be either on-site or off-site.
The major services provided by PAs include evaluation, monitoring, diagnostics, therapeutics,
counseling, and referral. They practice in offices, hospitals, HMOs, clinics, nursing homes,
States vary with regard to licensure and accreditation requirements. There are more than 150
educational training programs nationwide. In addition, NPs complete clinical training in direct
patient care. Certification examinations are offered by the American Nurses Credentialing
Center, the American Academy of Nurse Practitioners, and specialty nursing organizations.
The primary function of NPs is patient education. NPs spend considerable time with patients to
2. What factors are associated with the development of health services professionals in the
United States?
3. What are the major distinctions between primary care and specialty care?
Primary care may be distinguished from specialty care by the time, focus, and scope of the
services provided to the patients. Primary care is first-contact care or the portal to the healthcare
4. Why is there a geographic maldistribution of the physician labor force in the United
States?
Physicians are more likely to concentrate in metropolitan and suburban areas than in rural and
inner-city areas because the former generally offer greater prospects for high income,
5. Why is there an imbalance between primary care and specialty care in the United States?
The principal determinant of need for primary care physicians is the demographics of the general
population. The major driving force behind specialists is the development of medical technology.
6. What measures have been or can be employed to overcome problems related to
physician maldistribution and imbalance?
A number of attempts have been made to resolve the maldistribution problem. To alleviate the
shortage of physicians, for example, new medical schools were instituted in the underserved
7. Who are nonphysician primary care providers? What are their roles in the delivery of
health care?
Nonphysician primary care providers include nurse practitioners, physician assistants, and
certified nurse midwives. They play a critical role in the provision of health care, particularly
8. In general, who are allied health professionals? What general role do they play in the
delivery of health services?
Allied health professionals can be divided into two broad categories: technicians/assistants and
therapists/ technologists. Assistants and technicians include physical therapy assistants (PTAs),
9. Provide a brief description of the roles and responsibilities of health services
administrators.
Health services administrators are employed at the top, middle, and entry levels of various types
of organizations that deliver health services. Top-level administrators provide leadership and
