01-03B - Introduction To Healthcare and Public Health in The US - Unit 03 - Delivering Healthcare Part 2 - Lecture B

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.
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
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
Lecture b
3
Primary Care Medical Specialties
Family Practice
General Internal Medicine
Pediatrics
Obstetrics and Gynecology (OB/GYN)
Lecture b
4
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
Lecture b
5
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.
Lecture b
6
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

Lecture b
7
Obstetrics and Gynecology
Obstetrics care of women during
pregnancy and immediately after childbirth
Gynecology care of the female reproductive
system
Womens health and GYN preventive care
are an important facet of primary care
Often the same clinician provides both OB
and GYN services

Lecture b
8
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
Lecture b
9
Examples of Specialties
Dermatology
Pathology
Radiology
Nuclear Medicine
Psychiatry
Emergency Medicine
Preventive Medicine

Lecture b
10
Specialty clinics
Medical specialties
Examples:
Cardiology
Immunology
Gastroenterology
Surgical specialties
Examples:
Orthopedic surgery
Neurosurgery
Plastic surgery

Lecture b
11
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
Lecture b
12
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
Lecture b
13
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
Lecture b
14
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
Lecture b
15
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
Lecture b
16
Why Dont 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
Lecture b
17
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

Lecture b
18
Summary Lecture b
Primary care locations
Primary care specialties
Outpatient specialty care
The primary care crisis

Lecture b
19
References Lecture b
References
American Board of Family Practice at https://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): 11541164
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/

Lecture b
20

01-03B - Introduction To Healthcare and Public Health in The US - Unit 03 - Delivering Healthcare Part 2 - Lecture B

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Introduction to Healthcare and

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