Health Policy 100 Week 2

Introduction 

U.S. health care industry is the largest

employer in the U.S. – 13% of the labor

force

• Growth of health care services and

types of health care professionals have

been closely linked

• Accordingly, distribution and types of

services and providers has changed

over time

• Current imbalances in health care

Professions

13% largest employer USA

Introduction continued 

The health care sector continues to

grow due to:

Introduction, continued •

4v reasins

Growth in the population, mainly due

to immigration

• Aging of the population

• Increased life expectancy

• Expansion of health insurance under

the Affordable Care Act (ACA),

leading to greater utilization of health

care services- more people l are covered, more health servies are used 

• More concerned with chronic conditions now 

• Imbalances in healthcare professions 

• Health services shift to meet with population 

• Live longer part due to medicine (longer life expectancy_ 

yes

Top 10 Fastest Growing Occupations

Majority related to health

Nurses

Nurse practitioners and medical

Growth in numbers

Increase demand in direct and administrative roles in healthcare

Many health focus on annual wages

Rapid expansion; we need well-trained professionals in the coming decade

yes

Health Service

Professionals• 

Physicians

• Nurses

• Pharmacists

• Optometrists

• Dentists

• Psychologists

• Podiatrists

• Allied Health Professionals

⚬ Therapists, Lab/Rad Techs,

Social Workers, Health

Educator

They are part of the health service professionals

Stats 

Well educated in the workforce 

Work in different healthcare settings 

Majority in hospitals then offices and clinics

yes

How do I become a physician?

Graduate from an accredited medical

school

⚬ Doctor of Medicine (MD) or Doctor

of Osteopathic Medicine (DO)

⚬ 192 medical schools in U.S.

￭ 163 – allopathic medicine

￭ 29 – osteopathic medicine

• Licensing exam

• Residency

⚬ 1 year rotation

⚬ 2 to 6 year residency

MDs & DOs

MDs 

• Allopathic medicine

⚬ Emphasizes active intervention to

neutralize effects of disease

• Generalists also use preventive medicine in

addition to allopathic treatments

• Less likely to be generalists (1/3)

• Non-holistic approach

• Classical form of medicine 

• Specialty settings 

• Classical form of medicine 

• Specialty settings 

DOs

• Osteopathic medicine

⚬ Emphasizes interconnectedness of body

systems

• Preventive medicine

• More likely to be generalists (> ½)

• Holistic approach

• To holistic then just treating the symptoms alone 

•  Primary care setting 

• Corrective structural problems and take 300 hours more on emphasis skeletal system 

Both require 

Type of Active Physicians 

All active physicians increase over time 

Doctors of medicine - increase over time but flat 

Doctors of osteopathy - increase slightly 

• Alays more MDs than DOs 

• Btoh types of physics have increase over time 

• DOS increase not as drastically as MDs 

DOS made reputation lack of traning is not as intensive or throughout as MD training 

Yea

Doctors growing over time 

Number of DOS increase

Yes

Primary vs. Specialty Care

Primary Care 

• First contact

• Gatekeeper

• Long term

• Person as whole

• Generalist training

• Refers to specialist 

Yes

Speciality  Care

• If needed

• May require referral

• Episodic

• Disease/organ systems

• Specialty training

• More severe problems 

• Referrals to specialist 

Yes

Specialty Groups

⚬ Subspecialties of internal medicine

⚬ Broad group of medical specialties

⚬ Obstetrics and gynecology

⚬ Surgery

⚬ Hospital-based radiology, anesthesiology,

and pathology

⚬ Psychiatry

• Most common: anesthesiology, cardiology,

dermatology, specialized internal medicine,

neurology, obstetrics and gynecology,

ophthalmology, pathology, pediatrics,

psychiatry, radiology, surgery

Yes

• Hospitalists - are organizing sites of care in hospitals 

• Involved in inpatient medicine 

• They manage care of hospital patients 

• 
  

Yes

Number of primary care and speciality physicians 

Specialty physicians -

Primary care physicians 

• There is a huge imbalance in specialty and primary care doctors 

• 1992 - 13 % primary and 120% Specialty 

• Now about 38% primary and 62% are specialty 

• Generalists make up 50% in other countries 

• In USA we have more specialist than generalist 

Yes

Physician

Supply Issues• 

Specialty maldistribution

⚬ Too many specialists (62%) and not

enough OB/GYN, Peds, Internal

Medicine, General/Family Medicine

(38%)

⚬ Medical technology, reimbursement

and remuneration, and specialty-

oriented medical education are to

blame

⚬ Specialists have higher incomes,

more predictable hours, enjoy

higher prestige

• Because medical technology 

• Reinbursment 

• HMO related 

• Meds school and take out student loans - not mkaing a lot of money and why go meds school reinfbuse 

• Specialty maldistribution 

• A lot of med school like to push out specialists 

• A lot of medical education is encouraged in specialty, specialty than general not as exciting 

• Specialists have a higher income and better hours, more predicable hours 

• More prestgage to me a specialist 

• 
  

Number of primary care physicians 

• 2012

• Number of pshycains per popiualtionis not even across the USA 

• Number of primary care physicians 

• County to county 

• Big difference in counties 

Yea

Physician

Supply Issues• 

Geographic maldistribution

⚬ Concentration in metro and suburban

areas vs rural and inner-city

￭ 80 PCPs / 100,000 people

￭ 84 PCPs / 100,000 urban residents

￭ 68 PCPs / 100,000 rural residents

⚬ Living standards, professional

interaction, access to modern facilities

and technology, and professional

Growt

Disparity in physicians 

Geographic maldistribution 

Urban areas tend to be more and rural areas tend ot be fewer

Big gaps, better living areas and better in professional access to modern facilities and professional grpwht, more concerned in urban areas pshucains, opportunities to grow 

More hospitals - ucla hospitals and there is many hospitals more opportunity to move

More concentaed in metropoletin areas and physicans attected to that 

Physician Shortage 

Causes:

• Physician burnout

⚬ Early retirement

⚬ Lagging replacement rates

• ACA

⚬ Increase in insured population

 We cannot increase the physician-to-patient ratio we need to increase physicns 

• Aging workforce

⚬ ⅓ of current physicians will retire in the

next 10 years

⚬ Younger physicians tend to work fewer

hours than previous generation

• A lot of doctors retiring in the next 10 years 

• Physicians to replace them 

• We need more doctors in the workforce to meet the patient demand 

• EX. pedreiction works less 4 days then 6 days nwo 

• Aging population

⚬ 78 million baby boomers will turn 65 by

2030

⚬ Already short supply of geriatricians

(1:1,900)

⚬ IOM says U.S. will need 36,000

geriatricians to meet needs

• Baby boomers , we do not have geritatricns we need mroe as baby boomers age 

Yes

Addressing the Storage 

Policy Solutions

• Expanding residency slots

• Resident Physician Shortage Reduction

Act of 2025 aims to add 14k Medicare-

supported residency positions

• 
  

• Loan repayment & scholarships for

physicians who commit to working in

shortage areas

• Financial aids 

• International Medical Graduation Pathways

• Foreign-trained doctors can get licensed

without repeating their entire residency if

they practice in shortage areas

• Get license in the usa easier from foreigner ones 

We need more doctors 

Yes

Addressing

the

Shortage

Educational & Recruitment Strategies

• “Grow Your Own” Programs

• Med schools prioritizing recruitment

of students who grew up in rural

Areas

• Rural Training Tracks

• Training in rural areas vs

urban/suburban hospitals reduces

the culture shock of living in a rural

Area

• Programs can reduce the cultural shock 

• Debt Forgiveness for Primary Care

• Some Med schools offer tuition-free

programs for students going into

primary care

Yes

Addressing the Storage 

Nurses

• Expanding Full Practice Authority for NPs

• 27 states have granted FPA to NPs

• NPs are more likely to open practices in

shortage areas

• Bridge Programs

• “APN to NP” or “Direct-Entry MSN”

programs to upskill into provider roles in

2-3

• Allow nurses to get defreeses faster 

• Passing less complex cases to nurses

• Nurses handle care coordination, patient

education, and routine screenings so

physicians can focus on most complex

cases

• Nurses do charting so physicians don’t

Burnout 

• Improve the nursing force 

Yes