Non-Physician Clinicians in the Health Care Workforce

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Non-Physician Clinicians in the Health Care Workforce William J. Pettit, D.O. Relate Dean for Rural Health Oklahoma State University Center for Health Sciences

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Psychology Homeopath Podiatry Optometry Nurse Practitioner Chiropractors Naturopath Physical Therapy Pharmacist Physician Assistant Pre-Lecture Quiz Instructions: Chose the best reply from the rundown beneath for each of the accompanying portrayals.

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"… allude to themselves as specialists … or doctors, analyze and treat patients whose wellbeing issues are connected with body's solid, anxious, and skeletal frameworks, particularly the spine. … more than 90% … view themselves as essential care professionals and trust that they ought to be, are, the 'essential care entryway of section' for human services for their patients." Psychology Homeopath Podiatry Optometry Nurse Practitioner Chiropractors Naturopath Physical Therapy Pharmacist Physician Assistant

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"… propelled scholastic and clinical experience, which empowers him or her to analyze and oversee most regular and numerous interminable diseases, either autonomously or as a major aspect of a medicinal services group. Administrations gave… incorporate however are not restricted to requesting, leading, and translating fitting indicative and research facility test, remedy of pharmacological operators and medicines and treatments. The sort of preparing and accreditation required is directed by state licensure laws and in this manner shift from state to state." Psychology Homeopath Podiatry Optometry Nurse Practitioner Chiropractors Naturopath Physical Therapy Pharmacist Physician Assistant

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"… all encompassing way to deal with solution that takes a more extensive perspective of ailment, reasons for malady and how individuals express their infections independently. … allude to themselves as doctors … utilize characteristic solutions for help the body in its common inclination to mend itself. … in view of three standards: the law of similars, the guideline of least measurements and medicine for the person. Some … respect mental, enthusiastic, physical and even profound ailments as interconnected, cures are recommended on an individual premise, not only for his/her malady… " Psychology Homeopath Podiatry Optometry Nurse Practitioner Chiropractors Naturopath Physical Therapy Pharmacist Physician Assistant

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NPC's in the Health Care Workforce 1

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Background

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Definition of NPC Mid-level suppliers planned to work under the supervision of or in a joint effort with a doctor Others who work autonomously of doctor in a specific medicinal range Lastly, the individuals who hone as a free option treatment

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Access to Care Taber's Medical Dictionary: "The privilege or capacity of a person to acquire restorative and social insurance administrations" People without human services "access" for the idea of general wellbeing is best served by the broadest access to the social insurance workforce Efforts to give health awareness by suppliers other than doctors notwithstanding rising health awareness costs customers and bosses are searching for cost sparing choices incorporates state and government activities numerous NPC's considered lower cost elective

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Scope of Practice Dependent on state law, subsequently factor state to state what administrations can be given Expansion of extent of practice by "enactment" not "training" Prescriptive, surgery, self-governance, are a portion of the issues

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Non-Physician Clinicians in the Health Care Workforce 2

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AOA – 2005 Education Licensure Relationship to Physicians Prescriptive Authority Reimbursement Legislative Agenda

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Oklahoma Licensed NPC's No Anesthesiology Assistants (enactment a year ago) (BA) Certified Registered Nurse Anesthetist (RN) Certified Registered Nurse Practitioner (RN) Physician Assistant (Prerequisite differs – typically BA) Optometrist (Prerequisites shifts – normally BA) Pharmacist (Six year program to Pharm D) Psychologist (BA) Podiatrist (BA) Physical Therapist (Prerequisite fluctuates – normally BA) Chiropractor (Prerequisite changes – typically BA)

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Oklahoma NON Licensed NPC's Acupuncture Naturopath Homeopath

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Relationships to Physicians Supervision – You are bound to a doctor keeping in mind the end goal to practice Physician Assistants Collaborative – Pharmacist and ARNP Independent – ARNP, Podiatrist, Chiropractor, Optometrist

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Prescriptive Authority Full – Only DO and MD Partial – ARNP, PA, Optometrist None – Chiropractic, Homeopath, Naturopaths

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Reimbursement Medicaid – Primary guardians are DO, MD, PA, ARNP Medicare – DO, MD, Psychologist, Podiatrist, PA, ARNP, ARNA, Optometrist, Chiropractor, Physical Therapist Private – Variable Compared to DO and MD some are on a lower scale; Psychology, for instance, contrasted with Psychiatrist in Medicaid

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Non-Physicians in Healthcare Workforce 3

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Primary Care in Crisis National Data Graphs, tables and maps

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Primary Cary Supply Figure 2 . Percent Change somewhere around 1998 and 2006 in the Percentage of U.S. Medicinal School Graduates Filling Residency Positions in Various Specialties. Information are from the National Resident Matching Program. From:   Woo: N Engl J Med, Volume 355(9).August 31, 2006.864-866

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Figure 1 . Family Medicine Residency Positions and Number Filled by U.S. Medicinal School Graduates. From the American Academy of Family Physicians, in light of information from the National Resident Matching Program. From:   Bodenheimer: N Engl J Med, Volume 355(9).August 31, 2006.861-864

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Figure 2 . Extents of Third-Year Internal Medical Residents Choosing Careers as Generalists, Subspecialists, and Hospitalists. For 2001, the information mirror the vocation anticipates all third-year inward prescription occupants, including downright, essential care, solution pediatrics, and different tracks. Information for every single other year mirror the profession arrangements of third-year inhabitants selected in all out and essential care inward medication programs. Information for 1998 through 2003 are from Garibaldi et al. [6] Data for 2004 and 2005 are from Carol Popkave, American College of Physicians. NA means not material. From:   Bodenheimer: N Engl J Med, Volume 355(9).August 31, 2006.861-864

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Figure 2 . Extents of Third-Year Internal Medical Residents Choosing Careers as Generalists, Subspecialists, and Hospitalists. For 2001, the information mirror the vocation gets ready for all third-year inner medication inhabitants, including all out, essential care, drug pediatrics, and different tracks. Information for every single other year mirror the vocation arrangements of third-year occupants selected in clear cut and essential care inside medication programs. Information for 1998 through 2003 are from Garibaldi et al. [6] Data for 2004 and 2005 are from Carol Popkave, American College of Physicians. NA means not relevant. From:   Bodenheimer: N Engl J Med, Volume 355(9).August 31, 2006.861-864

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Primary Care in Crisis proceeded with Oklahoma Data Graphs, tables and maps

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OSU College of Osteopathic Medicine Graduates Entering a Primary Care Residency 1977 - 2008

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Number of Patient Care Physicians in Oklahoma & Neighboring States Per 100,000 Population

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Number of Primary Care Physicians in Oklahoma & Neighboring States Per 100,000 Population

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Primary Care in Crisis proceeded with OHCA Concept DO, MD, ARNP, PA (Sooner Care)

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Healthcare: Urban versus Rustic

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Healthcare: Urban versus Rustic

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Non-Physicians in Health Care Workforce 4

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2008 Concept of PCMH "Essential care doctors assume a necessary part in planning a patient's general care." AOA, AAFP, AAP, and ACP 2007 Seven Joint Principles: Personal Physician Directed Medical Practice Whole-Person Orientation Coordinated or potentially Integrated Care Quality and Safety Enhanced Access Better Payment Model

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History North Carolina Model prompted to $225 million dollar reserve funds in social insurance costs CMS (Centers for Medicaid and Medicare Services) will do exhibit extends in 2009

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OHCA January 2009 PCMH – DO, MD, ARNP, PA, FQHC, RHC, HIS Facilities Networks – Hospital, Community Health Centers, Public Health Departments, Physicians, RHC's, FQHC's or other perceived wellbeing net suppliers (OSU and OU)

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OSU CHS and the Center for Rural Health Rural Residency Programs – Tahlequah, Enid and Durant; Lawton in non-essential care, EM OSU Physician Clinics – Enid, Country Club Gardens Quad System of Education Approach Telemedicine for Specialty Care OSU MC Maps and Pictures

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NPC's in Health Care Workforce 5

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Discussion Health Promotion and Disease Prevention Quality and Safety Electronic Health Records E-Prescribing Changing the Primary Care Reimbursement Levels In Oklahoma the main "full administration" suppliers are the MD and DO; despite the fact that PA's and ARNP's could qualification for doctor's facility, there must be, by law, an association with a doctor

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