Healthcare Professionals

Aisha Syed

Healthcare is comprised of many professions that work on different levels to care for their patients. Some healthcare professionals have tasks that vary from complicated surgical procedures, to changing a baby’s diaper. This chapter will discuss some of many professions that make up the healthcare system. Nevertheless, when we think of healthcare professions we assume that only nurses and physicians are involved. While physicians and nurses are a vital part of the healthcare system there are many other professions that makeup the healthcare field. This chapter will discuss the duties, skills, and educational level of many healthcare professions.

The chapter which follows is divided into seven sections. The first of these sections contains Healthcare Professionals, which will include medical doctors, doctors of osteopathy, and nurses. The section will also discuss the differences between a medical doctors and doctors of osteopathy. The second section describes the official medical specialties. The next section is on Nursing, including different types and their duties, skills, and educational background. The fifth section will discuss other licensed professions like, Rehabilitation specialists, Occupational therapist, and Physical therapist. The sixth section will cover Healthcare Managers. This refers to the people that are providing services instead of care. The last section will discuss controversy between physician, nurse practitioners, and physicians assistant.

Healthcare Professionals

There are hundreds of healthcare professions that array from medical doctor to dietitian. Similarly, 11.6 million people work in healthcare in the US which includes 778,000 physicians where 5 percent are Doctors of Osteopathy², 2.1 million registered nurses, and 160,000 dentists¹. The remaining are involved in research, care-giving, teaching, or administration¹.

Doctors prevent, treat, and advise patients to keep healthy. Nevertheless, doctors can be categorized in two groups, medicine as practiced by MD’s, known as allopaths (traditional) and Doctor of Osteopathy, DO². The majority of doctors practice allopathy. There are 15 accredited osteopathy schools compared to over 120 medical schools. According to New England Journal of Medicine, osteopathic philosophy focuses on a patient-centered approach, where it is based on prevention along with concentrating on the patient as a whole, rather than individual parts of the body separetly². In addition, the body is used to assist in healing the body with the manipulation of bones, muscles, and tendons. This technique used by DO’s is not practiced by most MD’s. An osteopath focuses on the symptoms and its treatment rather than the disease only. Both forms of doctors use medicines, surgery, and standard methods of treatment; however the approaches for the doctors are slightly different¹. Osteopaths have the same specialties as MD’s (see Specialty section for further information).

MD’s and DO’s have the same level of education, training, and residency programs, however there are many more MD’s then DO’s. In addition, MD’s and DO’s attend separate and different schools that have variation in curriculum. Many more MD’s enter into specialty where many DO’s enter in primary care. Whatever type of doctor a patient chooses, they should realize that both physicians meet the same standards, but have different approaches in treatment.

Those who desire to attend medical should pursue a pre-medical curriculum in undergraduate and then apply to medical school or osteopathic school. Most medical schools take four years to complete however, there are schools that allow for a completion of both pre-medical and medical school in six to seven years⁴. Typically, in medical school the first two years are spent in the classrooms and laboratories, the next two years are spent in the hospital learning and training under supervision. After graduation medical students enter a residency program, research programs, or may decide to teach.

The largest health professional group is nurses. There are different levels such as: licensed practical nurse, nurse practitioner, registered nurse, and nurse midwife. These topics will be discussed in detail later in the chapter.

Graduate Medical Education Year

1 2 3 4 5 6-7

Medical Specialties

Primary and specialty care received by a patient may include ambulatory care (primary), secondary (specialty), and tertiary. Primary care refers to care received when needed for example, you go to a primary care physician for a cough or cold in addition to immunizations. Primary care aims for prevention and focuses on the maintenance of high quality of life³. Some key points that primary care concentrates on include: disease prevention, early detection of disease to eliminate further and or serious problems, educates the patient, advises the patient for better health, and refers the patients to other providers for the appropriate times³. Some examples of primary care physicians include internist (internal medicine) and pediatricians. The primary care provider offers a wide array of services to their patients such as: physical exams, health screenings, and immunizations, infection assessment, advise on different conditions and many others health-based advise³. Primary care providers are essential to the healthcare system; however, they may be less paid then the other specialty doctors or surgeons. Primary care physicians provide direct care to patients, which is the difference between secondary and tertiary care.

Secondary care is often referred to as specialty care. Normally, a patient receives care from their primary care giver; moreover if a specific problem arises the patient will be referred to a specialist. Secondary care is often provided in hospitals and allows for long term care³. Similar to primary care providers, specialists deal with diagnosis, prognosis, and treatment³. In addition, secondary care concentrates on one specific part of the patient’s body. There are several types of specialties (and there are subspecialties which are not included for example cardiology):

SPECIALTY	DESCRIPTION
Allergy and Immunology (formed in 1971)	Study, diagnosis, and treatment of disorders of the immune system, including allergy, immune deficiency, and autoimmune disease.
Anesthesiology (1938)	Use of anesthetic agents to prevent pain during surgical or other painful procedures
Colon and Rectal Surgery (1935)	Surgical treatment of disorders of the anus, rectum, and intestines
Dermatology (1932)	Diagnosis and treatment of disorders and diseases of the skin
Emergency Medicine (1979)	Treatment of patients suffering from sudden, life threatening injury and illness.
Family Practice (1969)	Comprehensive care of individual of all ages on a long-term basis.
Internal Medicine (1936)	Non-surgical diagnosis and treatment of disorders of the internal organs.
Medical Genetics	Study, prevention, diagnosis, and treatment of genetic disorders.
Neurological Surgery (1940)	Surgical treatment of the nervous system, including the nerves, brain, and spinal cord.
Nuclear Medicine (1971)	Use of radioactive substances to diagnose and treat disease.
Obstetrics and Gynecology (1930)	Diagnosis and treatment of disorders of the female reproductive system and management of pregnancy, labor, and childbirth.
Ophthalmology (1917)	Diagnosis and treatment of disease and disorders of the eyes.
Orthopedic Surgery (1934)	Diagnosis and surgical treatment of disorders of the bones, muscles, and associated structures.
Otolaryngology (1924)	Study, diagnosis, and treatment of disease of the head and neck.
Pathology (1936)	Study of the nature of disease and the changes it causes in the body.
Pediatrics (1933)	Study of the growth and development of children, as well as diagnosis and treatment of disease in children.
Physical Medicine and Rehabilitation (1947)	Treatment of disorders by physical means, such as heat, cold, and radiation.
Plastic and Reconstructive Surgery (1939)	Surgical treatment, to repair superficial parts of the body.
Preventive Medicine (1948)	Study and use various measures to prevent disease by immunization and other controls.
Psychiatry and Neurology (1934)	Study of the mind and the treatment of its disorders.
Radiology (1934)	The use of x rays and other radiation to treat disease.
Surgery (1937)	Use of various procedures called operations to treat and diagnosis disease and injury.
Thoracic Surgery (1948)	Surgery of the chest, including surgery of the heart, lungs, and chest wall.
Urology (1935)	Diagnosis and treatment of diseases of the urinary tract in female and the urogenital tract in males.

Source: American Board of Medical Specialties, Encarta ® Online Encyclopedia 2001.

Primary care is synonymous with promoting health and prevention of disease, secondary care specializes in certain areas such as dermatology or orthopedic surgery, and tertiary care provides highly specialized care like intensive-care.

Alternative Healthcare

The definition of alternative medicine is not clear cut, but the previous written chapter by Anna Rosenfeld discusses some of the professions that are considered as alternative medicine today. Chapter three discusses chiropractors, acupuncture, Chinese medicine, homeopathy, naturopathy, massage therapist, hypnosis, and biofeedback.

Nursing

Nurses are a vital part of the healthcare system. Next to doctors nurses are most familiar with the patient’s cases. Nevertheless, there are several levels of nursing who have different skills and qualifications. The two main categories of nurses are Licensed practical nurses or LPNs and Registered nurses or RNs.

There are approximately 700,000 licensed practical nurses that provide different types of care⁴. LPN’s provide for patients in hospital, nursing homes, and extended care facilities⁴. LPNs do not have the same education and training as an RN; however provide the physicians and other nurses assistance with patient care. Some of the duties that a LPN performs include: record keeping of the patient, taking blood pressures, care of newborns, administer medications, bathe patients, and other tasks that are needed by the physicians⁴. LPNs work a 40 hour week, but not all nurses work the usual nine to five, most nurses have to work odd hours because patients need 24 hour care. Most nurses are first to arrive and assist a patient and if they seem necessary they will call a physician for duties they cannot perform such as prescribing medication. Nurses also feel stressed and strained similar to doctors because they have risks involved with their job. Some risks include injuries, sleep deprivation, and emotional problems.

An LPN can receive their education through trade, technical, and vocational schools⁴. The length of the program is one year in addition to a high school diploma. After the completion of the program the nurses are certified by the state to practice.

Registered Nurses or RNs are extremely important in health care. They work hand in hand with physicians and administering medications to patients⁴. Nurses are likely to work on several different patients at one time in intensive care unit or a children’s ward. Registered nurses can work in a variety of environments such as patient’s homes, schools, public clinics and other community related areas⁴.

RNs differ from LPNs by the level of education and training received. RNs either attend nursing school after graduating high school. RNs usually complete a four year bachelor degree or receive an associate degree to be properly certified to practice nursing where LPNs do not need a bachelor’s degree to practice. Indeed most RNs work part-time with varying times in different areas of health care. Nevertheless, LPNs and RNs educational background and duties vary so their tasks are different also but both nurses are essential to doctors and their areas of work.

HEALTH CARE PROFESSIONALS	DESCRIPTION
Anesthesiologist Assistant	Assists the anesthesiologist in developing and implementing the anesthesia care plan
Art Therapist www.arttheerapy.org or www.atcb.org	Uses drawings and other art/media forms to assess, treat, rehabilitate patients with mental, emotional, physical, and/or developmental disorders
Athletic Trainer	Are involved in prevention, recognition, evaluation, management, treatment, rehabilitation, organization, administration, and education.
Audiologist and Speech-Language Pathologist	Audiologist determines what type of hearing loss a person has and what can be done to assist the person. A pathologist evaluates speech, language, and swallowing skills of people to determine any communication problems and treats them.
Blood Bank Technology-Specialist	Tests blood group for antigens, investigates abnormalities, supports physicians in transfusion, and performs blood collection and processing.
Cardiovascular Technologist	Reviews patient history and performs cardiovascular and therapeutic services.
Clinical Laboratory Science/Medical Technology www.aspc.org	Perform complex analyses, fine-line discrimination, and error correction.
Counseling-related Professions www.nbcc.org	Deal with human development concerns through support, therapeutic approaches, consultation, evaluation, teaching, and research.
Cytotechnologist Email:asc@cytopathology.org	Prepare cellular samples for study under microscope and assist in diagnosis of disease by examining the samples.
Dental-related Occupations www.ada.org or www.aads.jhu.edu	Include Dental Assistant, Dental hygienist, and Dental Laboratory Technician.
Diagnostic medical Sonographer	Provides patient services in use and interpretation of ultrasound procedures.
Dietitian www.eatright.org/caade	Integrate and apply the principles derived from the sciences of food, nutrition, biochemistry, physiology, food management, and behavior to achieve and maintain the health status of the public.
Electroneurodiagnostic Technologist	Taking and abstracting histories, applying adequate recording electrodes and using EEG, EP, and PSG techniques; documenting the condition of the patients.
Emergency Medical Technician-Paramedic Email: naemthq@aol.com	Practice out-of-hospital medicine in conjunction with medical direction. The asses and provide medical care, goal is to prevent death due to injury or illness.
Genetic Counselor www.fadeb.org/genetics	Consulting individuals with birth defects or genetic disorder.
Health Information Management	Related to the management of health information and the systems used to collect, store, process, retrieve, analyze, disseminate, and communicate that info.
Kinesiotherapist	Treats the effects of disease, injury, and congenital disorders through the use of therapeutic exercise and education.
Medical Assistant	Work under the supervision of physicians in their offices or other medical settings.
Medical Illustrator	Create visual material designed to facilitate the recording and dissemination of medical, biological, and related knowledge.
Music Therapist www.musictherapy.org	Music is used within a therapeutic relationship to address individuals’ physical, psychological, cognitive, and social needs.
Nuclear Medicine Technologist	Uses nuclear properties of radioactive and stable nuclides to make diagnostic evaluations and provide therapy.
Occupational Therapy	Uses purposeful activity and interventions to achieve functional outcomes to maximize health of injured or ill.
Ophthalmic Dispensing Optician	Fit corrective eyewear, including glasses and contact lenses.
Ophthalmic Laboratory Technician	Cut, grind, edge and finish lenses and fabricate eyewear.
Ophthalmic Medical Technician/Technologist	Assists ophthalmologists by administration work and collection of data.
Orthoptist www.orthoptics.org	Evaluation and treatment of disorders of vision, eye movements, and eye alignment in adults and children.
Orthotist and Prosthetist www.oandp.com/academy or www.oandp.org	Rehabilitation of the physically challenged.
Perfusionist www.amsect.org	Conduct extracorporeal circulation and auto transfusion equipment temporarily.
Physical Therapy www.apta.org	Help improve patients’ strength and mobility, relieve pain, and prevent permanent physical damage.
Physician Assistant	Prepared to practice medicine with the supervision of a licensed doctor of medicine or osteopathy.
Radiologic Technology	Deliver prescribed doses of radiation to patients for therapeutic purposes.
Rehabilitation Counselor	Determines and coordinates services to assist people with disabilities.
Respiratory Care	Provides respiratory care.
Surgical Technologist	Assist surgeons to provide surgical care.
Therapeutic Recreation Specialist www.nrpa.org/branches/	Uses various interventions to treat physical, cognitive, emotional, and social conditions associated with illness, injury or disabilities.

Health Professions Career and Education Directory. American Medical Association, 2000.

Other Licensed Professionals

Besides doctors, nurses, and administrators there are other professions that are important to the health care system. Rehabilitation counselors, Occupational therapists, and Physical therapist are some of the few licensed professionals that are not given very much attention in the medical field. Each profession plays an important role to its patients and with their specialized care they provide.

Rehabilitation counselors have various backgrounds which include public health nursing, social work, and school counselining⁵. Rehabilitation counselors work with persons who have a disability, where they encourage psychological, emotional, and economic growth⁵. Furthermore, counselors aid patients who have other disabilities such as mental and emotional along with physical. Some additional tasks of rehabilitation counselors include: assist patients in locating and keeping employment, break down social barriers that the society creates for disabled individuals, aid in the disabled to create a bond between themselves and family and friends, they assist in training individuals so they are more independent, and encourage good job performance and progress in daily living^4,5. There are a range of jobs and areas that a counselor may be employed however, they must be certified through the Commission on Rehabilitation Counselor Certification (CRCC) in addition to training programs that last up to two years. Approximately 43 million Americans have some disability and having rehabilitation counselor’s assist with their lives, jobs, and relationships the disabled will have better quality of life⁵.

Occupational therapists are similar to Rehabilitation counselors because they both assist disabled individuals and aid them into a “normal” way of life. First, the patient is evaluated to observe the type of therapy needed with tests which measure the skills of the person. After the tests are interpreted the treatment or training begins with education, consultation with the individual and or their family⁵. Victims of accidents which have left them disabled are assisted with therapy by skills such as weaving, knitting, and other intricate projects. Other similar activities provide a creative skill which assists the patients in restoring their lost ability⁴.

In addition, Occupational therapist can also be considered one of several Home care specialists because they may make home visits and plan educational, recreational, and social activities to aid the patients regain their bodily functions⁶. The optimum goal of occupational therapist is to have their patients become independent even with their handicaps. The goals of occupational therapists are similar to rehabilitation counselor, which is for optimum health and well being in addition to the patient being independent.

Occupational therapists must have a bachelor’s degree and afterwards they take an examination to be certified for their state of residence, where the state regulates the practices of therapist⁵.

Physical therapists work with a broad range of individuals; they work with patients recovering from accidents to Olympic atlethes⁵. They use methods such as exercise, massage, ultrasound, electricity, heat, cold, and water to increase the mobility of patients, relieve pain, and improve muscle and skin condition^{5, 6}. Physical therapists have a detailed job in evaluating patients such as providing the family with proper training instructions to assist in the care of the patient. Along with a extensive skills involved in treating a patient a physical therapist does not need to only work in a hospital, they are employed in many other areas, such as sports facilities, health care centers, and nursing homes. There is a great need for physical therapists that provide home health care. Attending therapy session is a task for the patient and their family. This entails the family taking time out of their schedule to take the patient to the hospital to provide therapy; however, with the ease of having a therapist do home-visits is easier for the family and patient. Moreover, life expectancy is very high for Americans today, so there are a growing number of elderly individuals (baby boom) that require physical therapy after a surgery. Equally important is our love of sports in the US, we have many athletes that push their limits daily, however, in doing so they have an increased number of injuries which leads to surgery afterward receiving physical therapy.

Physical therapists have a bachelor’s degree in physical therapy and attain a certification by the state which gives them the license to practice.

These are only a few of licensed professionals that are important in the functions of the health care system. We’ve noticed that simple surgery is not enough to retain a good quality of life, therefore having counselors and therapist is very important in patient care.

Healthcare Managers

So far we’ve discussed health care professionals that provide care of some sort, with primary or secondary care. However, coordinators within a hospital do not provide care, but services. A Healthcare manager can have one task or many such as planning, engineering, administration, application, and policy⁵. Planning refers to strategic efforts engineering is designing modes and the flow of the department, administration is handling various information and organizing it, application is analyzing and using the data for attaining information, and policy is implementing confidentiality, integrity and other standards within the hospital⁵.

Most healthcare managers have tasks based on the work environment so there are no specific duties that are assigned on a daily basis, however the main skill the manager should have and implement is to run the health care system as smoothly as possible. Being the bridge between doctors and drug, insurance, or other companies is a difficult task for an individual to handle. So the employees work as a team to function as a good system. Another responsibility the health manager faces is the serving as an information service; such as clinical quality assessment so the data is used properly and effectively⁵.

The Health and Human Services Department is an example of a large administrator employee. Within the federal government it resides over 12 major divisions like the Administration for Children and Families with provides services to encourage the proper and healthy development of children⁷. Programs such as this allow the assistance programs to run properly and with managers with skills to run a healthcare system the entire organizations are able to assist children and families.

For more information on Healthcare Manager see chapter three.

Lastly, there has been controversy between the roles of physicians, physicians assistant, and nurse practitioners. Nurse Practitioners are RNs who have received specialized training who work under a physician similarly to a physician assistant. A physicians assistant is fully capable of practicing medicine but under the supervision of a physician⁵. Nurse practitioners practice mainly primary care and which is well received by patients. However, individual states have authority to allow NPs to practice independently, but the majority of states require the supervision of physicians¹. All three are able to prescribe medications. Nevertheless, physicians have more training which means that PA and NPs will always have to report to physicians. Moreover, if all doctors, assistants, and nurses work together with separate duties will allow for better and effective patient care.

The medical field requires an individual to be extremely disciplined and devoted to their career. Doctors are extremely respected for their knowledge, devotion and hard work that made them a doctor. The healthcare system may or may not always acknowledge the difficulty of their careers, but hopefully this chapter has made readers more aware of some different professions and importance of each profession. Doctors and nurses are backbones of the medical field but it takes more than a backbone for a human to function. There are many more professions that were not mentioned in the chapter that contribute a great deal to the healthcare system. With some introductory knowledge an individual may want to explore other options and hopefully want to pursue a career in the medial area.

References

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3. Miller M. Health Care Choices for Today, a Consumers Guide to Quality and Cost. New York: John Wiley and Sons, Inc., 1997.

4. Selden, A. Handbook of Health Care Careers. Lincolnwood: VGM Career Horizons, 1994.

5. Health Professions Career and Education Directory. American Medical Association, 2000.

6. Cardoza, A. Homecare Services Careers. Lincolnwood: VGM Career Horizons, 1993.

7. “Health and Human Services”. Microsoft® Encarta® Online Encyclopedia 2001. http://encarta.msn.com

8. Belshaw, Chris. Osteopathy Is it for you? Element Books limited, 1987.

9. Fabb, W., Fry, J. Principles of practice management in Primary care. Lancaster: MTP Press, 1984.

10. Stephen, William. An analysis of primary medical care: an international study. Cambridge: Cambridge University Press, 1979.