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HCM 500 CSU Global Campus Wk 3 Imbalance in Care Discussion

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US Healthcare System
Division of Healthcare
Division of Healthcare
Primary Physician Care
Included
Defining Primary
Care
Includes
Infuences
Specialty Physican Care
Typically Primary Care to Specialty
Imcludes
First Contact
Care
Portal to
Healthcare
System
Follows
Primary Care
Includes
Development of
Medical
Technology
Defining
Specialty Care
Inclludes
Includes
Includes
Focuses on
the person
as a whole
31.3% Average Med
Shool Grads
Factors Leading
to Med School
Grad Choice
Influences
Includes
Centers on
disease or
organ systems
68.7% Average Med
School Grads
Includes
Factors Leading
to Med School
Grad Choice
Includes
Incudes
Icludes
Includes
Includes
Includes
Less
School
Debt
Includes
Prestige
Lifestyle
none
factor
Medium
Pay
$257,726
Demographics
of the
General
Population
Medium Pay
$425,136
More
funding/fancier
equipment
Prestige
Life style
Higher
Reimbursements
HCM520: Quality & Performance in Healthcare
HCM520: WEEK 3 Paper
Week 3 Paper: Leadership & Quality Improvement Initiatives
Choose a current article from the following website about hospital leadership and a quality
improvement initiative:
https://www.beckershospitalreview.com/hospital-management-administration.html?%C2%A0
Instructions:
Write an essay that summarizes the article by including the following:











Introduction
Level of management (CEO, physician, nurse, etc.) implementing initiative
What is the challenge/issue/problem?
What are the goals of the quality improvement initiative?
What statistical tools were used to measure quality improvement?
What were the results of the improvement initiative?
Could management have handled this better? In other words, should adjustments or
changes have been made for better outcomes? If so, what?
What is the impact of results on the organization? Patient outcomes?
As a healthcare leader, what are three key take-a-ways from the article that really stood out
to you? Why?
Conclude with a commentary regarding how positive leadership can be applied in the
workplace to improve healthcare quality goals.
Conclusion
Submission Requirements:
Your paper should meet the following requirements:



Be 3 – 4 pages in length, not including the cover or reference pages.
Provide full APA citations for articles selected along with associated in-text citations.
Utilize headings to organize the content in your work.
Week 2: Discussion Post ~ 300-500 words.
The Manager’s Role
In this discussion, you are to think of an instance in which you had or observed an experience of
excellent healthcare quality. You may have had this experience as a customer, patient, provider, or
employee.





Describe the factors that made this experience excellent and how you felt as a result.
Include a description of the management’s influence on your experience.
Do the same for a situation in which you experienced poor quality.
What is the role of leadership pertaining to quality?
What is your leadership style and how can you use it to improve quality?
Page 1
HCM520: Quality & Performance in Healthcare
References for Paper / Discussion Post:
Agency for Healthcare Research and Quality. (2019, September 7). Leadership role in improving
safety Links to an external site.. PSNet. https://psnet.ahrq.gov/primer/leadership-role-improvingsafety
American College of Healthcare Executives. (2020). ACHE healthcare executive 2020 competencies
assessment tool. https://www.ache.org/-/media/ache/career-resourcecenter/competencies_booklet.pdf
Andersen, L. B., Bjørnholt, B., Bro, L. L., & Holm-Petersen, C. (2018). Achieving high quality through
transformational leadership: A qualitative multilevel analysis of transformational leadership and
perceived professional quality Links to an external site.. Public Personnel Management, 47(1), 51–
72. https://doi.org/10.1177/0091026017747270
Borkowski, N. & Meese, K.A. (2021). Organizational behavior in health care. Jones and Bartlett Learning.
Burns, M. J. (1978). Leadership. Harper & Row.
Gandolfi, F., & Stone, S. (2018). Leadership, leadership styles, and servant leadership Links to an external
site.. Journal of Management Research (09725814), 18(4), 261–269.
Kenney, C. (2019). Purpose and character: The ultimate differentiators of a legacy leader. Links to an
external site.American Journal of Health Promotion, 33(7), 1087–
1090. https://doi.org/10.1177/0890117119866957d
Spath, Patrice L. (2022). Applying quality management in healthcare: a systems approach (5th ed.). Health
Administration Press. **THIS IS OUR TEXTBOOK**
Transactional Leadership Theories. (n.d.). Leadership-central. http://www.leadershipcentral.com/transactional-leadership-theories.html#axzz4vsLkYTse
Ward, S. (2018, August 22). Leadership definition. The Balance Small Business.
https://www.thebalance.com/leadership-definition-2948275
Zellman, M. (2019, March 4). The advantages of transformational leadership style. Chron.
https://smallbusiness.chron.com/advantages-transformational-leadership-style-18809.html
Page 2
HCM520: Quality & Performance in Healthcare
***Helpful Resources from this week’s readings for Paper***:
The Role of Leadership in Managing and Implementing Quality
Initiatives
This module focuses on the role of leadership in managing and implementing quality initiatives
throughout healthcare organizations. In this module, you will explore and analyze different styles,
theories, and traits of leadership to develop your thoughts on what type of leadership is necessary to
provide quality healthcare.
Learning Outcomes
1. Connect the impact of leadership to promoting and managing quality initiatives.
2. Interpret the changing leadership role for providers.
3. Compare and contrast several leadership styles and assess their effectiveness in healthcare.
4. Classify those involved in managing change initiatives.
Defining leadership is an elusive undertaking. Multiple theories on leadership styles, skills, and traits
strive to define components of effective leaders. It is likely you have encountered a variety of leaders
in your work environments, each with particular styles, skills, and traits. Based on your experiences,
how would you define effective leadership? Have you found effective leaders to be inspiring and
motivating? Do the effective leaders you have encountered possess one specific leadership style?
Take a moment to think of your definition of leadership. Now that you have a definition, identify a
healthcare leader that fits your leadership definition. Keep this individual in mind to use as a
comparison for our work in this module.
The healthcare arena is not selective of any one style or theory of leadership. As you move through
this module and learn more about the role of leadership in managing and implementing quality
initiatives, you will also have the opportunity to begin to analyze your strengths and weaknesses in a
leadership role.
1. What is Quality in Leadership?
While leadership and its study have existed since the beginning of history, paradoxically, we cannot
define the concept precisely. Ward (2018) defined leadership as “the art of motivating a group of
people to act towards achieving a common goal” (para. 1). Do you see the leadership role in healthcare
in the 21st century challenged with complexities? Do you feel multiple driving forces impact
leadership decisions, thus creating extraordinary challenges? The financial climate alone can change
the landscape of the whole organization. We must be cognizant of how this can affect leaders in a
healthcare environment. Leaders must maintain a clear purpose with realistic goals. Organizations can
Page 3
HCM520: Quality & Performance in Healthcare
face difficulties when they are already financially challenged, and unrealistic goals are set for
subordinates. Leaders can lose their followers rapidly when the goals are not achievable.
To get an inside look at what leadership is and what it entails, view the following video segment from
Alex Haslam. Haslam defines leadership, explains why it is needed, and discusses the limitations of a
traditional leadership approach (See video)

In the fast-paced environment of healthcare, having the ability to motivate and guide improvement is a
major component of leadership.
In fact, according to Spath (2022) “Leaders must nurture a culture of continuous improvement, high
reliability, and accountability” (p. 80) and “…must constantly look for ways to make things better” (p.
74). Additionally, to achieve effectiveness, leaders must combine their knowledge of management and
quality to understand and improve the organization (Spath, 2022).
The readings for this module provide a comprehensive approach to identifying leadership theories,
styles, and roles, as well as how leadership is involved in change processes.
2. Leadership in the 21st Century: The Opportunity to Transform Environments
Many theories in leadership, though developed in other fields, can and will be applied to the
healthcare environment. They are quite individual, depending on each leader’s ability, knowledge, and
experience. Transformational, servant, situational, and transactional are just a few of the leadership
theories/styles you may encounter within your career. The entire process of improvement can be
viewed in many dimensions. How do we link the leader to a transformational process or any other
leadership theory? Can the organizational mission, vision, and values affect the style leaders adopt?
Borkowski and Meese (2021) support the transformational leadership role and see it as vital to an
organization’s success. They state, “Because of regulatory changes, financial pressures, and evolving
care delivery models, health care organizations will be transformed in many ways in the years to come”
(p. 209). Leaders must increase their transformational skills because they will experience increasing
demands to demonstrate high performance and quality outcomes while reducing cost in the midst of
decreasing revenues (Borkowski & Meese, 2021). Given this endorsement for using a transformational
leadership approach, what about the other prominent leadership styles? Can a transactional or
charismatic leader provide what is necessary for the organization? Most leadership theories started in
other fields, but they have been transferred and translated into the healthcare industry. How do we
make sure that the theories and styles we select are appropriate within current healthcare
organizations?
Page 4
HCM520: Quality & Performance in Healthcare
Image Caption: Arrows pointing to transformational leadership: leveraging your emotional intelligence,
building strategic relationships, leading through change, translating strategy into action, developing
employee capability.
Page 5
HCM520: Quality & Performance in Healthcare
3. Leadership Styles in Promoting and Managing Quality
We have addressed the fact that many theories and styles of leadership are utilized in our healthcare
arenas. The specific leadership styles examined in our course include transformational, transactional,
and servant. These styles of leadership are the most well-known and embody a
contemporary approach, addressing what is occurring in our healthcare systems, what customers need
and want, and how the team will deliver the optimal quality service they are striving for. However,
other styles may also be used in the field.
5 Different Types of Leadership Styles:
https://smallbusiness.chron.com/5-different-types-leadership-styles-17584.html
Level 5 Leadership:
https://www.mindtools.com/atqwpnm/level-5-leadership
Sir MacGregor Burns introduced the concepts of transformational and transactional leadership in
1978. He viewed the follower as having input into the process, becoming reciprocal. Eventually, he
proposed the possibility of leaders and followers working together. What is the act of transforming
leadership? The act of transforming leadership, according to Burns (1978), raises the level of the
followers’ morality of conduct and ethical aspirations to lead to active engagement. Click through the
following activity to learn more.
Transformational leadership attempts and succeeds in raising colleagues, subordinates, followers,
clients, or constituencies to a greater awareness of the issues of consequence. According to Zellman
(2018), a benefit of the transformational leadership style is that managers have the adeptness to retain
employees. This retention can be a major incentive for healthcare organizations, given the need for
highly qualified and dedicated workers.
Transactional leadership, in comparison, is based off of performance and reward and consists of task
accomplishment and the maintenance of a good leader/subordinate relationship (Borkowski & Meese,
2021).
What is deemed valuable may be different for each transactional leader and their organization, but the
principle remains the same. This style of leadership often relies on a system of rewards and
punishments. Some criticisms of this style are that not every employee may be personally motivated
by the rewards being offered; additionally, transactional leadership does not take social values into
account (Leadership-central.com, n.d.).
Servant leadership was first developed in the 1970s. It “focuses on serving the highest needs of other people in
an effort to help others to achieve their goals” (Borkowski & Meese, 2021, p. 213, as cited in Greenleaf, 1969).
This style of leadership requires that the leader makes a personal investment in his or her employees; the leader
must value the contributions of the team and encourage each person to grow in their abilities and interests. If
you are interested, you can learn more about the Ten Principles of Servant Leadership.
10 Principles f Servant Leadership (and Why It’s Our Favorite Style):
https://www.teamgantt.com/blog/servant-leadership
Page 6
HCM520: Quality & Performance in Healthcare
The styles, theories, and thoughts of leadership you have learned about in this module vary greatly in
defining leadership. Have you been involved with any of the types of leadership that were discussed in
this module?
In summary, the leadership theories/styles presented here have been and will continue to be used in
the healthcare setting. Now that we have explored leadership and leadership styles ask yourself: Are
you a leader or a follower? If you are a follower, what will engage you to follow the leader? If you are
the leader, what is your philosophical approach to leadership? What leadership theory might you
subscribe to in the leader role?
Healthcare Leaders
While all leaders have specific characteristics that define them as transformational, transactional, or
servant leaders, healthcare leaders also require additional skills and knowledge to be effective in the
constantly evolving healthcare environment.
Review the healthcare leadership assessment tool.by the American College of Healthcare Executives (ACHE) to
see what is expected of leaders in the three stages of career development: novice, competent, and expert.
https://www.ache.org/-/media/ache/career-resource-center/competencies_booklet.pdf
Page 7
HCM500: The U.S. Healthcare System
HCM500: WEEK 3 Paper
Week 3 Paper: Health Services Professionals & Medical Technology:
Imbalance in Care
Submit a paper that examines the Medicare Trust Fund and its projected solvency. Some key
questions to consider:
Create a concept map that represents the relationship and factors creating the
imbalance/maldistribution between primary and specialty physician care in the United States
healthcare system.
Please include a brief 1–2-page summary of your diagram to explain its contents; this can be viewed as
what you would say in a in a presentation of your diagram. Your paper should be well-written and
meet the following requirements:



Brief introduction
Concept Map discussing imbalance / maldistribution between primary and specialty
physician care in the US healthcare system.
Conclusion
Your paper should be well-written and meet the following requirements:


1-2 pages in length,

Be sure to discuss and reference concepts taken from the assigned textbook reading and relevant
research.
Include a minimum of at least 2 credible, academic references from peer-reviewed articles beyond the
text or other course materials. (Not more than 5 years old)
Week 3: Discussion Post – 300 words.
Discuss the role of one specific healthcare professional (Recommend Pharmacist: Pharm D.), other
than your own role. You may select any career in the healthcare field with the exception of registered
nurse or physician as the idea is to become more familiar with the range of professions in the industry,
especially those that are less commonly understood by the general public.
In your summary, include a description of the role, required education, work setting, expected income,
and future demand. What limitations do these professionals have? Discuss how this healthcare
professional contributes to the organization’s success and patient outcomes.
The initial post must be substantive (250-300 words); use peer-reviewed, academic sources to support
your statements with logic and argument; and cite all sources referenced
Page 1
HCM500: The U.S. Healthcare System
References for Paper & Discussion:
Agency for Healthcare Research and Quality. (2017). National healthcare quality and disparities report:
Chartbook on rural health care. https://www.ahrq.gov/sites/default/files/wysiwyg/research/
findings/nhqrdr/chartbooks/qdr-ruralhealthchartbook-update.pdf
American Medical Association. (n.d.). Requirements for becoming a physician. http://www.amaassn.org/ama/pub/education-careers/becoming-physician.page
Health Resources and Services Administration. (n.d.). Shortage designation: Health professional shortage
areas & medically underserved areas/populations. http://www.hrsa.gov/shortage/
Kane, L. (2020). Medscape physician compensation report 2020.
https://www.medscape.com/slideshow/2020-compensation-overview-6012684#1
Moore, N., & Constantinescu, A. E. (2019). Impact of technology on quality and customer
experience Links to an external site.. Journal for Quality & Participation, 42(1), 22–24.
Redford, L. J. (2019). Building the rural healthcare workforce: Challenges–and strategies–in the current
economy Links to an external site.. Generations, 43(2), 71–75.
Shi, L., & Singh, D. A (2019). Delivering healthcare in America: A systems approach (7th ed.). Jones and
Bartlett Publishers. **THIS IS OUR TEXTBOOK**
Stiffler, S. (2014, September 4). Rural doctor shortage worsens as newly insured Washington residents
seek care. The Seattle Times. http://kaiserhealthnews.org/news/rural-doctor-shortage-worsens-asnewly-insured-washington-residents-seek-care/
Tarassoli, S. P. (2019). Artificial intelligence, regenerative surgery, robotics? What is realistic for the future
of surgery? Links to an external site. Annals of Medicine and Surgery, 41, 53–55.
Page 2
HCM500: The U.S. Healthcare System
***Helpful Resources from this week’s readings for Paper***:
Learning Outcomes
1. Examine the distribution of providers, services, and products in the healthcare continuum.
2. Identify various workforce roles that contribute to healthcare services.
3. Contrast the roles and the impact of professional healthcare organizations on the healthcare
industry.
4. Describe how technology impacts healthcare delivery.
1. How Much Money Do Physicians Really Make?
Before examining data about physician income, it is important to remember that physicians work long
and hard to become doctors, and many work just as hard once they enter the profession. Few
physicians work a standard forty-hour work week; most work sixty or more hours per week.
Historically, physicians were paid for their efforts based on the nature of the work they performed.
For example, they would bill the patient or the insurance company for providing services such as a
physical examination in the office or hospital setting, or for performing procedures or surgeries. In
general, they were not paid based on how many hours they worked.
There are still sole practitioners who own their practices, which are often located in rural areas. These
doctors may have one or two physician partners, and generally have a small office staff. Before these
doctors take any money home, they first pay for things like office rent, utilities, business and
malpractice insurance, staff salaries and benefits, and so on. These physicians practice
medicine and run their own businesses.
Today, however, many physicians are employed by medical groups and are often paid a salary, usually
based on productivity, and occasionally modified by clinical quality and patient satisfaction outcomes.
These medical groups generally hire administrative professionals to manage the business, allowing the
physicians to concentrate on clinical practice. A medical group receives its revenue in the same way a
sole practitioner does: by billing the insurance company and/or the patient for services provided.
Medscape, a subsidiary of the website WebMD, conducts an annual survey of physician compensation
and publishes a report based on the responses. The Medscape’s 2020 Compensation Report examined
data from over 20,000 doctors in 29 specialties. Some highlights are provided in the image below
(Kane, 2020):
Page 3
HCM500: The U.S. Healthcare System
See source below for excellent graphs:
(Source: https://www.medscape.com/slideshow/2020-compensation-overview-6012684#1)
Page 4
HCM500: The U.S. Healthcare System
2. What it Takes to Become a Physician: Education & Training
Physicians play a central role in the delivery of healthcare services; they analyze and interpret data and
information provided via numerous sources, such as the patient, laboratory tests, imaging studies, etc.
Using this information, they offer a diagnosis and then prescribe a plan of treatment that is
implemented by various members of the healthcare team, including nurses, pharmacists, respiratory
care practitioners, physical and occupational therapists, and so on.
In the United States, the process to become licensed as a physician is quite lengthy and involves
undergraduate education, medical school, and graduate medical education (i.e., residency and
fellowship). Click below to explore the general route to becoming a physician.




The first step involves earning a bachelor’s degree, which typically takes 4 years.
Next comes medical school, which generally takes an additional 4 years.
Advance medical training, known as residency, follows, for an average of 3 to 4 more years (although
some specialties take longer).
Becoming a physician takes an average of 11 to 12 years of education beyond high school!
In reality, the education process never ends for a physician. States, hospital medical staff, and professional
organizations typically require physicians to earn continuing medical education (CME) credits to renew their
licenses, memberships, and certifications. This ensures that a physician’s knowledge and skills remain current.
3. Where Physicians Work: Urban Surplus and Rural Shortage
The term maldistribution is used to refer to the surplus or shortage of physicians in terms of either the
number (geographic maldistribution) and/or the type of physicians (specialty maldistribution)
necessary to maintain the health status of a defined population.
The Agency for Healthcare Research and Quality (2017) estimated that 19.3% of the U.S. population
lives in rural areas; however, only 9% of physicians practice in these areas. The U.S. Health Resources
and Services Administration (HRSA) uses shortage designation criteria that it developed to decide
whether or not a geographic area or population group is a Health Professional Shortage Area (HPSA).
For example, primary care HPSAs are based on a physician-to-population ratio of 1 provider for every
3,500 residents; that is, when there are 3,500 or more people per primary care physician, that area can
be designated as a primary care HPSA. As of June 19, 2014, there were 6,100 designated primary care
HPSAs. HRSA calculates that approximately 8,200 additional primary care physicians are needed to
address this shortage (HRSA, n.d.).
Why such a shortage in rural areas?
Physicians often leave rural areas for personal or family reasons; for example, the desire to raise a
family in a suburban area. Some leave for professional reasons; for example, they might move to areas
where they will see more patients and have better access to a broader professional network. Finally,
many leave for financial reasons.
Page 5
HCM500: The U.S. Healthcare System
A 2014 report in The Seattle Times, produced in partnership with Kaiser Health News, noted several
additional reasons for the shortage of doctors in rural areas:

Reason 1: The percentage of doctors practicing primary care is about 34%; the rest are
specialists who are less likely to practice in rural areas (Stiffler, 2014).

Reason 2: Rural healthcare providers tend to work long hours and are often on call (Stiffler,
2014).

Reason 3: Most residencies are through teaching hospitals in big cities, and research has shown
that the location of this training often has a strong impact on where a doctor will practice later
(Stiffler, 2014).
One solution to addressing physician maldistribution, whether specialty or geographic, is the use of nonphysician providers. One of these is the nurse midwife, who functions in many of the same ways as an
OB/GYN.
4. Will Robots Replace Surgeons?
The science fiction of the 1950s has become the reality of the twenty-first century. Medical technology, such as
pharmaceuticals, biologics, computers, and other machines, have evolved at a rapid pace. Technology has, in
many cases, improved safety, reduced hospital length of stay, and reduced patient recovery time. It is also a key
driver in the increasing cost of healthcare.
The term “robotic surgery” is used to refer to procedures performed using very small tools attached to
a robotic arm. A physician controls the robotic arm with a computer. Because incisions are often
smaller and there is greater precision, there are some key advantages to robotic surgery: less pain and
bleeding, reduced risk of infection, reduced length of hospital stay, and faster recovery. Robotic
surgery may be used in a number of procedures, including gallbladder removal, heart surgery,
hysterectomy, kidney removal and transplant, and the removal of cancerous tissue from delicate areas
such as blood vessels, nerves, or organs.
Will these robots replace surgeons? While we never fully know what the future holds, it is not likely.
For one thing, the current robots are manipulated by a trained surgeon. The surgeon controls the
instruments from a console that is usually located in the operating room.
Remote robotic surgery is possible, however, and is currently in use at many hospitals. The possible
applications for remote surgery are exciting and promising. For example, the expertise of specialized
surgeons could be made available to patients anywhere in the world, eliminating the need for patients
(and the surgeon) to travel further than their local hospital. Unfortunately, the cost for these systems
is high (often exceeding one million dollars), and therefore too expensive for most small hospitals,
especially those in rural areas.
Recently, though, medical technology has focused more on the individual patient rather than the
hospital or other clinical setting. Watch this video on how wearable technology has the potential to
improve lives.
Page 6
Running head: Imbalance in Care
1
Option #1: Imbalance in Care
Audrey Roberts
CSU Global University
HCM500 The US Healthcare System
4/5/2020
This study source was downloaded by 100000808075316 from CourseHero.com on 11-25-2022 18:17:00 GMT -06:00
https://www.coursehero.com/file/66136009/HCM500-Module3-Critical-Thinking-Roberts-Adoc/
Imbalance in Care
2
Concept Map-Imbalance in Care
Five areas of distinction between Primary Care Physicians
(PCPs) and Specialty care:
Primary care is the entry point into healthcare versus specialty
care being the follow-up.
PCPs help control costs, allocation of resources, and rates.
PCPs provide longitudinal care versus specialty care being
episodic.
Primary focus on the whole person versus specialty care
focuses on a particular disease.
PCPs and specialists are trained differently.
Reasons for the Imbalance
between Primary and Specialty
Care
Reimbursement
Insurance
Insurance reimburses
reimburses
specialists
specialists at
at aa
higher
rate
higher rate than
than
primary
primary care
care..
Most
Most insurances
insurances
reimburse
reimburse will
will pay
pay
for
for hospital-based
hospital-based
services
services versus
versus
preventative
preventative care.
care.
Under
Under Medicare’s
Medicare’s
resource-based
resource-based
relative
relative value
value scale
scale
(RBRVS),
(RBRVS), PCPs
PCPs
receive
receive lower
lower
payment
payment than
than
specialists.
specialists.
Income
Specialists
Specialists earn
earn
more
more than
than PCPs.
PCPs.
Specialists
Specialists earned
earned
about
about 45.6%
45.6% more
more
than
than PCPs.
PCPs.
In
In 2017,
2017, the
the top
top
procedural
procedural specialist
specialist
earned
earned $489,000
$489,000
compared
compared to
to PCP
PCP
which
which earned
earned
$225,000.
$225,000.
Medical Technology
Increased
Increased reliance
reliance
on
on technology
technology to
to
treat
treat and
and diagnose
diagnose
diseases.
diseases.
Specialists
Specialists rely
rely
more
more on
on medical
medical
technology
technology than
than
PCPs.
PCPs.
Hospitals
Hospitals with
with the
the
most
up-to-date
most up-to-date
technology
technology employ
employ
specialists.
specialists.
This study source was downloaded by 100000808075316 from CourseHero.com on 11-25-2022 18:17:00 GMT -06:00
https://www.coursehero.com/file/66136009/HCM500-Module3-Critical-Thinking-Roberts-Adoc/
Marketing in
Medical School
47.7%
47.7% of
of
physicians
physicians work
work
in
in the
the primary
primary
care
care setting
setting and
and
52.3%
of
52.3% of
physicians
physicians work
work
in
in specialty
specialty area.
area.
The
The number
number of
of
physicians
physicians
entering
entering the
the
primary
primary care
care
setting
setting has
has
dcreased
dcreased with
with
21.5
21.5 of
of third-year
third-year
residents
residents
reporting
reporting entering
entering
the
the primary
primary care
care
setting.
setting.
Appeal
Appeal of
of
speciality
speciality benefits
benefits
versus
primary
versus primary
care
care setting.
setting.
Imbalance in Care
3
Imbalance in Care
There are five distinct differences between a primary care physician (PCP) and a
specialist physician. Patients first see their PCPs prior to being referred to a specialist. Primary
care is viewed as the entry point into the healthcare system. If a specialist is needed, typically a
referral will made for follow-up care (Shi, L. & Singh, D., 2019). Thus, since a referral needs to
be made by a PCP for a specialist, the PCP helps control costs, allocation of resources, and rates.
The third difference is the time spent with a patient. PCPs have a longitudinal relationship with
the patient. This means PCPs are with the patient from the start, meaning treatment and
diagnosis, and providing follow-up care. PCPs are reposinsible for the continuity of care (Shi, L.
& Singh, D., 2019). Speciality physicians are with the patient briefly, typically for the treatment
of one condition. Another different is PCPs treats the patient as a whole versus specialists treat
one specific disease or organ (Shi, L. & Singh, D., 2019). Lastly, training between a PCP and
specialty physician differs. PCPs are generally trained in an outpatient setting, learning about
various illnesses and condition. Specialists are mostly trained within the hospital, learning the
latest medical technology (Shi, L. & Singh, D., 2019).
Even though PCPs are an important role within the healthcare system, more and more
physician are choosing to become specialists. Thus, creating a speciality maldistribution with a
surplus of speciality phsyicians and a shortage of primary are physicians (Shi, L. & Singh, D.,
2019). There are four reasons for this maldistribution which are: reimbursement rates, physician
income, medical technology, and marketing within medical schools.
Reasons for Maldistribution
One of the reasons for more physicians want to become specialists instead of working
within the primary care setting are due to the reimbursement rates from insutance companies.
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Imbalance in Care
4
Specialists receive a significant higher reimbursement for their services compared to PCPs. The
resource-based relative value scale (RBRVS), contributes to PCPs receiving lower payments for
services under Medicare (Shi, L., 2012). Under the RBRVS, physicians are paid based on the
estimated practice cost and total work effort. Many insurance companies pay more for hospitalbased services utilizing advanced medical technology, but not for routine medical visits or
preventive care received in a primary care setting (Shi, L., 2012).
Thus, there is a significant income differential between a PCP and a specialisit. In 2017,
there was a survey conducted around physician compensation, which resulted in specialists
making 45.6% more than PCPs (LaPointe, J., 2017). Salaries in the primary care setting varied,
where family medicine physician made around $209,000 to internal medicine physicians making
$289,000 per year. However, specialists salaries nearly doubled that of PCPs. Procedural
specialist salaries ranged from $410,000 to $489,000 (LaPointe, J., 2017).
Thirdly, hospitals attempt to utilize the most up-to-date medical technology to diagnose
and treat patients (Shi, L. & Singh, D., 2019). Specialists rely more on medical technology than
PCPs. These three reasons contribute significantly to the reasons which medical students chose
to focus on becoming a specialist versus entering into the primary care setting. Specialists are
marketed as more appealing due to receiving higher reimbursements for their services, a
significantly higher income, and get to learn and work with advanced medical technology. Thus
only 21.5% of third year medical residents are entering into the primary care setting and
currently 47.7% of physician work within the primary care setting and 52.3% work as specialists
(Shi, L. & Singh, D., 2019).
Conclusion
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Imbalance in Care
5
More physician are entering into the healthcare setting as specialists and not as PCPs.
There are four main contributors to this maldistribution which are: reimbursement rates, income,
medical technology, and marketing. Specialists have significant higher salaries, great
reimbursement rates for their services, and get to work with the most up-to-date medical
technology. These reasons contributes to the appeal of becoming a specialists versus a PCP.
Therefore, medical students would rather become a specialist versus becoming a PCP, creating a
shortage of PCPs.
References:
LaPointe, J. (2017). Physician Compensation for Specialists 45.6% more than for PCPs.
Retrieved Apil 1, 2020, from https://revcycleintelligence.com/news/physiciancompensation-for-specialists-45.6-more-than-for-pcps
This study source was downloaded by 100000808075316 from CourseHero.com on 11-25-2022 18:17:00 GMT -06:00
https://www.coursehero.com/file/66136009/HCM500-Module3-Critical-Thinking-Roberts-Adoc/
Imbalance in Care
Shi, L. (2012). The Impact of Primary Care: A Focused Review. Retrieved April 1, 2020, from
https://www.hindawi.com/journals/scientifica/2012/432892/
Shi, L., & Singh, D.A. (2019). Delivering Healthcare in America: A Systems Approach.
Burlington, MA: Jones & Barlett Learning.
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