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SOC 574 The Health Professions

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Physical Therapy. Physical therapists in the U.S. created a professional ... Physical Therapy ... Physician Assistants. Nurse Practitioners. Medics. How do Bogus Doctors ... – PowerPoint PPT presentation

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Title: SOC 574 The Health Professions


1
SOC 574 The Health Professions
  • James G. Anderson, Ph.D.
  • Purdue University

2
Professionalization of an Occupation
  • Making the occupation a full-time pursuit
  • Linking training to schools and colleges and
    gaining control of professional education
    training
  • Establishing strong national and state
    professional associations
  • Obtaining a legal monopoly over a sphere of work
    by expanding the scope of practice
  • Developing a code of ethics that regulates
    professional behavior
  • Shaping the public image of the profession

3
Parameters of a Profession
  • Entry into the profession/curricula controlled by
    the profession
  • Profession is the guardian of its specialized
    knowledge and skills
  • Credentialing Occupational
    degrees Certification Licensing

4
Parameters of a Profession Cognitive
Characteristics
  • Specialized knowledge, skills, mode of reasoning
  • Learning specialized skills through an extended
    process of education, training and socialization
  • Post-baccalaureate degree for entry level into
    the profession

5
IndicatorsCognitive Characteristics
  • Post-baccalaureate degree required for entry into
    the profession
  • Entry level degree (e.g., DPT, PharmD, AuD, etc.)
  • Profession controls professional education
  • Profession sets standards and accredits
    professional education programs

6
Parameters of a Profession Autonomy and
Collective Self-Control
  • Technical autonomy
  • Control over services, resources
  • Direct access to patients/clients
  • Self-control based on socialization of attitudes,
    beliefs, practice patterns
  • Informal control by peers
  • Professional associations exercise control by
    licensing

7
IndicatorsAutonomy
  • State licensure laws
  • Control over board certification
  • Ability to exclude competitors from practice
  • Percent of professionals in independent practice
    compared to organizational practice
  • Profession has direct access to patients
  • Profession sets fees and rates of payment
  • Direct third-party reimbursement

8
Parameters of a Profession Value Components
Service, Commitment, Calling
  • Code of ethics
  • Fiduciary relationship with clients
  • Making the welfare of the client the first
    consideration
  • Conception of the larger ends and purposes that
    professional work serves
  • Commitment to a higher level of competence

9
IndicatorsOrganizational Cohesion
  • Homogeneity of membership in the profession
  • Membership commitment (e.g., members who join
    the professional association)
  • Membership stability over time (e.g., lifetime
    members)
  • Overlap of membership with other professional
    associations

10
IndicatorsRelational Cohesion
  • Competing professional associations
  • Membership in the major professional association
  • Major professional association includes other
    organizations within the profession
  • Establishment and circulation of professional
    journals

11
Parameters of a Profession Value Components
Service, Commitment, Calling
  • Do no harm to patients
  • Confidentiality
  • Code of professional ethics

12
Licensing Professions
  • Licensing protects the public from
    incompetence/charlatans
  • Licensing also creates a professional monopoly
    for services

13
Process by Which Occupations Evolve into
Professions
14
Competition
  • Clinical psychologists (PhDs) versus
    Psychiatrists (MDs)
  • Optometrists versus Opthamologists (MDs)
  • Nurse Midwives versus OBGYNs (MDs)
  • Sociologists versus Social Workers, Marriage and
    Family Therapists, and Professional Counselors

15
Public Prestige Ratings for Health Care
Occupations
Occupation Rating
Dentists 96
Osteopaths 96
Lawyers/Judges 93
Physicians/Surgeons 92
Pharmacists 82
Social Scientists 81
Optometrists 79
Veterinarians 78
Secretaries 61
Therapists/Healers 58
16
Public Prestige Ratings for Health Care
Occupations
Occupation Rating
Mail Carriers 53
Student Nurses 51
Medical/Dental Technicians 48
RNs 46
Postal Clerks 44
Opticians 39
Dieticians/Nutritionists 39
Policeman 39
Physician Office Attendants 38

17
Public Prestige Ratings for Health Care
Occupations
Occupation Rating
Plumbers/Pipe-fitters 34
Machinists 33
Bus Drivers 24
LPNs 22
Carpenters 19
Hospital Attendants 13




18
Critical Elements in Achieving professional Status
  • Unified national organization
  • Integrated state and national professional
    organizations
  • Accreditation of professional education
  • Use of studies and other activities to enhance
    the professions public image
  • Legislation to support changes in scope of
    practice and entry to the profession

19
Optometry
  • Since 1898 optometry has benefited from a strong
    national organization, the AOA
  • From 1940 state and national associations have
    worked for legislation to ensure favorable
    reimbursement rates
  • National Board of Examiners in Optometry was
    created in 1951
  • The 1965 Medicare Act included Optometrists as
    qualified providers

20
Optometry
  • By 1989 all 50 states and DC had passed
    legislation to allow optometrists to employ
    pharmaceutical agents
  • Currently 49 states all optometrists to treat
    glaucoma
  • Optometrists are gaining the right to perform
    laser procedures.

21
Physical Therapy
  • Physical therapists in the U.S. created a
    professional association in 1920 that became the
    APTA in 1946
  • The educational requirements have been gradually
    upgraded from a certificate to a BS in the
    1950s. In the 1980 some programs began offering
    graduate degrees including the DPT degree
  • In 1983 APTA became the accrediting body in place
    of the AMA

22
Physical Therapy
  • By 2002 there were about 60 accredited DPT
    programs and 85 MPT programs in the U.S.
  • The APTA is lobbying state legislatures and the
    federal government to change Medicare to allow
    patients direct access to PTs instead of through
    medical referrals.
  • To date 39 states allow patients direct access to
    PTs for evaluation and some level of treatment

23
Podiatry
  • By 1940 podiatrists needed a doctorate in
    podiatric medical education to take the licensing
    exam in many states.
  • Today podiatrists enjoy a broad scope of practice
    in treating foot and ankle problems
  • The APMA Council on Podiatric Medical Education
    accredits podiatric medical schools and residency
    programs

24
Podiatry
  • Podiatrists were defined as physicians in the
    1965 Medicare Act. But Medicaid defines them as
    optional services
  • The Balanced Budget Act of 1997 stated that
    podiatrists should be paid equally to medical
    doctors providing the same service.

25
Audiology
  • Audiology has three major national associations
  • American SpeechLanguage-Hearing Association
    (ASHA)
  • American Academy of Audiology (AAA)
  • Academy of Dispensing Audiologists (ADA)

26
Audiology
  • Only 15-20 states have strong audiology
    associations. Some states have two associations
  • ASHA affiliated organizations are dominated by
    concerns of speech-language pathologists, the
    dominant profession in ASHA.
  • There is little agreement over which organization
    should accredit degree programs. An
    ASHA-affiliated organization accredits degree
    programs and certifies competency of
    audiologists.

27
Audiology
  • In 2003 the Accreditation Commission on Audiology
    Education (ACAE) was created representing the
    AAA, ADA and direcvtors of AuD programs
  • Federal legislation in 1998 allows federal
    employees to obtain care from an audiologisxt
    without a physicians referral
  • Audiology is lobbying for an amendment to
    Medicare to authorize audiologists to provide
    services to beneficiaries without a physician
    refferal

28
Dangers in Licensing ProfessionsCulture
dominated by professionals
  • Monopoly.
  • The public relinquishes control.
  • Medicalization -Professionals determine needs.
  • Conflicts of interest. Needs/interests of
    patient vs. profit for professionals Misdiagnosis,
    over prescription, unnecessary surgery

29
Dangers in Licensing ProfessionsCreates
Professional Dominance
  • Legitimizes monopoly.
  • Limits competition through licensing boards
    dominated by members of the profession.
  • Enhances professionals prestige, authority,
    income
  • Inadequate self-regulation
  • Resistance to change - Limited experimentation
    and innovation.
  • Higher direct costs to consumers.
  • Services unavailable to poor, those who cant
    pay.

30
Dangers in Licensing ProfessionsAttempts in
state legislatures to license
  • Auctioneers
  • Well diggers
  • Home improvement contractors
  • Pet groomers
  • Electrologists
  • Sex therapists
  • RV repairmen
  • Appraisers
  • Tattoo artists
  • Lightening rod salesmen

31
Solutions to the Problems Created by the
Licensing Professions
  • Courts have struck down state laws prohibiting
    professional advertising.
  • Certification is an alternative to licensing to
    protect against fraud and deception.
  • Separation of diagnosis from services.
  • Second opinions allow consumers to comparison
    shop.

32
How Serious is the Problem of Fraudulent
Physicians?
  • 1/50 or 10,000 practicing medicine with
    fraudulent credentials.
  • 1982-1984 Medicare payments. 8.5 million sent
    to 271 unlicensed doctors in Florida.
  • 60 of the patients of fake MDs are elderly.

33
Who are likely to become bogus doctors/nurses?
  • Chiropractors
  • Pharmacists
  • Nurses
  • Physician Assistants
  • Nurse Practitioners
  • Medics

34
How do Bogus Doctors Obtain their Credentials?
  • Some obtain forged medical degrees and become
    licensed.
  • Some open clinics/apply to hospitals where
    documents arent checked.
  • Assume the name of a living or dead or retired
    physicians.
  • Purchase fake credentials form phony universities
  • Graduates from foreign medical schools.

35
How can Bogus Doctors be Detected?
  • National practitioner clearing house lists
    disciplinary actions against physicians.
  • Some licensing agencies fingerprint applicants
    and perform background checks.
  • Laws can make it a felony to pose as an MD.
  • Provide state medical licensing boards with more
    investigators.
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