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Brittany Pickering“>Brittany Pickering

Brittany Pickering

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Compare and contrast 2 of the following major types of health services professionals: physicians, nurses, dentists, pharmacists, physician assistants, nurse practitioners, and certified nurse midwives. Include their roles, training, practice requirements, practice settings, policy impact, and workforce issues.

There are many similarities and also many differences between physicians and registered nurses. One of these similarities is the ability to work within a hospital, in an office, in public health, or various other settings. Another similarity is the ability to become specialized in a specific area of healthcare. Nurses and physicians both have this opportunity with increased education, testing, and certifications. Nurses and physicians must both receive an education through an accredited school and then pass a national board exam in order to receive their licensure and ability to practice. Both, physicians and nurses also interact with patients and provide direct care.

There are also many differences between nurses and physicians. One of the biggest differences is the different scopes of practice. The scope of practice of a physician is much greater. They have the ability to diagnose, prescribe medications, inform patients of results and are able to perform much more extensive procedures. A registered nurse’s scope of practice is much narrower than that of a a physician. A registered nurse has the ability to assess patients and develop a nursing care plan, but can not prescribe medications or treatments, or diagnose a patient. They must receive orders from and practice under the guidance of a physician. Another significant difference between physicians and nurses is the amount of schooling required to obtain licensure. Physicians must receive a doctoral level degree (MD or DO) from an accredited school, complete a 2-6 year residency and pass a national board exam (Shi & Singh, 2023). As a registered nurse, there are various levels of education that can prepare you to pass the NCLEX and obtain your licensure. Nurses must obtain either a diploma, associates level nursing degree, or bachelors level nursing degree which can take 2-5 years to complete (Shi & Singh, 2023).

As nurses comprise the largest profession in health care, it allows them to have a significant impact on policies. Physicians also have a large impact on policies due to their level of education and the fact that they hold a central role in healthcare (Shi & Singh, 2023). Both nurses and physicians are already and will continue to experience a worsening shortage of personnel. As the population increases and ages, the demands for healthcare are also increasing. This creates a need for more physicians and nurses than ever before. There has been public funding put into place for both physician and nursing education in an effort to decrease these shortages. According to Beth Ulrich, EdD, RN, FACHE, FAONL, FAAN, nurses and physicians must work together to prevent further nurse and physician shortages. Interprofessional collaboration is key to advocating for changes in health care and to making a significant impact on policies. Nurses and physicians must first understand each others roles and competencies though in order to work well together (Ulrich, 2023).

Discuss the interrelationship between medical providers and professional and the patients they serve with the context of an overarching health care delivery systems.

When health care professionals work together as a multidisciplinary team this results in better patient outcomes and patient satisfaction. The ability for each role to voice their opinion based on their expertise allows for a better plan of care to be developed. This is especially beneficial when attempting to provide patient-centered care. When everyone works together as a team to provide the patient with the best care and listens to the patients values and beliefs it results in greater patient satisfaction. In a study done in Sweden, they saw a significant increase in time of admission to time of treatment and a decrease in length of stay (Rosell et al, 2018). In the U.S. the focus of the health care delivery system is on treating those who are sick and treating acute illnesses. The focus is not on preventative care, so this makes it even more important for all the different health care roles to work together in order to treat the patient and to achieve the best outcome possible. Romans 12:4-5 says “For as we have many member in one body, but all members do not have the same function, so we, being many, are one body in Christ, and individually members of one another” (New King James, 1982). I believe this biblical principle can be applied to healthcare and the use of the multidisciplinary team. Each member of the team serves a different and unique purpose, but working together we have the ability to provide the best care possible. 

Mariah Cad

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In the United States, the healthcare system is the largest employer. Approximately 12% of the nation is employed in the system and are directly affected by health care policy, industry changes, and technological advancements (Shi & Singh, 2023). This system employs both health care providers as well as health care professionals. Primary care providers encompass all physicians, nurse practitioners, and physician assistants who have license and ability to prescribe, diagnose, and prognose conditions. Those roles require advanced training (Shi & Singh, 2023).

Physician Roles, Licensure, Training, and Practice Requirements

Physicians can either carry the licensure of Medical Doctors (MD) or Doctor of Osteopathy (DO). The number of physicians per capita in the US has steadily increased over the last 70 years. The role of a physician includes prescribing medications, utilizing surgery or procedures, diagnosing, and constructing a treatment plan that is communicated with the treatment team who carries out the physician’s orders. Both MD’s and DO’s can accomplish this as their role in the health care industry. While MD’s tend to be more focused on disease management, DO’s primarily focus on holistic practices such as preventative practices, diet, lifestyle, and environmental factors. Both MD’s and DO’s have the ability and capability to generalize or specialize. If they generalize, they might go into a family practice or internal medicine role where they see several patients with general symptoms.

Contrarily, the physician can also specialize. When a patient goes to a generalist but requires further treatment and care for specific symptoms related to a specific disease or organ system that requires more detailed care than the generalist can provide. Specialists might be pulmonologists (lungs), cardiologists (heart and circulatory system), oncologists (cancer), urologist (kidney), orthopod (bones, joints, cartilage), pediatrician (doctor for children or infants), and so forth. One patient might have a primary care physician (generalist) who oversees their general care, diabetes medication, blood pressure medicine, immunizations, and annual physical. They might also have a few specialists they see on a regular basis for their atrial fibrillation (cardiologist), neuropathy (neurologist), and prostate cancer (oncologist). In some cases, there may be overlap. For example, a generalist can prescribe blood pressure medication, but might do so after consulting with the cardiologist to see what the cardiologist is recommending regarding specific medication, dosage, route, and frequency.

Physicians must be board certified in the United States, and they must practice only in the scope of practice for which they have been board certified. A dermatologist cannot practice cardiology unless they pass boards for cardiology and meet all requirements for the specialty. Licenses are issued by state (22 & Murphy, 2019) Additionally, according to the American Medical Association, Physicians are required to complete Medical School, pass all three parts of the USMLE (United States Medical Licensing Exam) which are taken separately, complete a residency, and earn board certification in the field for which they will practice medicine. (22 & Murphy, 2019)

Physician Policy Impact and Workforce Issues

Physicians were affected by the Affordable Care Act. When the largely uninsured population became insured due to the political reform, the patient market became flooded (Shi & Singh, 2023). Many of these people were over the age of 50, had comorbidities, and had not seen a physician for a regular checkup in some time due to not having health insurance. This affected both generalists and specialists, and the shortage is expected to continue. Additionally, even though life expectancy in the United States began decreasing in 2019 and is expected to continue to decrease (Woolf & Schoomaker, 2019), the number of American citizens over the age of 75 has increased and is expected to continue to increase through the year 2030 (Shi & Singh, 2023). This will require either more geriatricians (physicians specialized in geriatrics), or it will mean that primary care physicians and generalists will continue to require further education to continue to meet the needs of their aging patient population.

According to the text, there is also a maldistribution of physicians between generalists and specialists with many physicians opting to pursue specialty fields, leaving a shortage in the number of primary care providers needed to see patients. One of these reasons could be the issues we have experienced with Medicare Reimbursements. Physicians have continued to see patients who are on Medicare while Congress has reduced the amount of Medicare reimbursements to physicians, requiring them to make less money for the same work (Kronick et. al, 2019). This is not just an issue for generalists, but also for hospitals treating Medicare patients. It is expected that due to these policy and pay issues, physicians will continue to pursue specialty fields over generalist practice, and the ratio of generalists to specialists will continue to be unbalanced moving forward.

Nurse Roles, Licensure, Training, and Practice Requirements

Nurses can be called “Nurse” and have one of several different types of licensure, training, and/or practice requirements. A bachelor’s degree is not required to practice nursing. A Registered Nurse (RN) is a nurse that has attended a Registered Nursing school program Associates Degree program and has passed the NCLEX-RN licensure exam. A Licensed Practical Nurse (LPN) can only practice under the supervision of a senior medical professional, and they must complete a Practical Nursing program. They must also pass a licensure exam, the NCLEX-PN. A nurse can have a Bachelor’s degree, as well. This is the Bachelor’s of Science in Nursing (BSN), and most BSN programs concurrently serve as RN programs, so that the nurse earns both a BSN and an RN at the same time, and passes the NCLEX-RN. These nursing programs are approximately 1-2 years following the completion of prerequisites to attend the program (Shi & Singh, 2023). According to the text, this collective group of “nurses” made up of all different types of nurses with all different types of degree programs and nursing licensure is constitutes the largest collective group of healthcare professionals, and are the main caregivers for the sick and wounded.

Nurses can move easily and quickly from one specialty or setting to another. In this way, they are very much unlike the physician, who has to board-certify in different specialties. For example, a nurse working in a Neuro-ICU can quickly move into a dermatology clinic without having to obtain additional licensure. They may have to receive additional training or certifications to be fully functioning in their new role, but they do not have to license or attend additional nursing schooling to switch fields (Shi & Singh, 2023).In this way, nursing is a highly versatile field where one key opens thousands of doors. Nurses can also easily move into advanced practice, with options of becoming a Nurse Anesthetist, Nurse Practitioner, or Nurse Midwife. These fields do require a bachelor’s degree in Nursing and additional school work and licensure, and they are specialized. A nurse practitioner cannot practice anesthesia unless they are board certified CRNA in addition to their NP.

Nurse Policy Impact and Workforce Issues

Two key policy factors that largely impact the nursing workforce include the incorporation of the travel nurse role and temporary nursing staff (PRN staff) to fill transient shortages for hospital nursing roles and the Nursing Staffing Standards for Hospital Patient Safety and Quality Care Act reintroduced to Congress in March 2023. This act largely mirrored a California Bill that went into effect in 2004. Following this bill, nursing staffing standards were brought to a minimum in all situations for patient safety and nurse ability. In the years following the 2004 rollout, California experienced significant patient safety improvement rates and less nursing burnout (Lasater et al., 2021). There is effort to mirror this federally so that the entire United States can experience the elevation in patient safety and nurse retention. However, a nursing shortage already exists. Currently, many hospitals staff for only 80% capacity because it is not cost effective to have nurses staffed without patients present. Therefore, the hospitals have designed a transient workforce population in the means of having temporary staff (PRN, contract nurses) who are not full time staffing workforce, but only staff during the times of elevated patient census. Because these transient staff do not have benefits of full time employment, they are often paid more than the regular staffing workforce. This can create tension between hospital regular staff and the transient workers. If the California bill is successful in the federal court, this could possibly deepen the nursing requirements and create further shortage.

Interrelationship Between Medical Providers and Professionals

The dynamics involved between those who provide medical care directly and those involved in the delivery of health care services can be complex. Physicans discuss reimbursements, referrals, and the need for and types of studies required that are supplied by Allied Health Professionals. For example, an Intensivist Physician working in an ICU with a patient requiring enteral feeds and having both kidney failure, diabetes, and osteopenia might defer to the judgement of a Registered Dietician to order the correct tube feedings, and would work with a Case Manager to ensure that Medicare would pay for the tube feedings. In some ICU’s, both the Registered Dietician and the Case Manager will do patient rounds with the physician to ensure that there is productive and immediate communication, and if one tube feeding will not be reimbursed, the RD can quickly discuss an alternative with the physician so that the patient does not go without the proper nutrition. The same can also occur when a patient is ready to move from the Neuro Step Down unit to a Neuro rehab facility following a stroke. The physician might have a plan of care, yet the Case Manager will be required to discuss the patient’s insurance specifics regarding rehab placement, the number of days per facility, and several other factors that the physician might consider when determining the proper plan of care for the patient