Module 4 presents an overview of the greatest resources within the hospital orga

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Module 4 presents an overview of the greatest resources within the hospital organization—-people! As medical education evolves into specialty and subspecialty practice, this affects the future of medical practice. Additionally, changes within other major health care professions impact the ever-changing landscape of the hospital environment.
Module 4 provided an overview of the growth and change in medical education from the colonial apprentice system to today’s high technology, specialty-oriented instruction in the basic sciences and clinical fields. The evolution of specialty and subspecialty practice was discussed, as was the funding of graduate medical education. The changes in the practice of medicine and physician relationships with hospitals and insures following the introduction of managed care were also reviewed. More recent developments such as clinical practice guidelines, physician report cards, Internet usage, and new ethical issues were explored.
Additionally, this module defined the major health care professions, with particular emphasis on their educational preparation, credentials, numbers, and roles in the health service system. The factors that influence demand for the various healthcare providers and the workforce issues that divide them were also reviewed. The module included a discussion of the development of health work-force policy and some expectations for the future.
Despite unending speculation about the evolving structure of health care services, there has been little fundamental change in the way health professionals are organized and the way they interact with each other. For physicians, the number and variety of contractual arrangements has increased significantly, as has the oversight from intermediaries in terms of utilization review. But there has been little change in the way most physician’s practice medicine. Furthermore, physicians remain the central figures in American health care with non-physician providers poised to play a more critical part in the delivery of health care services but as yet unable to significantly penetrate the system. Although nurse practitioners (NP)s, and physicians’ assistants (PA)s, and other health care provides may possess skills that appear to be well suited to the demands of an environment with a greater focus on cost containment and managing health behaviors, their roles have been limited by their small numbers and the still significant clout of the medical profession. However, changes in the relative supply for new providers, changes in the relative of new providers, and their emerging roles may alter the landscape more drastically over the next 10 to 15 years than has occurred in the past 30 years. These changes, in many ways, will determine how quickly and in what ways new service delivery forms develop in the future
Discussion Question:
In 1992, medical residency programs in the U.S. were described as “responsive principally to the service needs of hospitals, the interests of the medical specialty societies, the objectives of the residency program directors, and the career preferences of the medical students.” In fact, there are so many more residency programs than can be filled by American medical school graduates, that an annual influx of foreign educated physicians has been required to satisfy the service needs of many hospitals. In addition, until recently, there has been no attempt to match America’s needs for various kinds of specialty and generalist physicians with the hospital-based training programs that were producing them. In light of these facts, pose an opinion on this question:
Few graduates of medical school choose primary care, and instead flock to specialties with greater pay and prestige. Since primary care is the basis for maintaining health and early diagnosis of potential health problems, who should be responsible for rectifying this misplaced emphasis of health care, insurers, medical schools, the government, the AMA, and others?

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