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SOC 574 The Health Professions James G. Anderson, Ph.D. Purdue University 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 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 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 Indicators Cognitive 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 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 Indicators Autonomy 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 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 Indicators Organizational 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 Indicators Relational 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 Parameters of a Profession Value Components: Service, Commitment, Calling “Do no harm” to patients Confidentiality Code of professional ethics Licensing Professions Licensing protects the public from incompetence/charlatans Licensing also creates a professional monopoly for services Process by Which Occupations Evolve into Professions Licensed Professionals Qualifying Examinations Certified Professionals Academic Training Tradesmen Apprenticeship Individual Workers On-the-Job Training 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 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 Veterinarians 79 78 Secretaries 61 Therapists/Healers 58 Public Prestige Ratings for Health Care Occupations Occupation Mail Carriers Rating 53 Student Nurses 51 Medical/Dental Technicians 48 RNs 46 Postal Clerks 44 Opticians 39 Dieticians/Nutritionists Policeman 39 39 Physician Office Attendants 38 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 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 profession’s public image Legislation to support changes in scope of practice and entry to the profession 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 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. 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 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 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 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. Audiology Audiology has three major national associations American Speech—Language-Hearing Association (ASHA) American Academy of Audiology (AAA) Academy of Dispensing Audiologists (ADA) 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 ASHAaffiliated organization accredits degree programs and certifies competency of audiologists. 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 physician’s referral Audiology is lobbying for an amendment to Medicare to authorize audiologists to provide services to beneficiaries without a physician refferal Dangers in Licensing Professions Culture 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 Dangers in Licensing Professions Creates Professional Dominance Legitimizes monopoly. Limits competition through licensing boards dominated by members of the profession. Enhances professional’s prestige, authority, income Inadequate self-regulation Resistance to change - Limited experimentation and innovation. Higher direct costs to consumers. Services unavailable to poor, those who can’t pay. Dangers in Licensing Professions Attempts in state legislatures to license: Auctioneers Well diggers Home improvement contractors Pet groomers Electrologists Sex therapists RV repairmen Appraisers Tattoo artists Lightening rod salesmen 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. 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. Who are likely to become bogus doctors/nurses? Chiropractors Pharmacists Nurses Physician Assistants Nurse Practitioners Medics How do Bogus Doctors Obtain their Credentials? Some obtain forged medical degrees and become licensed. Some open clinics/apply to hospitals where documents aren’t checked. Assume the name of a living or dead or retired physicians. Purchase fake credentials form phony universities Graduates from foreign medical schools. 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.
