01 Oct The ACA includes several provisions with significant effects on public health. One of these was the establishment of the Prevention and Public Health Fund.

This assignment reinforces information in your textbook and concepts presented in this unit. Your responses to the items below should be thorough, well-conceived college-level responses that are grammatically correct. Please write your answers in complete sentences. You must justify your responses with facts and details from the reading assignments and with your conclusions. It is recommended that you work through this assignment as you complete your reading assignment. Complete the questions and items below.

Questions

The ACA includes several provisions with significant effects on public health. One of these was the establishment of the Prevention and Public Health Fund. Summarize how this fund will be beneficial in improving the health of the public. (One to two paragraphs is an appropriate length)

Identify and summarize two of the four of the issues that remain central to the ACA’s workforce initiatives. (One paragraph is an appropriate length.)

How has the passage of the ACA impacted medical education as it relates to the delivery, access, and quality of services? (One paragraph per heading is an appropriate length.)

With the ACA’s new parity provisions for insurance coverage, newer models of care are emerging that emphasize the integration of behavioral health services with primary care. What are the benefits of this integration? Give some examples of how it is benefitting consumers. (One paragraph per innovation in an appropriate length)

Chapter 6 Medical Education and the Changing Practice of Medicine Medical Education: Colonial America to the 19th Century • No medical schools • Sick were treated with medicinal herbs and anecdotal information in their homes • Few university-trained European physicians emigrated to America; trained colonial “medical students” in apprenticeships • No formal methods of testing new physicians; practiced without regulation of any kind Medical Education: Colonial America to the 19th Century • Apprenticeship training with mentors continued until hospitals founded in mid1700s • First medical school established in 1756 (College of Philadelphia), 2nd at King’s College, 1768 (later Columbia Univ.) • 1800: only four U.S. medical schools added; each had a few faculty members teaching all courses Flexner Report and Medical School Reforms • 1904, AMA developed – Council on Medical Education: address needed educational improvements and standards – JAMA: published medical school state licensing failure statistics and group schools by failure rates, demanding poor schools to improve or resign the association Flexner Report and Medical School Reforms • 1905: Support for AMA reforms by Carnegie Foundation for the Advancement of Teaching; examine all 155 US & Canadian schools’ entrance requirements, faculty, laboratories & hospital relationships • Schools’ cooperated believing that review would lead to Carnegie Foundation support Flexner Report and Medical School Reforms • “Medical Education in the U.S. and Canada” – Lauded some schools: Harvard, Western Reserve, McGill, U of Toronto, Johns Hopkins (cited as a “model for medical education”) – Stimulated support from foundations & wealthy; University affiliated schools w/favorable ratings were primary recipients establishing future influence over future directions – Licensing legislation pursued; new standards for training duration, labs & other facilities Graduate Medical Education Consortia • Formal associations of medical schools, teaching hospitals, other organizations involved in residency training to improve organization, governance, MD supply and distribution through local coordination. • MD: allopathic physicians (138 schools); DO (Doctor of osteopathy- 29 schools); degrees are equivalent • No national licenses; state medical boards license with specific requirements; 3-7 yr. residency accredited by Accreditation Council for Graduate Medical Education (ACGME) required. Graduate Medical Education Consortia • ACGME: not-for-profit independent organization dedicated to quality of residents’ training – Accredits ~ 9,000 U.S. residency programs; also addresses MD distribution and supply – 2012 transition to outcomes-based evaluation system to measure competencies. – ACA: redistribute specific resident training slots to needed specialties and areas with Medicare reimbursement flexibility Delineation and Growth of Medical Specialties • AMA concerns began in mid 1800s: – Fragmented care (not treating “whole patient”) • AMA slow response prompted specialists to form their own societies – Late 1800s: specialty associations formed in ophthalmology, otology, obstetrics & gynecology, pediatrics Delineation and Growth of Medical Specialties • Deficient training of medical specialists – At 1910 Flexner Report, huge variations in specialty training duration & quality; virtually any physician could call themselves a “specialist.” – 1917 WWI army recruitment revealed shocking “unfit” to practice as “specialist” MDs and some overall “unfit” – American College of Surgeons est. oversight & practice standards for certifying surgeons in 1917 Delineation and Growth of Medical Specialties • Deficient training of medical specialists, cont’d – 1924: AMA Council on Medical Education began approving hospitals for residency specialty training programs; for next 40+ years, poorly conducted programs persisted – AMA: Citizens Committee on GME, chaired by John Mills; 1966 report eliminated independent internships, awarding residency accreditation to institutions, not hospital departments; report led to current residency requirements Delineation and Growth of Medical Specialties • Deficient training of medical specialists, cont’d – 1970: “internship” dropped; AMA endorsed first year graduate training in a program approved by a “residency review committee (RRC);” by 1980 AMA issued training recommendations for the first postdoctoral year. – Current curriculum for specialization: well defined & standardized: medical school graduation-> approved residency program-> pass qualifying examination(s). Specialty Boards & Resident Performance • Hospitalists – Growing field outside of formal specialty training; sole responsibility caring for hospitalized patients; 30,000 in practice in 70% of U.S. hospitals – Most trained in internal medicine or pediatrics – Hospitalist benefits: expedite & improve coordination of hospital care, reduce costs, enable continuity, improve patient satisfaction – Current initiatives to “certify” role in relevant specialties Physician Workforce Supply and Distribution • Mid 1960s: Government predicted national MD shortage; policies to increase no. of MDs – Medical schools increased by 50%: students by 100% • 1980-2000:

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