Primary Care Provider
A Primary Care Provider (PCP) is defined as, an individual who is responsible for rendering primary healthcare services to another (Patient). This provider is also responsible for advising and counseling a patient on health-related matters as it pertains to a specific ailment or general health. In medicine, a PCP can be a generalist or a specialist in a field of medicine, such as cardiology. The PCP can also be a non-physician (mid-level practitioner) such as a physician assistant or nurse practitioner. The PCP can also be any of the following: Chiropractor, Homeopathic Physician, Naturopathic Physician, Acupuncturist, Ayer-Vedic Practitioner, Chinese or Western Medical Herbalist. It is highly recommended that even if someone is followed by a specialist such as an oncologist (cancer) they still should be followed by a PCP for everyday health concerns.
The title of “Physician” is defined as, an individual skilled in the healing arts, that is educated, trained and certified or licensed to practice medicine. Normally, Physicians go by the title of “Doctor” which means “teacher”. So, a “Doctor of Medicine” would be a “Teacher of Medicine”. The two most commonly known Physicians are the Medical Doctor and Doctor of Osteopathic Medicine. The training for both is similar in the fact that they both take the same basic medical science courses, which is four years in length. After medical school, the physician enters what is known as first-year residency, also called an internship. During the first-year residency, the physician is referred to as “Doctor” but does not have a license to practice and must be supervised by senior residents. Licensing usually takes place after the first year and before the third year of residency. The term “resident” comes from the fact that doctors in training often resided on the campus of the hospital during this period. Although things have changed over the years, the title of resident is still in use. The physician (in training) enters one of the many residential training programs that will lead to a certification in a specialty. Residency can last anywhere from three to five years depending on the specialty. The chief resident, also known as the senior resident is the one in charge of that specialty. After the first-year residency, the physician sits for the licensing exam. Physicians in training begin seeing patients early in their medical training and throughout medical school.
Internal medicine is one of the most popular specialties for physicians. After the residency is completed, the physician is eligible to sit for the board examination for internal medicine. These physicians are responsible for treating patients with a variety of conditions. Many internal medicine doctors take positions in hospitals as “hospitalists”.
These are Physicians that specialize in hospital medicine. These providers spend most of their time tending to patients in the hospital. This allows the primary care providers to focus on their patients in the office. Physician Assistants and Nurse Practitioners can assist the Hospitalist.
Some physicians continue training by entering a sub-specialty after the completion of residency training. For instance, a physician can complete an internal medicine residency and enter the sub-specialty of cardiology. Another example would be that a physician completes residency as a general surgeon and enters the sub-specialty of colorectal surgery.
Other doctorate level providers
In some states, other types of doctors can function as primary care providers, such as chiropractors, acupuncturists, and naturopathic physicians.
Chiropractors are doctorate level practitioners who have completed four years of graduate school. The first two years of chiropractic school are very similar to that of medical school where the students take the same basic medical science classes. The last two years focus on chiropractic theory, treatment, and care planning of the patient. Chiropractors do have residency training that can lead to board certifications. Examples of these residencies are Radiology, Neurology, Sports Medicine, Orthopedics and Nutrition. Chiropractors can order lab tests, diagnostic studies such as X-rays, CT scans and MRI’s to help formulate a diagnosis regarding a patient’s condition.
The acupuncturist is an individual who has completed training in Traditional Chinese medicine. Acupuncturists (Chinese Medicine Practitioner) have the option of furthering their education by entering a doctorate level training program which leads to the title of Doctor of Oriental medicine or DAOM. (See alternative medicine section for more information)
The last type of primary care provider is the Naturopathic Physician (ND). ND’s complete four years of naturopathic medical school after completing an undergraduate degree. The school they attend is like that of regular medical school (MD, DO) with the addition of natural health theory and philosophy. An ND, in a state which they are licensed may have limited prescription writing authority for commonly used drugs. They can perform many minor surgical procedures and tend to a birth. As of the writing of this book, most ND’s do not have admitting authority or inpatient privileges in most states.
Non-physician providers can act as primary care providers and are referred to as mid-level practitioners. They include Physician Assistants, Nurse Practitioners and Certified Nurse Midwives.
Physician Assistants (PA) are non-physician, mid-level practitioners who have a similar function as a physician. A PA can take a detailed history, perform a comprehensive physical exam, order labs and diagnostic testing such as X-rays, CAT scans and MRI scans The PA can diagnose, treat, educate patients, and provide prescriptions for medications with certain limitations according to each state. A Physician Assistant completes two years of formal college education to sit for the national exam. This formal college training can be either a Bachelor’s degree or a Master’s degree. Both degrees teach the exact same thing and there is a trend for all the training to be at the Master’s level. Each PA candidate must have at least 2000 hours of paid medical experience before being considered for acceptance. The first-year comprises of classroom education and theory. The second year focuses on direct patient care by way of clinical rotations. Typical rotations consist of: emergency medicine, surgery, obstetrics, gynecology, pediatrics, internal medicine, psychiatry, geriatric medicine, and dermatology.
PAs have the option of entering many types of residency programs offered throughout the country. These residency programs include: internal medicine, neonatology, emergency medicine, cardio thoracic surgery, orthopedic surgery, obstetrics, pediatrics, psychiatry, and dermatology just to name a few. The residency programs can last anywhere from two to four years and are affiliated with major medical centers and universities. Supervision of Physician Assistants is mostly done in an indirect fashion by a licensed Physician. The referring process to a physician or specialist is dictated by the supervising physician and the state of which the PA practices. The PA profession started in the late 1960’s as a response to a shortage of primary care providers. The first class of Physician Assistants to graduate comprised mostly of former US Navy corpsman that had just completed tours in Vietnam. Since then, the PA has become an integral part of the primary care team in medicine.
The Nurse Practitioner (NP) is a registered nurse who has completed a Masters’ degree in Advanced Practice Nursing. The training for NP’s is very similar to that of the Physician Assistants. The scope of practice is also like that of the physician assistant. The NP can take a detailed history and perform a comprehensive physical exam. Labs and diagnostic tests can be ordered and interpreted. After a diagnosis has been made, a treatment plan is formulated. The NP has prescription writing privileges with certain limitations based on the state of which they practice. The Nurse Practitioner may enter residency programs which are offered through medical schools, Universities and Hospital based programs. This profession, over time has become an integral part of primary care
PCP’s are normally found in some type of practice. Medical practice can come in different forms. The most common form is the solo practitioner office. This is where a physician owns and operates the practice. As with any practice it can be staffed with medical assistants and office personnel. The next type of practice is the group practice. This is where more than one medical practitioner owns a stake in the office. A multi-disciplined practice has two or more practitioners that specialize in different areas of medicine. All practice models can apply to medical physicians, chiropractic physicians, naturopathic physicians and acupuncturists. Primary care providers can also be found in clinics and urgent care center
Other Staff Found in the Inpatient Setting
Consultants are physicians who are residents or board-certified specialists. They report their findings to the attending physician and offer advice. Consultants can also be non- physician providers such as physician assistants and nurse practitioners who work in a specialty.
Chief of staff (Medical Director)
The Chief of Staff is also known as the medical director and is the senior physician in the hospital or medical center. The Chief of Staff can be elected either by peers or the board of directors. The Chief of Staff has authority over the medical staff and monitors quality of care and performance of other physicians. The Chief of Staff can also act as mediator between physicians and between administration and physicians. The Chief of Staff is always a physician.
Where there is a hospital, you will find nurses. In the hospital, the nursing staff is usually comprised of registered nurses. A registered nurse is an individual who has undergone medical and nursing training and is responsible for carrying out the treatment plan set by the providers. The function and the scope of practice of the registered nurse can vary from state to state. The level of training for a registered nurse can vary as well. There are different levels of degree training for the RN, from the Associates degree to PhD. A registered nurse must take a comprehensive written exam prior to licensing in any given state.
Registered nurses are responsible for; assessment of patients, carrying out all legal medical orders of practitioners, administering medications such as oral and Intra-venous medication, maintaining safety and proper hygiene of the patient, formulating and carrying out plans of care, and supervises the practice of other nursing and non-nursing personnel.
Associate Degree in Nursing
The associate level degree nurse is an individual who has completed a two-year degree of nursing science at a community college. After this training, the individual sits for the licensing examination and upon passing is awarded the title registered nurse. The scope of practice for this level RN is the same as any other standard registered nurse. The two-year or Associates degree RN training program focuses primarily on hands on techniques
Bachelor’s Degree Level
The bachelor’s degree level nurse is an individual who has completed four years of under-graduate school focusing on nursing science. It individual does not need an Associate’s degree in nursing to enter the bachelor’s degree program. The bachelor’s degree program tends to focus on theory and management in addition to nursing technique. In most hospitals, for a nurse to go into management, a bachelor’s degree in nursing is required. Some hospitals have elected to compete for magnet status. To be magnet certified a certain percentage of the nursing staff must be at the bachelor’s degree level or higher.
Master’s Degree in Nursing
A Master’s degree in nursing is also known as the MSN. An individual entering this program does not need to be a BSN, but must have a bachelor’s degree in any field endeavor. The Master’s degree level nurse tends to focus on theory and management with the addition of research. Some Masters programs lead to the specialty such as, advanced practice nurse, advanced clinical nurse, nurse practitioner, nurse administrator, nurse anesthetist or other specialty. This degree is needed for it individual to enter the doctorate level training program for nursing.
The charge nurse is a senior nurse who is tasked with the responsibility for the operations of a unit or floor during a shift. The charge nurse is responsible for the safety of staff and patients. He or she is also responsible for the mediation of any disputes, delegates assignments and supervises junior nursing staff. The charge nurse reports directly to the unit manager or hospital supervisor. The charge nurse is always a registered nurse.
The unit director is responsible for the overall operations of the department. This position is always a registered nurse with an emphasis on having a bachelor’s degree or higher. The director reports to the Chief Nursing Officer (CNO). The director is also responsible for budgeting, staffing, and hiring of individuals.
The Nursing Supervisor is a senior level nurse who is responsible for the overall safety of patients within the hospital. The nursing supervisor is also responsible for all nurses in the hospital. The nursing supervisor is also the acting administrator in charge in the absence of senior administration staff, especially at night. During a disaster, the Nursing Supervisor will act as Incident Commander until properly relieved by higher authority. The Nursing Supervisor can also act as Director of Nursing in the absence of the chief nursing officer.
Chief Nursing officer
The Chief Nursing Officer (CNO), also known as the Director of Nursing, is the most senior nurse in a hospital setting. The CNO tends to be at the level of vice president. The CNO directly reports to either the Chief Operating Officer (COO) or Chief Executive Officer (CEO). The CNO is also responsible for the overall care and safety of all patients.
Other Nursing staff
Licensed Vocational Nurse
A Licensed Vocational Nurse (LVN) is a nursing professional who has completed roughly one year of nursing. An LVN is licensed to carry out nursing responsibilities with defined limitations. The scope of practice for an LVN is determined by each state. LVN's can be indirectly and directly supervised by registered nurses, Physicians, Physician Assistants and Nurse Practitioners. Military corpsman and medics can sit and take the LVN exam in certain states. LVN's perform functions such as; assessing patients, collecting data, administering medications (varies from state to state), help formulate care plans, can carry out physician's orders within their scope of practice, and provide patient education. LVN's can be found in hospitals, skilled nursing facilities, home health agencies, schools and clinics.
Certified Nursing Assistants
Certified Nursing Assistants are individuals who assist in the care of patients under the direction of licensed nurses. A CNA normally attends a certified nursing assistant program. CNA's do not administer medication or assess patients. A CNA's primary responsibility is, helping patients with dressing, eating, bathing and ambulating.
Physical therapists are trained professionals who specialize in rehabilitation and restoration of muscle dysfunction and mobility of various sports, trauma and post-surgical injuries. The training of a physical therapist can be at the Masters or Doctorate degree level. In the hospital the physical therapist acts as a consultant by order of the attending physician. The physical therapists are responsible for complete evaluation of the functionality of the patient and offers recommendations. The physical therapist will formulate a care plan and follow the patient's progress throughout the patients stay. Physical therapy can continue at home or at a skilled nursing facility after a hospital stay.
Occupational Therapists are trained individuals who work with patients who need to regain their physical function for daily living activities. Occupational therapy much like physical therapy has multiple degree levels as well, which includes a bachelor’s and master’s degree in occupational therapy. The Occupational Therapist acts as a consultant by order of the attending physician. The Occupational Therapist evaluates, recommends treatments and formulates occupational care plans. Much like physical therapy, occupational therapy can continue outside the hospital at home or at a skilled nursing facility.
Respiratory Therapists are professionals who specialize in the cardiopulmonary rehabilitation of patients. They work as consultants by order of the attending physician or pulmonologist. The Respiratory Therapist carries out functions such as: administering inhaled medications, ventilation support, ventilation monitoring, pulmonary function testing, and in the care and treatment of respiratory ailments. Respiratory therapists attend training that leads to either an Associate’s degree or a bachelor’s degree in respiratory therapy. Respiratory therapy can also continue working at home or skilled nursing facilities.
Radiology Technologists are trained professionals who work in the radiology department. Radiology technicians can be responsible for a wide range of tasks. These technologists also can receive advanced training in the areas such as: ultrasound, CAT scan, MRI, PET scan, basic x-ray, catheterized lab and radiation therapy. The basic entry level education is an Associate’s degree.
Laboratory Technologists (Medical Technologist) are bachelor’s degree trained lab scientists who concern themselves with processing and analyzing laboratory specimens and report their findings to the appropriate providers. Laboratory technologists are not to be confused with laboratory assistants.
Phlebotomists are trained personnel who collect specimens which can include drawing blood. They can also act as laboratory assistants. The phlebotomist is responsible for going to the patient's room and collecting various specimen samples.
Ward Clerks (unit secretary)
Ward clerks act very much like secretaries of the floor. Their job entails answering phones, call lights, organizing files and processing orders into the computer.
Registered Dietitians are responsible for conducting nutritional screening and evaluations of patients in the hospital. These evaluations help plan for adequate nutrition therapy that complement the care plan set by the attending provider. A typical dietitian has a college level degree which can be either a Bachelor’s or Master’s. Dietitians can also be found in the outpatient setting as well.
Dietitian assistants perform duties that assist the Registered Dietitian. Duties include simple diet screenings, follow up and data collection.
Food Service Worker
The food service worker should not be confused with the Dietitian. The food service worker helps prepare and deliver meals for patients.
Case management is focused on proper utilization of resources and the coordination of each patients care in and out of the hospital. The Case Manager helps ensure that each patient is seen by the right provider, at the right time and for the right reason. This person is also responsible for ensuring that each day in the hospital is medically necessary and is responsible for providing proper documentation to support such need to each individual health plan. Case Managers also help with discharge planning. Discharge planning begins at admission. The goal of the hospital stay is to stabilize the patient so he or she can go back to their prior living situation. Such things as medical equipment, follow up appointments, medications and transportation back to home are considered in the discharge plan. In some hospitals, discharge planning is handled by discharge planners. Case Managers are a majority of the time Registered Nurses and at times Licensed Vocational Nurses (LVN) with a vast clinical background and knowledge of insurance issues that pertain to medical needs.
Social Services can be an invaluable resource for patients who lack meaningful support from family or friends. Any patient who is having difficulties which can become a barrier to the healing process can gain benefit from these services. The social services department is made up of Social Workers who have obtained their Master’s degree in social work. Some have gone the extra step in gaining licensure as a clinical social worker. These professionals can provide a wide array of resources such as: housing, food, disability, transportation and additional medical or mental health assistance. Social workers can also help with clothing donation, medication assistance, substance abuse referrals and counseling.
Most hospitals are adopting what is known as “patient relations”. This is a department comprised of clinically experienced nurses who are trained in conflict resolution. They handle patient complaints as well as staff issues. The patient relations staff member seeks understanding and resolution to any crises. Patient relations can be a strong resource for the patients and their families. A consult to patient relations can be requested by anyone concerned.
A team of professionals who can help identify, clarify and foster relevant ethical values and goals and act as facilitators to reach resolutions to conflicts. Consults can be requested by a family member, patient, clergy, doctor, nurse, case manager, social workers, and legal representatives.
Discharge planners help patients and their families plan for a smooth discharge home or to a skilled nursing facility. Discharge planners can help set up home health services and order medical equipment. The discharge planner can also help arrange placement at a skilled nursing facility, Long Term Acute Care Center (LTAC), board and care or sub-acute facility. The discharge planner can help the patient and their family understands co-pays and any other cost associated with DME, Home Health or placement. The discharge planner will meet with the patient early in the admission to discuss discharge planning.
Some hospital employs individuals who can help patients navigate the often-confusing world of Medicaid and help identify any other additional resources for those individuals who need assistance financially with the admission to the hospital.
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