A health professional or health-care provider is an individual who provides preventive, curative, promotional or rehabilitative health care services in a systematic way to people, families or communities.
A health professional may operate within medicine, surgery, midwifery, dentistry, nursing, pharmacy, psychology or allied health professions. A health professional may also be a public/community health expertee working for the common good of the society.
Practitioners and professionals
Health care practitioners include physicians, dentists, pharmacists, physician assistants, nurses, advanced practice registered nurses, surgeons, surgeon's assistant, athletic trainers, surgical technologist, midwives, dietitians, therapists, psychologists, chiropractors, clinical officers, social workers, phlebotomists, occupational therapist, physical therapists, radiographer, respiratory therapists, audiologists, speech pathologists, optometrists, emergency medical technicians, paramedics, medical laboratory scientists, medical prosthetic technicians and a wide variety of other human resources trained to provide some type of health care service. They often work in hospitals, health care centres, and other service delivery points, but also in academic training, research, and administration. Some provide care and treatment services for patients in private homes. Many countries have a large number of community health workers who work outside formal health care institutions. Managers of health care services, health information technicians, and other assistive personnel and support workers are also considered a vital part of health care teams.
Health care practitioners are commonly grouped into a number of professions:
- Medical (including generalist practitioners and specialists)
- Nursing (including various professional titles)
- Midwifery (including Obstetrics)
- Dentistry (including dental team members)
- Allied health professions
- Health Scientists
Within each field of expertise, practitioners are often classified according to skill level and skill specialization. "Health professionals" are highly skilled workers, in professions that usually require extensive knowledge including university-level study leading to the award of a first degree or higher qualification. This category includes physicians, physician assistants, dentists, midwives, registered nurses, pharmacists, physiotherapists, optometrists, and others. Allied health professionals, also referred to as "health associate professionals" in the International Standard Classification of Occupations, support implementation of health care, treatment and referral plans usually established by medical, nursing, and other health professionals, and usually require formal qualifications to practice their profession. In addition, unlicensed assistive personnel assist with providing health care services as permitted.
Another way to categorize health care practitioners is according to the sub-field in which they practice, such as mental health care, pregnancy and childbirth care, surgical care, rehabilitation care, or public health.
Mental health practitioners
A mental health practitioner is a health worker who offers services for the purpose of improving the mental health of individuals or treating mental illness. These include psychiatrists, clinical psychologists, clinical social workers, psychiatric-mental health nurse practitioners, marriage and family therapists, as well as other health professionals and allied health professions. These health care providers often deal with the same illnesses, disorders, conditions, and issues; however their scope of practice often differs. The most significant difference across categories of mental health practitioners is education and training.
Maternal and newborn health practitioners
A maternal and newborn health practitioner is a health worker who deals with the care of women and their children before, during and after pregnancy and childbirth. Such health practitioners include obstetricians, midwives, obstetrical nurses and many others. One of the main differences between these professions is in the training and authority to provide surgical services and other life-saving interventions. In some developing countries, traditional birth attendants, or traditional midwives, are the primary source of pregnancy and childbirth care for many women and families, although they are not certified or licensed.
Geriatric care practitioners
A geriatric care practitioner plans and coordinates the care of the elderly and/or disabled to promote their health, improve their quality of life, and maintain their independence for as long as possible. They include geriatricians, adult-gerontology nurse practitioners, clinical nurse specialists, geriatric clinical pharmacists, geriatric nurses, geriatric care managers, geriatric aides, and others who focus on the health and psychological care needs of older adults.
Surgical practitioners
A surgical practitioner is a healthcare professional who specializes in the planning and delivery of a patient's perioperative care, including during the anaesthetic, surgical and recovery stages. They may include general and specialist surgeons, surgeon's assistant, assistant surgeon, surgical assistant, anesthesiologists, anesthesiologist assistant, nurse anesthetists, surgical nurses, clinical officers, operating department practitioners, anaesthetic technicians, perioperative nursing, surgical technologists, and others.
Rehabilitation care practitioners
A rehabilitation care practitioner is a health worker who provides care and treatment which aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. These include physiatrists, rehabilitation nurses, clinical nurse specialists, nurse practitioners, physiotherapists, orthotists, prosthetists, occupational therapists, recreational therapists, audiologists, speech and language pathologists, respiratory therapists, rehabilitation counsellors, physical rehabilitation therapists, physiotherapy technicians, orthotic technicians, prosthetic technicians, personal care assistants, and others.
Eye care practitioners
Care and treatment for the eye and the adnexa may be delivered by ophthalmologists specializing in surgical/medical care, or optometrists specializing in refractive management and medical/therapeutic care.
Oral health practitioners
A dental care practitioner is a health worker who provides care and treatment to promote and restore oral health. These include dentists and dental surgeons, dental assistants, dental auxiliaries, dental hygienists, dental nurses, dental technicians, dental therapists, and related professionals.
Foot care practitioners
Care and treatment for the foot, ankle, and lower leg may be delivered by podiatrists, pedorthists, foot health practitioners, podiatric medical assistants, podiatric nurse and others.
Public health practitioners
A public health practitioner focuses on improving health among individuals, families and communities through the prevention and treatment of diseases and injuries, surveillance of cases, and promotion of healthy behaviors. This category includes community and preventive medicine specialists, public health nurses, clinical nurse specialists, dietitians, environmental health officers, paramedics, epidemiologists, health inspectors, and others.
Alternative medicine practitioners
In many societies, practitioners of alternative medicine have contact with a significant number of people, either as integrated within or remaining outside the formal health care system. These include practitioners in acupuncture, Ayurveda, herbalism, homeopathy, naturopathy, Siddha medicine, traditional Chinese medicine, traditional Korean medicine, and Unani. In some countries such as Canada, chiropractors and osteopaths (not to be confused with doctors of osteopathic medicine in the United States) are considered alternative medicine practitioners.
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Practice conditions and regulations
Shortages of health professionals
Many jurisdictions report shortfalls in the number of trained health human resources to meet population health needs and/or service delivery targets, especially in medically underserved areas. For example, in the United States, the 2010 federal budget invested $330 million to increase the number of doctors, nurses, and dentists practicing in areas of the country experiencing shortages of health professionals. The Budget expands loan repayment programs for physicians, nurses, and dentists who agree to practice in medically underserved areas. This funding will enhance the capacity of nursing schools to increase the number of nurses. It will also allow states to increase access to oral health care through dental workforce development grants. The Budget's new resources will sustain the expansion of the health care workforce funded in the Recovery Act. There were 15.7 million health care professionals in the US as of 2011.
In Canada, the 2011 federal budget announced a Canada Student Loan forgiveness programme to encourage and support new family physicians, nurse practitioners and nurses to practise in underserved rural or remote communities of the country, including communities that provide health services to First Nations and Inuit populations.
In Uganda, the Ministry of Health reports that as many as 50% of staffing positions for health workers in rural and underserved areas remain vacant. As of early 2011, the Ministry was conducting research and costing analyses to determine the most appropriate attraction and retention packages for medical officers, nursing officers, pharmacists, and laboratory technicians in the country's rural areas.
At the international level, the World Health Organization estimates a shortage of almost 4.3 million doctors, midwives, nurses, and support workers worldwide to meet target coverage levels of essential primary health care interventions. The shortage is reported most severe in 57 of the poorest countries, especially in sub-Saharan Africa.
Occupational hazards
Occupational stress and occupational burnout are highly prevalent among health professionals. Some studies suggest that workplace stress is pervasive in the health care industry because of inadequate staffing levels, long work hours, exposure to infectious diseases and hazardous substances leading to illness or death, and in some countries threat of malpractice litigation. Other stressors include the emotional labor of caring for ill people and high patient loads. The consequences of this stress can include substance abuse, suicide, major depressive disorder, and anxiety, all of which occur at higher rates in health professionals than the general working population. Elevated levels of stress are also linked to high rates of burnout, absenteeism and diagnostic errors, and to reduced rates of patient satisfaction. In Canada, a national report (Canada's Health Care Providers) also indicated higher rates of absenteeism due to illness or disability among health care workers compared to the rest of the working population, although those working in health care reported similar levels of good health and fewer reports of being injured at work. There is some evidence that cognitive-behavioral therapy, relaxation training and therapy (including meditation and massage), and modifying schedules can reduce stress and burnout among multiple sectors of health-care providers. Research is ongoing in this area, especially with regards to physicians, whose occupational stress and burnout is less researched compared to other health professions.
Exposure to respiratory infectious diseases like tuberculosis (caused by Mycobacterium tuberculosis) and influenza can be reduced with the use of respirators; this exposure is a significant occupational hazard for health care professionals. Exposure to dangerous chemicals, including chemotherapy drugs, is another potential occupational risk. These drugs can cause cancer and other health conditions. Healthcare workers are also at risk for diseases that are contracted through extended contact with a patient, including scabies.
Female health care workers may face specific types of workplace-related health conditions and stress. According to the World Health Organization, women predominate in the formal health workforce in many countries, and are prone to musculoskeletal injury (caused by physically demanding job tasks such as lifting and moving patients) and burnout. Female health workers are exposed to hazardous drugs and chemicals in the workplace which may cause adverse reproductive outcomes such as spontaneous abortion and congenital malformations. In some contexts, female health workers are also subject to gender-based violence including from coworkers and patients. Health professionals are also at risk for contracting blood-borne diseases like hepatitis B, hepatitis C, and HIV/AIDS through needlestick injuries or through contact with bodily fluids. This risk can be mitigated with vaccination when there is a vaccine available, like with hepatitis B.
Healthcare workers are at higher risk of on-the-job injury due to violence. Drunk, confused, and hostile patients and visitors are a continual threat to providers attempting to treat patients. Frequently, assault and violence in a healthcare setting goes unreported and is wrongly assumed to be part of the job. Violent incidents typically occur during one-on-one care; being alone with patients increases healthcare workers' risk of assault. In the United States, healthcare workers suffer 2/3 of nonfatal workplace violence incidents. Psychiatric units represent the highest proportion of violent incidents, at 40%; they are followed by geriatric units (20%) and the emergency department (10%). Workplace violence can also cause psychological trauma.
The Occupational Health Safety Network is a system developed by the National Institute for Occupational Safety and Health (NIOSH) to address health and safety risks among health care providers. Hospitals and other healthcare facilities can upload the occupational injury data they already collect to the secure database for analysis and benchmarking with other de-identified facilities from throughout the U.S. NIOSH works with OHSN participants in identifying and implementing timely and targeted interventions. OHSN modules currently focus on three high risk and preventable events that can lead to injuries or musculoskeletal disorders among healthcare providers: musculoskeletal injuries from patient handling activities; slips, trips, and falls; and workplace violence. Slips, trips, and falls are the second-most common cause of worker's compensation claims in the US, and cause 21% of work absences due to injury. These injuries most commonly result in strains and sprains; women , those older than 45, and those who have been working less than a year in a healthcare setting are at the highest risk.
Health care professionals are also likely to experience sleep deprivation due to their jobs. Many health care professionals are on a shift work schedule, and therefore experience misalignment of their work schedule and their circadian rhythm. In 2007, 32% of healthcare workers were found to get fewer than 6 hours of sleep a night. Sleep deprivation also predisposes healthcare professionals to make mistakes that may potentially endanger a patient.
Regulation and registration of professionals
Practicing without a license that is valid and current is typically illegal. In most jurisdictions, the provision of health care services is regulated by the government. Individuals found to be providing medical, nursing or other professional services without the appropriate certification or license may face sanctions and criminal charges leading to a prison term. The number of professions subject to regulation, requisites for individuals to receive professional licensure, and nature of sanctions that can be imposed for failure to comply vary across jurisdictions.
In the United States, under Michigan state laws, an individual is guilty of felony if identified as practicing in the health profession without a valid personal license or registration. Health professionals can also be imprisoned if found guilty of practicing beyond the limits allowed by their licences and registration. The state laws define the scope of practice for medicine, nursing, and a number of allied health professions. In Florida, practicing medicine without the appropriate license is a crime classified as a third degree felony, which may give imprisonment up to five years. Practicing a health care profession without a license which results in serious bodily injury classifies as a second degree felony, providing up to 15 years' imprisonment.
In the United Kingdom, healthcare professionals are regulated by the state; the UK Health and Care Professions Council (HCPC) protects the 'title' of each profession it regulates. For example, it is illegal for someone to call himself an Occupational Therapist or Radiographer if they are not on the register held by the HCPC.
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