which required the expert to assess the time (and hence FTEE) required by neurologists to render patient care, work with residents, and perform other tasks at the VA medical center. To test this approach, staffing instruments were constructed for three actual VAMCs. Each facility was portrayed as consisting of a set of patient care areas (PCAs), where direct patient care and resident training occur. For each PCA, data were presented on the volume of patient workload expected, the number of residents available, and the overall availability of nursing and support staff. The critical question with respect to each PCA focuses on the amount of neurologist time required, in total, to meet these VA mission-related demands in the course of a typical workday. Each PCA was analyzed in turn, and total neurologist FTEE for the facility was computed. Additional questions at the end of the instrument elicited FTEE requirements for weekend coverage, special procedures, and non-VA physician consultants.

In the course of this first meeting the panel reached several initial conclusions about the assumptions that should underlie the development of subsequent physician staffing instruments:

  • Education of staff and residents is carried out mostly in the clinical setting, often as part of daily rounds. However, education time is not always documented properly in the VA's cost distribution report (CDR) for the neurology service. It is often allocated under the cost center for medicine.

  • Insufficient nurse and support staff is a major factor in reducing the efficiency of neurologists and may reduce the quality of care.

  • Physicians generally work 50 or more hours weekly, but 40 was used in estimating requirements in order to be consistent across panels.

  • The amount of research varies by the individual physician and is sometimes obscured by university exchanges. Research per physician cannot be inferred on the basis of the direct patient care requirements.

  • Vacation, leave, and sick time are not currently considered in physician requirements, and might be derived via a “multiplier” applied to the direct care requirements.

  • Although there was a great deal of debate about the issue of night and weekend coverage, panelists generally agreed that it is usually provided by “house officers” who are not purchased specifically by the neurology service, or else by residents. Therefore no extra staff physician FTEE would be allocated specifically for these off-hours.

  • The number of patients currently receiving neurology services is not an indicator of need, since a current lack of physician staffing in this specialty discourages many patients from presenting for treatment. Nonetheless, the panel



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