EXHIBIT 1 Detailed Staffing Exercise (DSE) for the Medicine Panel and One Member 's Response1

What follows is the medicine panel's DSE, slightly compressed to focus illustratively on the physician requirement estimates of one panel member. All of the panel member 's responses, numerical and narrative, appear in italic type.

INSTRUCTIONS FOR STAFFING EXERCISE TWO MEDICINE SECOND PANEL MEETING

In the previous meeting of the medicine panel, we asked you to estimate physician staff requirements in your specialty, for a real VA Medical Center (VAMC), in a number consistent with good quality of care. This new staffing exercise repeats the process, but we have provided a more specific description of the facility including the type of patients, number of admissions, and length of stay. We have also provided more details on the number and types of residents (including level of experience and specialty) available, and the numbers of any nonphysician practitioners (NPP) that may be present. While obtaining your numerical estimates for this facility, we also will be probing the thought processes used in determining physician staffing.

This highly affiliated VAMC participates in a moderate amount of research and is large with total operating beds of 978 and an average daily census of 772.

Your task in Section A is to calculate the physician hours required from the Medicine Service for each Patient Care Area (PCA) for an average weekday.

Do include in Section A:

  • Physician time spent on direct patient care

  • Physician time spent on patient-care-related activities such as:

    • chart documentation

    • related telephone communication

    • patient and family teaching and counseling

    • time spent interactively with residents in patient care and/or teaching on the PCA

1  

Included below are his actual physician time estimates and paraphrases of his explanations for how these were derived.



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