The Detailed Staffing Exercise (DSE) Approach
Initial Efforts

The first meeting of the medicine panel was conducted in the spring of 1990. The primary purpose was to examine whether the expert judgment panel process, as the study committee first envisioned it, was viable for medicine and its subspecialties. This process included the development of staffing instruments that would allow the panel to review information about workload, about various nonphysician personnel that might be available to deliver care, and then, given this conditional information, to make judgments about the physician FTEE appropriate to meet that workload.

The feasibility of this process was tested in the first panel meeting. A staffing instrument developed for this initial meeting elicited a great deal of discussion regarding the shared assumptions necessary for an expert group to render reasonable judgments about physician staffing.

After this first meeting, the panel concluded that study staff should proceed further with the expert judgment process. Several initial conclusions were drawn from the first meeting and guided the development of subsequent staffing instruments:

  • Residents have a two-way effect on staff physician time in the PCA; the instruction of residents absorbs staff physician time, but residents frequently carry out tasks that otherwise would have to be performed by their instructors. The net impact of residents on staff physician productivity is not a matter to be settled in the abstract, but rather to be inferred from the empirically based and expert judgment models.

  • Insufficient support staff and nurses will tend to reduce the efficiency of the physician and may harm the quality of care. But the empirically based and expert judgment models should be structured to account for the impact of nonphysician personnel on physician requirements.

  • Physicians generally work 50 or more hours weekly, but 40 would be used in calculating internist FTEE in order to be consistent across panels.

  • Research is an important factor in physician requirements, but determining the appropriate amount of FTEE for this purpose is difficult in the absence of information on indicators of research productivity such as grant funding and publication records.

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