Physician Staffing for the VA Volume I (1991) / Chapter Skim
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2 - BACKGROUND
2 - BACKGROUND
Pages 19-28
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From page 19... ...
CURRENT ALLOCATION OF PHYSICIANS IN THE VA Total Physicians, by Specialty For each of 11 specialty categories, data on the total quantity of VA staff physicians nationwide for FY 1989 are summarized in Table 2.1. For each specialty, the absolute and the percentage allocation of physicians to direct patient care (and miscellaneous other activities)
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From page 20... ...
This caveat must be kept firmly in mind when interpreting physician staffing data throughout the report. How Physician F1EE Levels Currently Are Determined At present, the VA has no national, centrally directed policy for determining how many physicians it needs.
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From page 21... ...
There are a number of practical limitations on the ability of that service chief to alter physician staffing significantly. With VA budgets growing slowly, at best, it is often the case that the chief can acquire additional physicians only if the VAM:C is willing to reduce staffing, or other resource commitments elsewhere in the facility.
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From page 22... ...
Two important points must be addressed. First, the committee recognizes that staff physicians serving in administrative positions in VA Central Office and other sites external to the VAMC have contributed significantly to the VA's mission-related activities of patient care, education, and research.
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From page 23... ...
Because this step would serve to enhance the effectiveness and validity of the methodology itself, the committee recommends that this linkage be achieved. This Is Not a Needs-Based Approach As noted in chapter 1, the VA requested a methodology for deriving physician requirements to meet current and future "workload demands," that is, current and fixture veteran utilization of the system.
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From page 24... ...
In response, the committee's physician requirements methodology has the following features: · Clinical judgment plays a critical quality assurance role. The expert judgment-based approach to physician staffing presented in chapter 5 complements and frequently serves as a counterpoint to staffing approaches based on the statistical analysis of existing VA data relating current physician staffing to current workload production.
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From page 25... ...
In addition, the committee has demonstrated that if the VA can develop models linking quality indicators to physician staffing levels, physician FTEE can be derived Tom the statistical models in ways that meet designated quality standards (see chapter 7~. In this regard, the committee applauds work recently begun by the VA Office of Quality Management to develop such indicators and explore their relationship to measures of resource intensity.
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From page 26... ...
A PCA is an administratively defined locus-of-care site whose patients share certain clinical characteristics; PCAs include, for example, the inpatient medicine bed section, the nursing home, and the psychiatric clinics within the ambulatory care program. The committee's underlying precept is that PCAs are useful not only in the analysis of current physician requirements, but can serve as the building blocks for models to determine physician requirements for types of VAMCs not presently seen in the system.
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From page 27... ...
With the size and age structure of the veteran population changing significantly, the VA health care system of the future may look quite different than the present one. In designing a physician requirements methodology, however, it was not the committee's intent either to defend and preserve the status quo or to overturn it in favor of a newly configured VA system.
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From page 28... ...
2Includes FTEE allocated to the training of residents and other staff, to the administration of education programs, and to continuing education for the VA physician. SOURCE: VA internal accounting data, with subsequent analyses performed by the VA's Boston Development Center, Braintree, Massachusetts.
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