Physician Staffing for the VA Volume I (1991) / Chapter Skim
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3 - OVERVIEW OF THE ANALYSIS
3 - OVERVIEW OF THE ANALYSIS
Pages 29-40
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From page 29... ...
In the remaining chapters, these questions are examined in some detail as the components of the methodology are developed piece by piece. The core elements of the methodology are presented in chapters 4 through 8; some important questions relating to VA physician requirements are examined in chapters 9 and 10; and the committee's main conclusions, including recommendations for additional analysis, are summarized in chapter 11.
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From page 30... ...
It involves the use of expert judgment approaches to derive appropriate physician staffing. It can accommodate physician staffing guidelines emerging from outside the VA health care system External norms)
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From page 31... ...
in the VAMC; there is an IPF for each of 11 major VA physician specialty categories. Both variants allow physician FTEE requirements for patient care and resident education to be estimated on a specialty-specific basis at the VAMC level, and the PF permits this also at the PCA level.
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From page 32... ...
boosts the case for a physician requirements methodology that gives substantial emphasis to an expert judgment or external norm approach. Moreover, during the course of the study's many specialty and clinical program panel meetings, critics of the empirically based approach sometimes asserted that, at best, the EBPSM can indicate how to achieve a more efficient rearrangement of the current aggregate supply of VA physician FTEE.
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From page 33... ...
As vividly demonstrated in chapter 4, the level of projected workload plays an independent and potentially strong role in driving the physician requirements calculations. If workload for some future year Is projected to rise from the present level, the prescribed quantity of physician FTEE will virtually always be higher than at present, all else equal, under either empirically based approach (or, for that matter, either expert judgment approach)
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From page 34... ...
To determine physician requirements for patient care and resident education, the VA decision maker should rely on the EBPSM to the extent that the modeling assumptions are met; otherwise, substantial weight should be accorded to approaches based on expert judgment or external norms. DETERMINING PHYSICIAN REQUIREMENTS FOR OTHE:R MISSION-RELATED ACTIVITIES For each of these activities (and any residual miscellaneous ones)
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From page 35... ...
The three components of physician FTEE consist of a major category (labeled simply AXE in chapter 6) that includes all patient care, resident education, administration, and leaves of absence; research; and continuing education.
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From page 36... ...
However, it should be emphasized that they guide in very specific ways. The empirically based and expert judgmentbased estimates establish the boundaries of the FTEE range within which the VA decision maker is supposed to choose.
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From page 37... ...
Although these workload projections are not directly applicable to the expert judgment staffing models, the committee demonstrates how they can be used to obtain indirect estimates of workload at the level of specificity required by the SADI and the DSE.
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From page 38... ...
However, the committee believes that equity and efficiency would be served if every VAMC were affiliated. Given the changing demographic structure of the veteran population with the implied shifts in the nature of patient workload presenting at VAMCs the committee believes that the VA should develop innovative affiliation arrangements that emphasize patient care, education, and research related to the chronically ill.
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From page 39... ...
Hence, the physician staffing recommendations emerging from the Reconciliation Strategy would be conditional on the assumed distribution of NPPs at the VAMC. · Continuing education on the use of NPPs should be provided to VA physicians, and to the nonphysician practitioners themselves, on an ongoing basis.
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From page 40... ...
40 PHYSICIAN STAFFING FOR ~ VA REFERENCE Musgrave, R.A., and P.B. Musgrave.
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