Physician Staffing for the VA Volume I (1991) / Chapter Skim
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EXECUTIVE SUMMARY
EXECUTIVE SUMMARY
Pages 1-12
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to develop ha sound methodology for estimating the number of physicians, by specialty groupings, required for the efficient delivery of high quality physician services in all programs and facilities operated by the Veterans Health Administration (VHA) , which has responsibility for all VA physician-related activities.
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The VA requested a methodology for deriving physician requirements to meet current and future Workload demands. Not addressed directly is the issue of physician staffing required for the amounts and kinds of health care that veterans may "need,"
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The committee did not analyze, however, the issue of determining the additional requirements for VA physicians in the event of a war or other national emergency. The data available to the committee, based on current VA patient care delivery, did not permit a sound empirical investigation.
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It involves methods for using expert judgment 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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Each model directly relates (specialty-specific) physician FTEE for patient care and resident education to a number of variables thought to influence physician requirements, including workload.3 Under either the PF or IPF variant, total FTEE required at the facility is the sum of the model-derived estimate plus separate estimates for those FTEE components, such as research and continuing education, not incorporated in the model.
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Reconciling the Approaches As an overall framework for determining VA physician requirements (given workload and other factors) , the committee endorses a Reconciliation Strategy in which the major components of physician FTEE are analyzed separately, then combined to produce the total FTEE required, by specialty or program, at the VAMC.
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in staffing would provide natural experiments for analyzing prospectively and rigorously whether the new physician FTEE levels lead to the hypothesized changes in access to care, indicators of the quality of care, and other measures of system performance. Using the Reconciliation Strategy to Calculate Physician FIEE Within the ~umbrella" of the Reconciliation Strategy, how exactly should VA physician FTEE levels be calculated, by specialty and program area?
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Hence, the committee concludes that: · Relying solely on analyses performed in this study, it is not possible to reach sound quantitative conclusions on whether current VA physician staffing levels are adequate in the aggregate. Though an important question, it is not one the committee was asked to address.
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The committee does believe that the physician staffing methodology would be more likely to influence VA physician staffing if the methodology were made an integral part of the budget process at the facility level. Therefore, the committee recommends that the VA undertake this integration concurrently with the implementation of the methodology.
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. Continuing education on the use of NPPs should be provided to VA physicians, and NPPs should receive continuing education to enhance their clinical skills.
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physician task times could then be applied to workload data from a given VAMC to derive an implied total quantity of physician FTEE required. · Extend current workload projection procedures to incorporate patient demand models, in which the veteran's predicted utilization of the VAMC becomes a function of income, health insurance coverage, and other factors affecting the propensity to select the VA system.
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