Physician Staffing for the VA Volume II, Supplementary Papers (1992) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-14
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. Future VA physician requirements, taking into account possible changes in the volume, mix, and case acuity of patient workload resulting from the aging of the veteran population and other demographic and administrative factors.
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, psychiatry, neurology, rehabilitation medicine (which also included spinal cord injury) , and other physician specialties (which included laboratory medicine, diagnostic radiology, nuclear medicine, and radiation oncology)
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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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DEFINING, BUILDING, AND RECONCILING ALTERNATIVE APPROACHES TO PHYSICIAN STAFFING The VA physician requirements methodology involves statistical formulas that use existing VA data. It involves methods for using expert judgment to derive appropriate physician staffing.
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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 b1E;E required at the facility is the slim of the model-derived estimate plus separate estimates for those [-I EE components, such as research and continuing education, not incorporated in the model.
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It sometimes would not be practical for a VAMC to realize instantaneously the new Target level of physician staffing in a given specialty or program that emerges from application of the Reconciliation Strategy. The committee recommends that when this is the case, the VA consider phasing in the target by establishing an intermediate target.
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Hence, the committee recommends the following: the VA, without delay, should apply the SADIs either across the board or to a representative sample of VAMCs; analyze the results; revise the instn~ments on the basis of what is learned; reapply the SADIs to VAMCs across the system; and, finally, integrate the resulting r1EE estimates into a Reconciliation Strategy-based assessment of physician requirements. · The relative weight accorded to empirically based versus expert judgment approaches in the Reconciliation Strategy should be determined on a facility-specific or facility-group basis.
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The committee recommends Hat a certain minimum amount of continuing education t~1EE be expected for all specialties at all VAMCs. External Nonns Without exception, the specialty and clinical program panels concluded that the non-VA staffing criteria developed in the study were of limited usefulness in determining VA physician requirements.
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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 He 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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Both the procedures for collecting data at the VAMC and the format of the SADI should be revised so that the impact of NPPs on physician requirements can be determined with greater specificity than at present, using either the empirically based models or this expert judgment approach. 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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· Extend current workload projection procedures to incorporate patient denoted 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. The workload projection procedures used in the present study, adapted directly from existing VA models, produced facility- and PCA-specific utilization estimates adjusted only for the projected change in the age distribution of the veteran population.
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EXECU71~ SUMMARY 13 If the VA adopts, and adapts as needed, the proposed methodology, He quality of its physician staffing decisions should Prove over time and so should the quality of VA health care.
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