Physician Staffing for the VA Volume I (1991) / Chapter Skim
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7 - MANAGEMENT USES OF THE PHYSICIAN STAFFING METHODOLOGY
7 - MANAGEMENT USES OF THE PHYSICIAN STAFFING METHODOLOGY
Pages 299-320
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From page 299... ...
The second issue is the degree to which analytical models for physician staffing, such as those developed here, should become one part of a larger decision support system for resource management in the VA. Finally, specific examples are presented showing how the VA decision maker can apply components of the physician staffing methodology to ask certain What if" questions important to resource management.
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From page 300... ...
However, the committee can envision a resource management policy in which the portion of the VAMC budget allocated to staff physicians is established in accordance with the FTEE targets (and intermediate targets) derived through applications of the Reconciliation Strategy.
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From page 301... ...
The Reconciliation Strategy could be applied to generate evidence either supporting, or failing to support, the facility's request. There are already precedents in the VA for policy decisions being influenced by a dialogue between Central Office and decision makers in the field; one of the more prominent examples arose in the context of Medical District Initiated Program Planning (MEDIPP)
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From page 302... ...
Rather, model building seeks to make explicit and to quantify the relationships between elements in the real world and to improve one's understanding of real-world phenomena. When the abstraction of reality that is used in management decision making consists only of words and some loosely related numbers, the resultant management decisions may carry with them some of the same quality of fuzziness.
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From page 303... ...
A decision support system typically has three components: a comprehensive data base, a high-level data-base manager or information processing software, and a set of appropriate decision models. It is the availability of decision models that differentiates the decision support system from a conventional management information system.
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From page 304... ...
In the present study, each of the modeling components of the physician staffing methodology is such a compact representation. To function properly within a VA decision support system, the physician staffing methodology would need to be backed up with accurate data bases on actual staffing for physicians and direct and indirect support personnel, availability of residents and fellows by specialty and postgraduate year of training, current workload levels, current and planned programs affecting physician requirements, facility characteristics, and so forth, as detailed in chapters 4 through 6.
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From page 305... ...
As management poses questions of the staffing methodology (e.g., the physician FTEE required to staff the psychiatry service at VAMC I in FY 1991) , sensitivity analysis can indicate whether the answers are implausible or counterintuitive.
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From page 306... ...
If such sensitivity analyses were to be performed in a functioning decision support system, the response of output to specified input changes could be displayed graphically in real time to permit rapid visualization and interpretation. To illustrate, the graph of workload as a function of internist FTEE in the inpatient medicine PCA of a hypothetical facility is shown in Figure 7.2; as above, it is assumed that all other variables in Equation 4.11, including SUPPORT/MD, are held fixed.
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From page 307... ...
The decision maker's confidence in prescriptions derived through the SADI or the DSE diminishes as the forecasts extend beyond the scale of operations, organizational structures, and technologies familiar to the expert judges. The examples above represent but one type of application of sensitivity analysis.
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From page 308... ...
of considerable importance to the VA decision maker if the Reconciliation Strategy is to be implemented as advocated earlier. Outlier Analysis: Comparing Actual Versus Model-Predicted Values for Physician FLEE and Patient Workload One potentially important aspect of the dialogue envisioned between Central Office and the individual VAMC is a careful scrutiny by all parties of the facility's actual performance, along several possible dimensions, in comparison with the performance predicted from components of the physician staffing methodology.
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From page 309... ...
To illustrate how the physician staffing methodology can inform this discussion, an actual-versus-predicted analysis using both variants of the EBPSM is conducted. Specifically, IPFs are used for medicine, surgery, and psychiatry specialties to predict the total amount of physician FTEE for patient care and resident education expected at two actual facilities, VAMC II and VAMC III, in FY 1989.
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From page 310... ...
The VA decision maker could call upon the models as needed. The following three linear programming problems focus on the ambulatory medicine PCA.
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From page 311... ...
Specifically, FTEE levels entered into this PF must be large enough, and in the proper mix, so that the ambulatory workload levels that these inputs are expected to produce equal or exceed the projected ambulatory workload. For this example and the variants that follow, the projected workload is assumed to be 3,859,312 capitation weighted work units (CAPWWUs)
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From page 312... ...
In this ambulatory medicine PCA, residents closely substitute for staff physicians, resulting in diminishing salary costs until the point is reached where the addition of more residents no longer justifies their salary expense. Clearly, in an actual application with these characteristics, one would not add more than six residents unless it was felt that the teaching mission or some other benefit not captured in the salary minimization objective justified this additional expense.
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From page 313... ...
An interesting alternative linear programming formulation of this problem (not presented here) is to recast the question as: What is the maximum output obtainable within a given budget constraint?
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From page 314... ...
If both the empirically based and expert judgment models are fully integrated into a comprehensive VA decision support system, it would be possible to derive a better understanding of the budgetary and organizational consequences of alternative staffing proposals. REFERENCES Dorfman, R., Samuelson, P.A., and Solow, R.M.
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From page 315... ...
x 100 Physician Specialties VAMC Physician FTEE for Patient Care and Resident Educations (~o) Weighted Work Units (WWUs)
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From page 316... ...
316 PRYSICLAN STAFFING FOR THE VA TABLE 7.2 Optimal Staff Physician FTEE and Corresponding Total Salary Cost for a Hypothetical Ambulatory Medicine PCA as the Number of Assigned Residents is Varied RESIDENTS MED_MD OTHER_MEDSalary Cost 0 11.968 0.767$1,128,939.00 1 9.873 0.633961,442.00 2 8.078 0.518822,169.00 3 6.582 0.422711,120.00 4 5.386 0.345628,298.00 5 4.488 0.288573,692.010 6 3.890 0.249547,313.00 7 3.890 0.249577,381.00
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From page 317... ...
MANAGEMENT USES OF TIlE METHODOLOGY DECISION MAKER 1 I N F O R M AT I O N P R O C E S S I N G _ 1/0 G RAP H I CS FIGURE 7.1 Elements of a Decision Support System 317 1 ~DECISION OPTI ONS I N Q U I R I E S , R E P O R T S 'WHAT I F
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From page 318... ...
318 5.5 ce O _ Y O ~, 3 4.5 _ a_ .= 0 ·O ~ 4 O - s _ _ ~ 3.5 3 P~YSICLAN STAFFING FOR THE VA / 1 , 1 1 1 1 1 1 4 5 6 7 8 9 10 11 1 2 Internist FTEE FIGURE 7.2 Nonlinear Relationship between Internist FTEE for Patient Care and Medicine Service Workload, as Derived from the Inpatient Medicine Production Function
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From page 319... ...
FIGURE 7.3 Impact of Surgery Inpatient Workload on Surgeon Requirements for Patient Care and Resident Education, as Derived from the Surgery Inverse Production Function
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From page 320... ...
320 12QO 1000 . 800 GOO 400 o o 200 O I I I I I I I I 0 1 2 3 4 5 6 7 Raged ME FIGURE 7.4 I-act of Editions ~ Resident FTEE on Pbysici~ Ssla~ Cost ~ Be ~ulato~ icicle PCA of s Hypothetical Large ~1~ ~C
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