Tip of the week: Identify the right number of physicians for your hospital

In last week’s issue, the “Seven Rs” of effective medical staff development planning were identified. This week, let’s discuss the first “r,” which is the right number of physicians.

In past years, medical staff development planning generally began and ended with trying to identify the right number of physicians needed to meet community and hospital needs using some variation of the following formula:

Community demographics + staff roster + aging analysis = Medical staff development plan

Unfortunately, this formula fails to take into account important operant factors and forces that cannot be accounted for by the numbers alone, including the following:

•  Community demographic analysis suffers from several inherent flaws. The definition of a hospital’s primary and secondary service area is often based on an analysis of where the majority of admissions arise by ZIP code. However, in many areas of the country, ZIP codes do not correspond to the “geographical” village, borough, town, township, or city, making it difficult to discern which populations within that ZIP code are served by the medical staff and the hospital. This becomes a bigger problem in areas characterized by urbanization or suburban sprawl. Further, often physicians within those ZIP codes who have no relationship with the hospital show up in a numerical analysis of need.
• Community needs often cannot be measured by demographics alone. Demographics provide an estimate of the relative number of physicians per 100,000 people compared to national indices. Such data, however, does not measure accessibility to services. Demographic data may show an adequate number of primary care physicians but fail to capture that none are taking new patients, or patients with XYZ insurance, or offering care after 5 p.m., making the hospital ED the off-hours community primary care provider. Data may show an adequate number of neurologists for the population but may not capture the average two-month wait for a consultation.
• Utilizing old data on physician-to-physician ratios will likely underestimate an important trend: new physicians coming out of training see fewer patients and are less productive than retiring physicians they are replacing.
• Community needs are often defined by physicians and hospitals who believe, “if you build it, they will come.” But what does the community want and need? Many medical staffs and hospitals are engaging community members in focus groups about the strategic development of new services in multiple areas such as women’s health, cancer services, geriatric services, and cardiovascular care. After this type of analysis, the right number of physicians may look quite different.
• Hospital needs may extend far beyond the need to replace aging physicians and support existing practices. Based on community focus group input or a well-reasoned hospital strategic plan, you may identify a need for physicians that would not show up in a strictly demographic analysis.
• Medical staffs often base the need for certain specialties on the absence of those services, an inadequate choice of specialists, or a lack of confidence in existing specialties even when an adequate number of specialists exist. Structured interviews with a broad range of community physicians are important when creating a board-driven medical staff development plan. Such interviews flesh out details that numbers alone can’t capture. It is also up to the medical staff to provide input while recognizing that they will be influenced by self-interest and inherent bias in many circumstances. Combined as part of a much larger development process, interviews are an invaluable source of information.

Ascertaining the right number of physicians is a wide-ranging process that includes an assessment not only of demographics, staff roster, and aging physicians, but also an analysis of accessibility, input from community-based focus groups, an analysis of hospital strategic/business needs, and in-depth interviews with a broad swath of community physicians. Failure to take a broader approach may result in a narrowed focus that does not fully realize what the community, physicians, and the hospital need.

This week’s tip is from The Greeley Guide to New Medical Staff Models: Solutions for Changing Physician-Hospital Relations by Richard A. Sheff, MD; and William K. Cors, MD, MMM, FACPE. Next week, the second “r” will be reviewed in detail.