Tip of the week: Identify the type of physicians needed

In last week’s issue, we discussed the first of the “Seven Rs,” the right number of physicians. This week, let’s explore how to identify the types of physicians needed for your facility to accomplish its goals.

Historically, hospitals have only looked at specialty-to-population ratios to identify the right type of physicians for their facilities. This approach, however, often fails to take into account strategic growth initiatives identified by community and the hospital. Also, numbers alone cannot account for legitimate community service needs, such as access to care and ED coverage. When identifying the right type of physicians, hospitals should consider the following:

• Service line development. When developing strategic growth initiatives, the hospital may identify clinical service lines to meet neglected or understand community needs. For example, a hospital in the Midwest identified the need to develop an oncology service line that integrated medical oncology, radiation therapy, surgical oncology, and complimentary medicine. Demographics alone did not support such a concept; however, strategic direction and community input suggested otherwise. Currently, this integrated service is known throughout the entire region for outstanding care.
• Centers of excellence. Many hospitals choose to offer centers of excellence based on a procedure, a group of procedures, or an integrated clinical service line.  For example, one hospital has an outstanding joint replacement surgeon on staff. By recruiting additional practitioners and developing a trained and competent hospital staff, the hospital created a center of excellence with a regional and interstate draw. Again, a demographic analysis alone would not have suggested the realized outcome. Similarly, some hospitals establish centers of excellence around a group of procedures, such as cardiovascular, endovascular, or breast services, that include hybrid rooms, integrated care, and multispecialty representation. Finally, hospitals that develop integrated clinical service lines, such as oncology, women’s health, and robotic surgery, often achieve center-of-excellence status. Another growing trend is for hospitals to become Joint Commission-certified primary or comprehensive stroke centers, which requires hospitals to integrate emergency medicine, neurology, neurosurgery, radiology, and laboratory services.
• ED coverage. More and more hospitals struggle to manage ED coverage. In many communities, the ED serves a safety net for emergency care and, quite frankly, routine care. Some physician specialties that bear a high call burden, such as general surgery, orthopedic surgery, and neurosurgery, lobby for some form of compensation for ED call. Hospitals, in response to mission and regulatory concerns, need to provide ED services. This is not an either-or problem to solve, but a set of dynamic tensions to manage. In addition to assessing community needs based on demographics, staff roster, and aging physicians, hospitals should examine ED call coverage needs as part of the medical staff development and planning process regardless of the numbers obtained in a specialty-to-population ratio study.

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 third “R” will be reviewed in detail.