To accomplish its mission-related responsibilities of patient care, education, and research, how many physicians does the VA require? The purpose of this study has been to develop a methodology to assist the Department of Veterans Affairs (VA) in answering this basic, but extraordinarily complex question. Specifically, the VA asked the Institute of Medicine (IOM) to develop “a 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.

Contents

• COMMITTEE TO DEVELOP METHODS USEFUL TO THE DEPARTMENT OF VETERANS AFFAIRS IN ESTIMATING ITS PHYSICIAN REQUIREMENTS
• INTRODUCTION
• EXECUTIVE SUMMARY
  • OVERVIEW OF THE STUDY
  • DEFINING, BUILDING, AND RECONCILING ALTERNATIVE APPROACHES TO PHYSICIAN STAFFING
  • OVERALL ADEQUACY OF PHYSICIAN STAFFING IN THE VA: COMMITTEE PERSPECTIVE
  • VA CENTRAL OFFICE AND THE VAMC: PROMOTING A DIALOGUE
  • AFFILIATIONS WITH MEDICAL SCHOOLS
  • NONPHYSICIAN PRACTITIONERS
  • FURTHER DEVELOPMENT OF THE METHODOLOGY
  • CONCLUDING REMARKS
• SECTION I. SPECIALTY AND CLINICAL PROGRAM PANEL REPORTS
  • OVERVIEW OF THE SPECIALTY AND CLINICAL PROGRAM PANELS
    • INTRODUCTION
    • COMMITTEE'S APPROACH TO ELICITING EXPERT JUDGMENTS AND REACHING CONSENSUS
    • THE PANEL PROCESS—IN PRACTICE
    • REFERENCES
    • EXHIBIT 1 Detailed Staffing Exercise (DSE) for the Medicine Panel and One Member's Response
    • EXHIBIT 2: The Staffing Algorithm Development Instrument (SADI) for Medicine: The Complete Instrument with Statistical Summary of Panel's Assessments
    • EXHIBIT 3 Application of the SADI to Compute Physician Requirements in Medicine at VAMC I
  • MEDICINE PANEL REPORT
    • INTRODUCTION
    • EXPERT JUDGMENT APPROACHES TO DETERMINING PHYSICIAN REQUIREMENTS IN MEDICINE
    • EMPIRICALLY BASED APPROACHES TO DETERMINING PHYSICIAN STAFFING IN MEDICINE
    • PHYSICIAN STAFFING RESULTS FROM APPLICATION OF EMPIRICALLY BASED AND EXPERT JUDGMENT APPROACHES
    • EXTERNAL NORMS
    • CONCLUSIONS
    • INSTITUTE OF MEDICINE
  • SURGERY PANEL REPORT
    • INTRODUCTION
    • EXPERT JUDGMENT APPROACHES TO DETERMINING PHYSICIAN REQUIREMENTS IN SURGERY AND ANESTHESIOLOGY
    • EMPIRICALLY BASED APPROACHES TO DETERMINING SURGEON AND ANESTHESIOLOGIST FTEE
    • PHYSICIAN STAFFING RESULTS FROM APPLICATION OF EXPERT JUDGMENT AND EMPIRICALLY BASED APPROACHES
    • EXTERNAL (NON-VA) PHYSICIAN STAFFING NORMS
    • CONCLUSIONS
    • INTRODUCTION AND INSTRUCTIONS (Abbreviated)
    • INTRODUCTION AND INSTRUCTIONS (Abbreviated)
    • INSTITUTE OF MEDICINE
  • PSYCHIATRY PANEL REPORT
    • INTRODUCTION
    • EXPERT JUDGMENT APPROACHES TO DETERMINING PHYSICIAN REQUIREMENTS IN PSYCHIATRY
    • EMPIRICALLY BASED APPROACHES TO DETERMINING PHYSICIAN STAFFING IN PSYCHIATRY
    • PHYSICIAN STAFFING RESULTS FROM APPLICATION OF EMPIRICALLY BASED AND EXPERT JUDGMENT APPROACHES
    • EXTERNAL NORMS
    • CONCLUSIONS
    • INTRODUCTION AND INSTRUCTIONS (Abbreviated)
    • INSTITUTE OF MEDICINE
  • NEUROLOGY PANEL REPORT
    • INTRODUCTION
    • EXPERT JUDGMENT APPROACHES TO DETERMINING PHYSICIAN REQUIREMENTS IN NEUROLOGY
    • EMPIRICALLY BASED APPROACHES TO DETERMINING PHYSICIAN STAFFING IN NEUROLOGY
    • PHYSICIAN STAFFING RESULTS FROM APPLICATION OF EMPIRICALLY BASED AND EXPERT JUDGMENT APPROACHES
    • EXTERNAL NORMS
    • CONCLUSIONS
    • INTRODUCTION AND INSTRUCTIONS (Abbreviated)
    • INSTITUTE OF MEDICINE
  • REHABILITATION MEDICINE PANEL REPORT
    • INTRODUCTION
    • EXPERT JUDGMENT APPROACHES TO DETERMINING PHYSICIAN REQUIREMENTS IN REHABILITATION MEDICINE
    • EMPIRICALLY BASED APPROACHES TO DETERMINING PHYSICIAN STAFFING
    • PHYSICIAN STAFFING RESULTS FROM APPLICATION OF EMPIRICALLY BASED AND EXPERT JUDGMENT APPROACHES
    • EXTERNAL NORMS
    • CONCLUSIONS
    • INTRODUCTION AND INSTRUCTIONS
    • INSTITUTE OF MEDICINE
  • OTHER PHYSICIAN SPECIALTIES PANEL REPORT
    • INTRODUCTION
    • EXPERT JUDGMENT APPROACHES TO DETERMINING PHYSICIAN REQUIREMENTS IN THE OTHER PHYSICIAN SPECIALTIES
    • EMPIRICALLY BASED APPROACHES TO DETERMINING PHYSICIAN STAFFING FOR THE OTHER PHYSICIAN SPECIALTIES
    • PHYSICIAN STAFFING RESULTS FROM THE APPLICATION OF EMPIRICALLY BASED AND EXPERT JUDGMENT MODELS
    • EXTERNAL (NON-VA) PHYSICIAN STAFFING NORMS
    • CONCLUSIONS
    • APPENDIX
    • LABORATORY MEDICINE
    • NUCLEAR MEDICINE
    • RADIATION ONCOLOGY
    • DIAGNOSTIC RADIOLOGY
    • INSTITUTE OF MEDICINE
  • AMBULATORY CARE PANEL REPORT
    • INTRODUCTION
    • EXPERT JUDGMENT APPROACHES TO DETERMINING PHYSICIAN REQUIREMENTS IN THE AMBULATORY CARE PROGRAM
    • EMPIRICALLY BASED APPROACHES TO DETERMINING PHYSICIAN STAFFING FOR THE AMBULATORY CARE PROGRAM
    • PHYSICIAN STAFFING RESULTS FROM APPLICATION OF EMPIRICALLY BASED AND EXPERT JUDGMENT APPROACHES
    • EXTERNAL (NON-VA) PHYSICIAN STAFFING NORMS
    • CONCLUSIONS
    • INTRODUCTION AND INSTRUCTIONS (Abbreviated)
    • INSTITUTE OF MEDICINE
  • LONG-TERM CARE PANEL REPORT
    • INTRODUCTION
    • EXPERT JUDGMENT APPROACHES TO DETERMINING PHYSICIAN REQUIREMENTS IN LONG-TERM CARE
    • EMPIRICALLY BASED APPROACHES TO DETERMINING PHYSICIAN STAFFING FOR THE LONG-TERM CARE PROGRAM
    • PHYSICIAN STAFFING RESULTS FROM APPLICATION OF EMPIRICALLY BASED AND EXPERT JUDGMENT APPROACHES
    • EXTERNAL NORMS
    • CONCLUSIONS
    • INTRODUCTION AND INSTRUCTIONS (Abbreviated)
    • INSTITUTE OF MEDICINE
• SECTION II. AFFILIATIONS PANEL REPORT
  • AFFILIATIONS PANEL REPORT
    • INTRODUCTION
    • BACKGROUND AND HISTORY OF VA-MEDICAL SCHOOL AFFILIATIONS
    • RELATIONSHIP OF AFFILIATIONS TO PHYSICIAN REQUIREMENTS
    • MAJOR ISSUES WITH REGARD TO VA-MEDICAL SCHOOL AFFILIATIONS
    • CONCLUSIONS AND RECOMMENDATIONS
    • REFERENCES
    • APPENDIX
• SECTION III. NONPHYSICIAN PRACTITIONERS PANEL REPORT
  • NONPHYSICIAN PRACTITIONERS PANEL REPORT
    • INTRODUCTION
    • DEFINING THE NONPHYSICIAN PRACTITIONER
    • THE NPP AND THE PHYSICIAN STAFFING METHODOLOGY
    • SURVEYS ON THE CURRENT AND FUTURE ROLES OF NONPHYSICIAN PRACTITIONERS IN THE VA
    • SYNOPSIS OF OBSERVATIONS AND RECOMMENDATIONS CONTRIBUTED BY CHIEFS OF STAFF, NONPHYSICIAN PRACTITIONERS, SUPERVISORS, AND PANEL MEMBERS
    • PANEL CONCLUSIONS AND RECOMMENDATIONS
    • APPENDIX A ANNOTATED BIBLIOGRAPHY
    • APPENDIX B EXHIBITS
    • INSTITUTE OF MEDICINE
    • Nonphysician Practitioners Panel Roster
• SECTION IV. FURTHER EXAMINATION OF THE EMPIRICALLY BASED PHYSICIAN STAFFING MODELS
  • FURTHER EXAMINATION OF THE EMPIRICALLY BASED PHYSICIAN STAFFING MODELS
    • INTRODUCTION
    • OVERVIEW OF THE EBPSM
    • STATISTICAL EVALUATION
    • MARGINAL PRODUCT ANALYSIS
    • REFERENCES
    • Tables
• APPENDIX A
• APPENDIX B LIST OF ABBREVIATIONS

This study was supported by the U.S. Department of Veterans Affairs under Contract No. V101(93)P-1166.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for this report were chosen for their special competences and with regard for appropriate balance.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education.