Do Qualitative Factors Matter in Determining Physician Need?
- May 14, 2019
Questions that often arise during physician needs assessment projects are about factors that go beyond a simple supply/demand analysis. For example, what role do qualitative factors play in the determination of physician need in a given specialty in a service area?
The quantitative analysis is a standard in determining physician needs, and the major factors are the service area definition, the ratios being applied to the population of a service area, and the definition of physician supply. It is evident in most service areas, however, that there are factors that go beyond you-have-this-many-and-you-need-this-many. Some key areas that are important to consider are accessibility for new patients and consults, provider age, scope of practice, perceived quality concerns, patient outmigration, referral patterns, and others.
We recently completed a project that, based on the quantitative analysis, indicated no need in a specific specialty. The health system came back to us and requested a deeper dive into that specialty. A more comprehensive qualitative review revealed more about the actual need in this specialty in that particular market. Our findings included the following:
- One of the physicians in the specialty in this medical community had opted out of the call rotation and had decided to limit his inpatient practice (admissions and consults) drastically.
- One other single specialty group in the service area, comprising three full-time physicians, provided coverage at two hospitals and four outpatient clinics. The practice had two offices in the service area. There was no feasible way for the three to provide adequate coverage at all of these locations.
- The physicians were unable to respond on a timely basis to consults at either hospital (inpatients or follow-up consults).
- Follow-up appointments were scheduled out for two to three months, which was far from ideal in providing quality patient care.
- Inpatients who were discharged in this specialty were unable to get a follow-up appointment within the necessary two-week period and were typically scheduled out for a month or even longer.
- Providing call coverage at both hospitals was nearly impossible with the current staffing level.
The benefit to the community in the recruitment of an additional physician in this specialty became apparent, but documentation had to consider the qualitative factors outlined above. Relying solely on quantitative supply/demand would not provide the necessary documentation.
Most medical communities have situations similar to those described. In our experience, these qualitative factors are often critical and necessary in the determination and documentation of need in a specialty. If ignored, these dynamics can result in an ineffective analysis of the true needs of a community.
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