Choosing the Right Approach to Medical Staff Planning

To photograph mountain climbers on a distant peak, you need a telephoto lens, while the sweeping view from a summit calls for a wide angle lens. Choosing the right "lens" is also essential for medical staff planning. If the hospital needs to look at its broad physician landscape, assessing strategic requirements for primary care and specialty physician resources, the right approach is a comprehensive medical staff development plan. When the institution needs to drill down to the details of community and internal physician resources related to a specific specialty or program, a physician community need study is the answer. A community need study is done primarily for compliance purposes. Matching the approach to the planning purpose will save time and money, and avoid frustration. This article further differentiates the purpose and use of these two approaches.

Getting the Big Picture: The Medical Staff Development Plan

A medical staff development plan answers the following questions:

What is the strategic direction of your hospital or health system and how does this translate into physician needs? For example, do you need physicians to replace retiring internal medicine admitters who refer to your specialists?
In what specialties does your hospital need more physicians to develop and support clinical programs and services? Are endocrinologists required to support a new clinical program initiative on metabolic syndrome? Are there enough gastroenterologists to keep referrals by primary care physicians within your medical staff?
Are there geographic sub-markets with specific needs, even though the hospital’s market as a whole does not show need? Looking at geographic areas in a medical staff plan allows you to target more detailed physician community need analyses in areas that appear to have need.

A medical staff development plan is also the basic document for achieving board and stakeholder buy-in on the need to recruit new physicians or develop specific services.

The Medical Staff Development Plan: What it Takes

The plan is based on both quantitative and qualitative analysis of the physician workforce in your service area (either the area required for regulatory issues or a strategically focused area). A medical staff aging and attrition analysis is prepared. An inventory of physicians practicing in the area is developed and local physician to population ratios are compared with various published standards. In areas with very large elderly populations, some age-adjustment may be appropriate. Stakeholders’ views of physician workforce issues are determined through interviews and group meetings. These findings are looked at together with the quantitative analyses, industry and environmental trends, physician workforce trends, the hospital’s strategy and service line plans, and operational and call coverage requirements to produce the conclusions and recommendations of the medical staff development plan.

Sweating the Details: The Physician Community Need Study

A physician community need study provides the documentation required for the hospital or health system to offer financial assistance to newly recruited physicians. The study may also inform the details of a recruiting plan. It is the right approach when:

The hospital or health system is already aware of specialties in which it, and the service area, appears to be lacking sufficient physicians. For example, a hospital may have an affiliated practice with aging physicians and want to bring in a young doctor.
The strategic direction of the hospital has already been set and there is board and stakeholder buy-in for physician recruitment activities. The community need study will serve to confirm the number and locations of physicians.

It’s important to have the study completed and documented before making any recruiting commitments. A community need analysis may show that need cannot be demonstrated and so the hospital cannot provide any assistance.

Avoid letting a group practice start recruiting physicians “while the hospital puts together an analysis to see how it can help.”
Don’t assume physicians are needed without performing the need analysis and having a documenting letter in the file.
Do not expect a broad medical staff development plan to support a more narrowly focused community need. Pursuing any of the courses above would expose the hospital to regulatory risk, and to considerable physician animosity if support that has been promised or extended must subsequently be withdrawn.

The Community Need Study: What it Takes

A community need study is a detailed quantitative analysis of the physician workforce within the service area defined by regulations. While a medical staff plan looks at physician counts and offices, a community need study assesses the specific level of resources available to provide clinical care within the defined community. When DGA does such a study, we call doctors’ practices to find out how many physician-hours are actually being spent in an office and whether the practice is open to new patients. We also consider the presence of physician extenders, which can be important in some practices. If a deficit exists, the hospital may be able to offer financial assistance to physicians that move to the service area. Legal counsel should be sought in this situation.

Your organization’s needs determine the right physician planning tool. The medical staff development plan addresses a comprehensive strategic perspective; while a physician community need study provides regulatory and tactical support for system or hospital-supported physician recruitment.