Coordinated Medical Staff Development Planning for Large Health Systems

Medical staff development planning requires analytic rigor and detailed work. There is no way around it; a multi-hospital health system needs to determine the needs of each of its individual hospitals, as well as the system in the aggregate, in a consistent manner. Health systems can realize resource efficiencies and strategic benefits by addressing medical staff needs utilizing a system-wide approach across hospitals.

Advantages of such an approach include:

• Consistency in planning methodology across all system hospitals, reducing the potential for confusion and for disparities relating to calculation of needs;
• A framework for greater cross-referral and retention of patients within the system;
• Ability to deploy specialty physicians throughout the system with maximum efficiency; and
• Potential savings on the effort and resources expended on analysis and planning.

There may be some hospitals within a system whose leaders perceive that they have a unique approach to physician staffing, and feel that only their process will address their facility’s specific needs. This is more likely to occur in systems with disparate structures than in systems with a high degree of integration. However, using a consistent methodology will lead to uniform identification of physician need as well as consistent recruitment and retention goals, procedures, and techniques.

How System-Wide Medical Staff Planning Works

Hospitals in a health system may be geographically dispersed, with minimal overlap of their service areas (e.g., where the hospitals have a common religious affiliation), or they may have developed within a metropolitan area or region, and have hospitals with overlapping service areas.

When determining physician requirements in system-wide planning projects, start by considering each hospital’s service area independently, using the same approach as in community need planning for an individual hospital. This assures that the health system can appropriately recognize the distinct characteristics of each geographic area, adjusting for variables that impact physician need, including demographics and health risk indicators, availability of health insurance, and health services utilization profiles.

Once you have calculated the physician need of each of the system’s service areas, you can assess the supply of physicians. Where hospital service areas overlap, there are likely to be some economies of effort when determining physician supply. After considering physician full-time versus part-time status, non-clinical time or responsibilities, and/or the number of session hours per week a physician spends in each office, it’s a simple matter to allocate that physician’s clinical FTE level to the relevant service areas.

Once community physician supply has been determined, determine system-specific requirements (considering clinical support for strategic initiatives, needs to support intra-system referrals, replacement of retiring physicians), to create an integrated medical staff development plan.

If you determine that there is a deficit of physicians in a specific specialty, a coordinated approach becomes a significant advantage, as it allows for regional recruiting strategies rather than being limited to hospital-specific recruitment. As an example, system hospital A may show a deficit of 1.5 cardiologists, while system hospital B has a deficit of 0.5 for the same specialty. If these hospitals were undergoing separate planning processes, the system might need to recruit three cardiologists (2 for the hospital that needs 1.5, and 1 for the hospital that needs 0.5). With regional planning efforts, the system may be able to meet its objectives with just two cardiologists, one or both of whom work part-time in each location.

A system-wide approach to medical staff planning also allows for coordination of primary care physician bases as a source of referrals, so that specialty practices can ramp up more quickly. Of course, the feasibility of this approach depends on just how far apart the relevant hospitals are located and other planning factors. Where hospitals are spread across a rural area, one or more specialists may dedicate part of their time to coverage via telemedicine.

Key Considerations for Success

For multi-hospital medical staff planning to be successful, it’s important that:

1. The health system takes ownership of the process and involves physician leaders to reality test interim findings and proposed strategies.
2. Legacy leaders from newly merged organizations are involved in the process, as they will be most familiar with the relevant medical staff history and unique characteristics of their respective service areas. Both legacy and current stakeholders should review and validate the physician inventories and confirm where succession planning is required because physicians are nearing potential retirement.
3. A common physician community need methodology is used for all hospitals, with physician need ratios adjusted based on the demographic and health status characteristics of varying geographies. All presentations should “show the work,” so that participants can see both the consistency and the appropriateness of the adjustments.
4. Interviews and stakeholder conversations are held with those in equivalent positions across the system so that everyone feels heard, and information-gathering is consistent.
5. Recruitment and retention strategies are coordinated to address deficits or gaps and achieve economies when recruitment can be shared or distributed for providers that may be able to fulfill specialty needs among multiple hospitals
6. An implementation plan is developed that includes recruitment targets, timeframes, responsibilities, estimated costs, etc. for priority need areas

Conclusion

While coordinated system-wide medical staff development planning still requires development of hospital-specific plans, benefits include improved functional integration of multiple medical staffs across the entire health system and enhanced ability to meet the needs and priorities identified in the plan. By focusing on the requirements for success, health systems can realize greater benefits and more effectively meet the needs of the communities they serve.