Doctors’ Disorders

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The Department of Veterans Affairs can’t decide on the right yardstick to ensure its 7,000 doctors are pulling their weight. The agency has been squabbling about it for more than 30 years. Thursday, the VA inspector general tried to measure the VA’s dithering: 824 of the VA’s 7,011 full-time-equivalent (FTE) specialty physicians apparently aren’t doing enough work.

“The 824 physician FTEs represented approximately $221 million in physician salaries during FY 2011,” the IG noted in a new report. (Battleland notes this works out to more than $268,000 per FTE per year. FTEs include part-time personnel added together to generate their “full-time-equivalents”). “Although we did not analyze the productivity of individual physicians, our results support the need for an in-depth evaluation of staffing.”

This is not a new problem. “In 1981, the Government Accountability Office (GAO) recommended that VHA [Veterans Health Administration] develop a methodology to measure physician productivity,” the IG pointed out. “Since then, six VA OIG and GAO reports have made similar recommendations.”

The impact, of course, is that hundreds of under-utilized doctors can contribute to longer waits for appointments and other frustrations suffered by the nation’s veterans, who are depending on the VA for $56 billion in taxpayer-funded health care this year.

The IG measured doctors by their specialties, ranging from cardiology, to endocrinology, to surgery, against each speciality’s national average workload. The least-busy docs – 20% of their FTEs were below the median workload for their fields – were those practicing anesthesiology, infectious diseases, and pathology. But even the fields that scored highest – psychiatry, radiology, and urology – had 8% of their FTEs with a below-median workload.

Once you wade through the VA lingo, some of the discrepancies were startling:

— A medical facility classified as “1a” had 1 FTE providing infectious disease care to 316 unique patients for a total of 603 encounters. During the same period, a medical facility also classified as “1a” had 1.4 FTE that provided infectious disease care to 1,868 unique patients for a total of 3,476 encounters. Although the latter medical facility had about 40 percent more in staff, the medical facility provided over five times more encounters to 1,552 more patients.

— A medical facility classified as “1a” had .8 FTE providing endocrinology care to 1,053 unique patients for a total of 1,627 encounters. During the same period, a medical facility also  classified as “1a” had .4 FTE that provided endocrinology care to 1,347 unique patients for a total of 2,286 encounters.  Although the latter medical facility had about 50 percent less staff, the medical facility provided  41 percent more encounters.

The inspector general also visited VA medical facilities in Augusta, Ga., Boston, Mass., Houston, Tex., Indianapolis, Ind., and Philadelphia, Penn., to study the issue first-hand. “None of the five medical facilities,” the IG said, “could provide a staffing plan that addressed the facilities’ mission, structure, workforce, recruitment, and retention issues to meet current or projected patient outcomes, clinical effectiveness, and efficiency.”

The IG’s bottom line:

VHA did not have an effective staffing methodology to ensure appropriate physician staffing levels for specialty care services.  Specifically, VHA did not establish productivity standards for 31 of 33 specialty care services we reviewed, and VA medical facility management did not develop staffing plans. These conditions occurred because of a lack of agreement within VHA about which methodology to use to measure productivity, and current VHA policy does not provide sufficient guidance on developing medical facility staffing plans. As a result, VHA’s lack of productivity standards and staffing plans limit the ability of medical facility officials to make informed business decisions on the appropriate number of specialty physicians to meet patient care needs, such as access and quality of care.

The VA promises to do better.