Looming Shortages Necessitate Surgical Workforce Planning
Surgical services continue to be the backbone of the hospital’s bottom line. These services will grow over the next 5 to 10 years, in both inpatient and outpatient settings. Sg2’s Impact of Change® (IoC) forecast predicts a modest growth rate of 3% in inpatient surgical volumes but a robust 23% growth in outpatient surgery volumes over the next 10 years.
But will the surgical workforce be adequate to meet this demand?
Estimates of the overall US physician supply have many provider organizations worrying that the answer is no. The Association of American Medical Colleges predicts a shortage in 2025 of 124,000 physicians, affecting primary care and specialties equally. In certain specialties, notably general surgery, thoracic surgery and neurosurgery, the supply of surgeons is highly problematic. Moreover, in 2011, 30% of US counties lacked even a single surgeon.
Consider general surgeons as a case in point. General surgeons perform the bulk of high-volume procedures such as hernia repairs, breast surgery, appendectomies, cholecystectomies and colon resections. Many health care workforce experts consider an appropriate general surgeon/population ratio to be five to six per 100,000. More than a quarter of hospital service areas have fewer than three general surgeons per 100,000 population, indicating a critical shortage. A shortage of general surgeons will result in difficult access or even suboptimal clinical care.
Plan Now to Meet Future Needs
No business strategy—corporate, health care or otherwise—can be executed successfully with an inadequate workforce. Health care is labor-intensive, and a health care organization’s workforce is arguably its most important asset. However, many health systems do not have a workforce plan for physicians and surgeons. Indeed, it is common that there is no planning, let alone a plan!
Workforce planning in health care must consider everything from the organization’s overarching strategic goals, to its experience with risk-based payment models, to its current relationships with its physicians and surgeons, to organizational and market factors such as geographic footprint and the competitive landscape. The workforce needs of a fully integrated accountable care organization (ACO) with employed physicians and a well-developed System of CARE including medical homes will be very different from the needs of a traditional fee-for-service model with multiple independent providers. Service line programmatic priorities also need to be established, given variance in capital and labor requirements.
Fortunately, quantitative tools are available to measure workforce supply and productivity as well as demand for services, thereby turning workforce planning into a systematic, data-driven operational activity.
Build a Workforce Plan in Surgery
- Identify Supply of Surgeons. Develop a dashboard of surgical services along with number, age and anticipated retirement, if known, of surgeons providing those services. Sg2’s Physician Supply application provides a dashboard with details such as names, hospital affiliation, age, gender and other important characteristics necessary to profile the organization’s surgeon workforce. Indicators of the adequacy of surgeon supply include access metrics such as third-next available appointment for a surgeon office visit and time to surgery once the decision to operate has been made. Adequacy of ED call coverage by surgeons is another useful measure.
- Project Future Procedural Demand. The Sg2 IoC forecast can assist in defining future procedural demands. Leveraging the IoC forecast, the Sg2 Physician Demand application calculates physician/surgeon demand by specialty for custom-defined markets. The application’s dashboard can help health systems identify vulnerable service lines where unmet demand may surface. The application estimates demand from the current year through 2024, utilizing a productivity model. Organizations can select from a range of productivity benchmarks, allowing the modeling of different demand scenarios for their market. As with the IoC forecast, Sg2 Physician Demand forecasts are displayed side by side with population-only projections.
- Plan for Physician Alignment and Succession/Recruitment. Your analyses of surgeon supply and demand will provide a roadmap for the organization’s efforts in these areas, pinpointing potential gaps as well as strengths. Use the insight you have gained as you choose to align with surgeons or surgical groups and develop coordinated plans for recruitment and succession.
- Redesign Care. Supply and demand calculations in some markets will reveal major shortfalls in the numbers of surgeons needed—shortfalls that cannot easily be remedied. In that case, consider clinical restructuring to increase the efficiency of surgical care. Clinical restructuring is an element of care redesign that uses protocols, data and care team insights across the continuum to ensure that treatment occurs in the optimal setting with the most appropriate level of provider. A key strategy for achieving clinical restructuring is to elevate advanced practitioners (pharmacists, advanced practice nurses and physician assistants) to the top of their licensure to free up surgeons’ time.
Market-specific physician and surgeon shortages will be increasingly common during the next decade. It will be critical for health systems to consider both trends in local market demand and physician supply to meet that demand. As the landscape continues to shift, supply and demand in secondary and tertiary service areas may also become important. Sg2 Analytics provide the tools to enable in-depth, data-driven understanding of both market demand and the ability to meet that demand. For some organizations, strategies to redress shortages will be critical; for others, early identification of unmet demands beyond primary service areas will reveal important opportunities for enterprise growth. But whatever the balance of supply and demand, health care leaders need to establish workforce planning as an ongoing operational imperative.
Sources: Association of American Medical Colleges. The complexities of physician supply and demand: projections through 2025. November 2008; American College of Surgeons Health Policy Research Institute website. Accessed November 2014; Ricketts TC et al. Developing an index of surgical underservice. American College of Surgeons Health Policy Research Institute, July 2011; Valentine JR et al. Ann Surg. 2011;254:520–526.