April 1996 Bulletin

Work force study gets underway

Program to assess need for orthopaedic services

The Rand Corp. has started work on an orthopaedic work force study and supporting data system that will assess market demand and public health needs for orthopaedic services now and in the future.

Authorized by the Academy's Board of Directors in December 1995, the $250,000, one-year project will result in the development of sophisticated computer models that will be kept up-to-date and can be used to provide alternative simulations based on changing conditions in the evolving health care delivery system.

The project was recommended by the Academy's Task Force to Study the Orthopaedic Workforce, chaired by 1994 Academy President Bernard F. Morrey, MD. Other members are James H. Herndon, MD; James Urbaniak, MD; Michael A. Simon, MD; William W. Tipton Jr., MD, Academy executive vice president; and Allan Praemer, Academy research manager.

Formed in 1995

The task force was formed at the 1995 Annual Meeting, following a year of national debate on health care reform. One of the central issues was the perception that there were too few primary care physicians and too many specialists. A number of studies by commissions, foundations, and others came to the conclusion that a national policy should be developed to insure 50 percent of the medical school graduates would be primary care physicians and to reduce to 110 percent from 140 percent the percentage of medical school graduates trained in graduate medical school. The physician supply changes would be implemented through a federally-administered graduate medical education allocation system.

"There was considerable concern that the basis of work force policy may be based on inaccurate information," Dr. Morrey said. "The Academy and other physician organizations wanted the medical community to have a more active role in future physician training, especially when it came to setting quotas for determining how many specialists would be trained."

The Academy's task force was formed to examine existing work force data, define what additional information might be of value and the best method of assessment, including the feasibility of using an independent third party to assess the matter, explore the interest of other orthopaedic organizations to participate in the process, and explore how nonorthopaedic organizations have studied the work force issue.

Review efforts

A year-long comprehensive examination of the complex work force issue included a full review of past Academy efforts, discussions with the Department of Justice and Department of Commerce, and discussions with other orthopaedic and nonorthopaedic medical organizations.

"The discussions with government officials and legal experts made it clear that antitrust laws prevent the Academy and other organizations from engaging in most activities that would influence the work force," Dr. Morrey explained.

The task force found that the Academy needed more data on the work force issue. In a report to the board of directors in December 1995, the task force recommended that the Rand Corp. develop a computerized system of work force models of physician supply and requirements and an accompanying data collection system to provide future updates. Because the impact of such a study has implications to other orthopaedic specialty organizations, the Academy has invited these organizations and some subspecialty societies to actively participate in the process.

Rand has started developing computer models on the demand for services provided by orthopaedic surgeons and on the future supply or work force of orthopaedic surgeons.

"Rand will use past studies of the Academy, information from government and the Academy's database, studies by other organizations, as well as extensive reviews of the literature and epidemiologic studies," Praemer said. "A survey of 1,250 orthopaedic surgeons will provide specific work-time estimates on treatments and procedures."

Variety of data

The demand model will incorporate data on the current practice environment and changes that might arise in the future from an aging population; growth in managed care; and competition from other providers, both physicians and nonphysicians, such as podiatrists, chiropractors, and allied health personnel, Praemer said.

Rand also will develop data on the prevalence of musculoskeletal diseases and projected incidence of injuries that could influence the demand for orthopaedic services.

"For the supply model, Rand will develop data on residency program output and the number and distribution of fellowships in orthopaedics and its subspecialties," Praemer said.

The computer model will reconcile the data from the demand and supply models to determine if there is an adequate or excess supply of orthopaedic surgeons currently and into the future.

The model will be able to provide simulations of supply and demand which would result from future changes in the health care environment.

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