October 1996 Bulletin

RAND seeks work-time data for orthopaedic work force study

RAND will mail a survey to 1,250 Academy fellows this month to develop vital information for the Academy's orthopaedic work force study.

The year-long project, which is expected to be completed by the 1997 Annual Meeting, will create computer models to assess market demand for orthopaedic surgeons now and in the future.

The internationally-known think tank is approaching the project by looking at both the demand side and supply side of the equation. RAND has reviewed data on the types of orthopaedic conditions and procedures. Using ICD-9 and CPT-4 codes, RAND organized the range of orthopaedic conditions and procedures into subspecialty and anatomic groups.

RAND will use statistics on current demand, which are segmented by the age of the patients, and demographic growth trends to project demand into the future.

Catherine A. Jackson, PhD, coprincipal investigator of the project at RAND, said the October survey will ask fellows to report the time required to treat specific conditions and to perform specific procedures.

The work-time information will be combined with expected demand for orthopaedic services to produce an estimate of the balance of current and future requirements for orthopaedic surgeons.

To determine available supply, data on the current number of orthopaedic surgeons will be combined with the number of physicians completing orthopaedic residency programs and the number of orthopaedists who are retiring.

RAND also will look at current utilization patterns and identify diagnoses that may be treated by other physicians and nonphysicians in the future. One of the survey questions will ask orthopaedic surgeons to indicate with what other specialties they interface for patients.

In the future, for example, other physicians may treat more of some conditions that are now treated by orthopaedic surgeons, such as simple fractures and arthritic conditions.

To distribute required care among different types of providers, RAND will use a technique called linear programming. RAND will assign priorities to different subspecialties according to the percentage of patients treated for specific conditions. The information will be combined with the expected demand for the services to create statistical ranges of how many orthopaedic surgeons will be needed in various subspecialties. The information can be adjusted to various scenarios to reflect future changes in the delivery of health care.

For maximum flexibility in adjusting to changes in health care patterns, RAND will convert the supply and demand numbers into full-time equivalents (FTEs).

Results of the work force study are expected to be completed by the Annual Meeting in February 1997.

The $250,000 study was authorized by the Academy's Board of Directors in December 1995. The action was recommended by a task force chaired by 1994 Academy president Bernard F. Morrey, MD, following a year-long examination of the complex work force issues. This included examination of Academy data and discussions with the Department of Justice, Department of Commerce, and other medical organizations.

The Academy sees this as a unifying activity of the profession, hence, specialty societies were given the opportunity to review the plans for the project, provide financial support and make appointments to the advisory committee. As this is being written, the following societies have made contributions and made appointments to the advisory committee: Academic Orthopaedic Society, Association for Arthritic Hip and Knee Surgery, American Orthopaedic Foot and Ankle Society, American Orthopaedic Society of Sports Medicine, American Society for Surgery of the Hand, and the Pediatric Orthopaedic Society of North America. The American Orthopaedic Association made a financial contribution. Organizations that made appointments to the advisory committee are American Spinal Injury Association, Arthroscopy Association of North America, Cervical Spine Research Society, Musculoskeletal Tumor Society, North America Spine Society, Orthopaedic Research Society, Orthopaedic Trauma Association and Scoliosis Research Society.

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