Environmental Scan - Government of Nova Scotia

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Physician Resource PlanningAn Environmental ScanCategory Description Time Period Primary Source(s)3-Need-Epidemiology3b-Need-ProvinicalProgram managedDiseases4a-Need-FacultyUtilizationIP4b-Need-FacultyUtilization-AMB5-Supply-CurrentRoster(PHReD, PhysicianHealth ResourceDatabase)6-Supply-PaymentsCurrent-RosterIncidence and prevalence e.g.,chronic diseaseCancer, Diabetes, Cardiovascularhealth, Kidney/RenalHospital inpatient stays,procedures, doctor services2006 onward CIHI CommunityHealth Survey –2011, Department ofHealth and Wellnessprovincial programs2006 onward Department ofHealth and Wellnessprovincial programs,CIHI, StatisticsCanada2005 and 2010 Department ofHealth and WellnessDay procedure, outpatient volume 2005 and 2010 Department ofHealth and WellnessDemographics of the currentregistered physician workforce,organized according to FunctionalSpecialty (See ‘Terminology’ fordescription of Functional Specialty).MSI, Block Fund, Salary, 3 rd party,and other physician payment data7 - Wait Times Wait time data on surgical andmedical servicesMay, 20112008/09 and2009/10April 2010 to May2011Department ofHealth and Wellness,DFM, CPSNS,Department ofHealth and Wellness,DFMDepartment ofHealth and WellnessPatient AccessRegistry Nova Scotia(PARNS) database8 - CIHI Benchmarks Inter-provincial comparativephysician data9 – CAPERS & CaRMS National medical education systemdata for all Faculties of Medicine2005 onward CIHI – NationalPhysician database2000 onward CAPERS & CaRMSdatabase andwebsites.6.2 Data LimitationsEach research source comes with limitations; however, the Consultant, with stakeholder assistance, hasworked to mitigate each limitation. The Consultant consistently applied a number of research techniquesincluding the use of corroborating evidence, standardized interview questionnaires, iterative data refinementto improve accuracy and quality, and conducted testing, revision, and validation of preliminary analytic resultswith stakeholders.The data analyzed spanned 2004/05 to 2009/10. This time frame was long enough to permit trendidentification and analysis. Within the data, limitations were noted:40 | Page Social Sector Metrics Inc. & Health Intelligence Inc. | 12/31/2011
Physician Resource PlanningAn Environmental Scan− Access to services – Very good data on access to services are recorded by DHAs, IWK, and collectedand reported by DHW on surgical wait times and lists. Data on access to medical consultation andservices wait times and lists were not available. Validated data on residents without a familyphysician were spotty. The Consultant was, therefore, unable to incorporate this element asoriginally envisaged in the work plan.− Active physicians – The Consultant narrowed the CPSNS registry file of 2,800 individuals to 2,500active physicians as of 2009/10 by matching to itemized individual payment records. The list of2,500 then underwent extensive external review and reconciliation to DHA department memberlists, Alternative Funding Plan (AFP) rosters, and Dalhousie Faculty of Medicine academicappointment lists, resulting in a final count of 2,215 individual physicians and 1,988 full-timeequivalents. These added review steps, albeit time consuming, added substantial integrity to theresulting databases.− Alternative Funding Plan(s) – DHW, DHAs, IWK, and DFM are reviewing and revising AFPagreements. When complete, these agreements will establish a percentage distribution betweenclinical and academic (research, teaching, and academic leadership) time, whether funded by theAFP or another source. In the interim, the Consultant set the percentage of academic time equal tothe proportion of academic salary to total income. This approach is not ideal but is a reasonable,evidence-based option. The Forecast Model specifically provides for disaggregation of an FTE intoclinical and academic components by individual.− Functional Specialty – Functional specialty (e.g., a cardiologist who spends 50% of professional timedoing ‘general internal medicine’) is a complex, time-intensive construct to define and maintain. Forexample, an individual can, and often does, change a functional focus in response to changes inlocal physician supply, such as the recruitment of a general internal medicine specialist enabling acardiologist to revert to full-time cardiology, which in turn decreases cardiology referrals outsidethat DHA. A second significant complication is blurring of the definitional line between licensed andfunctional specialty (e.g., to practise cardiology one must also practise general internal medicine.)This report uses licensed specialty except in a few (less than 2%) instances where an individual islicensed in one specialty but has, often for many years, functioned 100% in another specialty. Inthese instances, the individual is reassigned to their functional specialty.− Licensed Specialty – Currently no single source has complete, accurate information on licensedspecialty by individual. Working from the license status assigned by the CPSNS, the Consultantfacilitated an external review with DHAs, IWK, DFM, and AFP which resulted in about 1% ofindividuals to change from a general adult or paediatric specialty (e.g., Internal Medicine or GeneralPaediatrics) to a subspecialty (e.g., Cardiology or Hematology/Oncology).− Payments – Block-funded contracts are paid to groups rather than individuals, making thedetermination of full-time (FTE) equivalency a challenge in some cases. The Consultant usedcorroborating evidence to mitigate this weakness, e.g., Alternative Funding Plan (AFP) FTE budgetstatus, DFM work status (full-time, part-time, retired), CPSNS registry status, and income from allother sources for each physician.− Timing - Changes in physician counts and FTEs occurring after March 31, 2010 are not reflected inthe baseline of the forecast projections. This is particularly important in certain subspecialties withsmall numbers. This report contains specific recommendations on the importance of maintainingthe transferred physician resource forecast model and supporting database. A system of ongoingupdating of the model database to ‘current day’ physician counts and FTEs can eliminate timingdifferences to reproduce an updated forecast.41 | Page Social Sector Metrics Inc. & Health Intelligence Inc. | 12/31/2011
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Page 10: 3 KEY OBSERVATIONS3.1 IntroductionP
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Page 43 and 44: 7 CONCEPTUAL MODELS7.1 Methodologie
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INCIDENCEPhysician Resource Plannin
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PHYSICIAN SERVICESPhysician Resourc
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Environmental Scan - Government of Nova Scotia

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