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Ask the expert: How should our hospital choose an overall physician-to-population ratio for the community?

Medical Staff Leader Connection, September 23, 2010

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The first step in choosing an appropriate overall physician-to-population ratio for a community is to use publicly available data to obtain or estimate current physician-to-population ratios in as many comparable medical markets as possible. Where a county falls on the urban-rural continuum (metropolitan, micropolitan, urban nonmetropolitan, and rural) has more influence than any other factor on physician supply and specialty mix. Thus, the first place to look for comparable medical markets is within the urban/rural/metro/micro cluster where the community fits.

One limiting factor is that most publicly available data on physician supply are available at a county level. But counties that cover a large geographic area are likely to have subareas with relatively high physician-to-population ratios (e.g., near large hospitals), as well as subareas with physician-to-population ratios well below the countywide average. The list of comparable medical markets is also somewhat limited by the high degree of variability in physician supply within each of the urban/rural/metro/micro clusters.

The search for an appropriate benchmark is not necessarily limited to nearby cities, metropolitan areas, or counties. In some cases, a statewide or regional average represents a reasonable benchmark for a community need analysis. A community known for providing high-quality service, achieving excellent clinical outcomes, and having a moderate physician-to-population ratio may also be chosen as a benchmark, regardless of where it is located.

Because patterns of healthcare utilization are generally difficult to change, the current benchmark for a community, or the target ratio used to determine future physician need, should usually not be more than 15% from the current physician-to-population ratio in the community.

This week’s question and answer are from The Hospital Executive’s Guide to Physician Staffing, by Hugo J. Finarelli, Jr., PhD, published by Health Leaders Media.

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