Allied Health Manpower Strategies: Estimates of the Potential Gains from Efficient Task Delegation

This study analyzes the potential impact of physician extenders on the productivity of primary care practices and considers the consequent implica tion for future health manpower requirements. A number of previous inves tigations have evaluated a variety of extenders in experimental settings. This study, in contrast, constructs and operates a simulation model of the repre sentative practice permitting one to synthesize the experiences and insights of earlier demonstration projects. The model requires the practice to delegate tasks to paramedical personnel including the physician extender in such a way as to minimize the total cost of delivering a list of required medical services. The alternative acceptable techniques for delivering care are defined by the number of minutes of each type of medical personnel that must be employed in producing each service. Primary care is characterized by distinct medical services. The model reveals that physician extenders could increase the productivity of a representative primary care practice by up to 74 per cent Alternatively, the commitment of physician time required to serve a patient load of 100 visits a week might be reduced by 14.2 hours through effective use of an extender. The article concludes with observations on the implications of physician extenders for future health manpower requirements. O rig in a l A rticles The demand for medical services is in creasing dramatically. As public and private insurance schemes develop to cover the costs of care, the demands on the health care system will expand further. These ex panded demands have prompted experts to propose that additional resources b e allo cated towards existing programs of physi cian training. Such proposals are premised on the the assumption that th e current organization of the health care system will continue indefinitely. However, in view of the extraordinary cost of medical education and the great length of time required to develop new training programs, it seems appropriate to explore alternative strate gies for the expansion of medical services. Considerable i n t e r e s t h a s developed within the medical profession in task dele gation and in the training of new classes of 45