## Calculation of internal medicine staff

The calculation of the medical staff of this clinic functional unit is presented in three sections:

- Data, criteria and variables considered
- Calculations and results
- Summary, conclusions and recommendations

**Data Criteria and Variables **

It takes into account the following paragraphs:

- Resources and means available
- The Working day
- The annual days of absenteeism
- The Guards
- The schedule of activities
- The distribution of physician time
- The medical time-consuming
- The activity
- The physician performance goal to achieve.

**Resources & Facilities**: Resources and are considered material and human resources currently available. The material resources available are beds and clinics. But beds are not attached, so we ascribe the 32 beds of Internal Medicine, Cardiology, Gastroenterology, Pulmonology and Rheumatology in proportion to the template. Internal Medicine and has 10 beds with attached and two clinics. The currently available medical staff consists of a clinical or section chief and four senior doctors (specialists or optional health area). Residents are of Family Medicine, rotating for a month in each service and all activity is monitored, so that for the purposes of calculating the staffing requirements are not considered. The working day: The normal working day is 36 hours weekly, distributed in five days, 7 hours and 18 minutes each: 7 x 60 + 18 = 438 438 x 5 = 2,190 2,190 - 30 = 2,160 2.160/60 = 36. That is, seven hours and 18 minutes is 438 minutes of time daily. For five days is 2190 minutes per week. Less than 30 minutes is 2160 minutes, which are divided by sixty 36 hours. A working week of 36 hours and 30 minutes consists of five days, 7 hours and 18 minutes each. The annual day is calculated as follows: 365 calendar days less 30 days of vacation minus 48 Sundays, until 48 on Saturdays, at least 14 public holidays, unrestricted least 6 involve working 219 days per person (in reality and in the holiday month there is always a festive holidays should only be reduced by 13 instead of 14 annual days and would be 220 instead of 219). As the work day is 7 hours and 18 minutes (438 minutes), the annual time in hours is calculated as: 219 x 438 / 60 = 1,599 hours per year. In the 11 months of work involving 146 hours or 20 working days each month, on average. To summarize:

- Workday 7 hours and 18 minutes. Workweek 36 hours and 30 minutes (five days)
- 146 hours per month (20 days) Annual Day 1599 hours (219 days).

- Annual Day of 1596 hours and 228 days: 8 to 15 hours.
- Annual Day of 1596 hours and 219 days: 8 to 15 hours and 17 minutes
- It seems that the time to apply is the last indicated. The data provided so they say.

Annual days of absence from work: Indicates the days of absence to work in three groups: disease, permits and other. In the latter group includes labor hours. There is no data on absenteeism. From the third hypothesis is estimated 10 days of sick leave and 10 days.

The Guards: Every day there is a duty doctor of physical presence and a guard at a distance (localized). The guards in the physical presence means that each day of work is going to miss a doctor, outgoing call. That is, the guards, in addition to economic rewards, are compensated partially working. For every doctor on duty per year, physically present, calculate how many hours of working time is contracted.

The calculation is as follows: The annual number of guards is 365, which "give back" to work day as follows:

- Four days from Monday to Friday every day of guard in a day.
- Saturday guards are not rewarded with time.
- Guard on Sunday was rewarded with a day (being waged on Monday).
- According to doctors this guard / year of physical presence, the total contracted hours for the service will be deducted as follows:
- 52 x 6 x 7 = 2184 hours
- 2184 / 365 = 5.98 hours

This means that for every duty from 15 to 8 hours of physical presence can be considered accredited for 5.98 hours workday. When the guards are only for activities of the Service, do not discount anything, unless they are also net the activity during it

According to this criterion the total care time are: 1 Heads of Section 1 x 1599 x 0,55 879 hours, 4 MA 4x 1599 0.80 x 5116 hours, TOTAL TIME CARE CONTRACT 5995 hours

(TMC) (5 x 1,599) 7,995 hours per year. Time Contracted Medical Care (TMA) 5,995 hours per year. Time Contracted Medical Assistance not 1999 hours / year. These data suggest that practitioners of the 5 Service: 4 (5.995/1.599 = 3.75) engaged in full time care activities at a rate of 1,599 hours annually, and 1 (1.999/1.599 = 1.25) did not care to work also full time. Equally, since 5995 is 74.99% in 7995, can be estimated that the staffing of dedicated service on average 75% of their time to care work and 25% of it to work not welfare. (The New Management Model these rates fixed at 80/20).

Medical time-consuming: In each of the activities performed while consuming the doctor follows:

In 1999 the activity was as follows:

- Incoming 358
- High 357
- Stays 3169
- 795 first consultations
- Successive consultations 2466
- 365 Guards
- Physician Performance Goals
- It is believed that optimal workload to be competitive in quality and medical care productivity is that of a medical time performance of 85%. Recall that Performance Assistance (RTMa) is the percentage ratio between the time contracted for medical assistance (TMA) and accredited by the same (TMAC). The TMAs were obtained from the application to the TMC, the average percentage of time care.
- When expressed in terms of time, is the relationship between time accredited by the activity actually performed and the time appointed for the same.
- 100 x TIME ACCREDITED
- PERFORMANCE = -------------------------
- CONTRACT TIME physician time

**Calculations and Results**

With these data and criteria designed the table on the next page, on which make the following clarifications:

**Calculation assumptions **

The seven columns of numbers are working hypotheses which in principle involve:

The first column refers to the current reality (2000). There is no change in the data provided. The staffing required is 4.60 physicians. The second column is for 2001 and is the same as above The third column differs from the earlier of:

- Add 10 days of sickness absence and 10 per permit.
- The day declines of 1,599 hours per year to 1,566 (of 36 hours per week to 35 hours and 45 minutes)
- The staffing required is 4.90 physicians.

The fourth column is unlike the earlier of:

- It decreases the time until 35 hours (1,533 hours per year).
- The staff needed is 5 physicians.
- The other columns are prepared to make other assumptions that may be of interest.

Intermediate Calculations: In point of medical care are some concepts and data that may require explanation: Stays Capacity is the maximum number of rooms available with beds (10). Beds is obtained by multiplying the day (365 x 10 = 3,650). Office capacity ratio is obtained by time staffing clinics and time spent at each visit, starting with the time of each process (a first and corresponding successive). The allocation of office time is: are two clinics that begin at 9 and end at 14 hours that is running 5 hours a day each. The annual working days are: 365-52 Sunday - 52 Saturday - 14 holidays = 247

The time will be 2 clinics equipped for 5 hours by 247 days equals 2470 hours annually, or 148,200 minutes. In each initial consultation and 25 minutes are consumed in each successive 20 minutes are consumed. Each "process" consists of an initial consultation and 3.10 succeeding, so its time consumption will be 25 + 3.10 x 20 = 87 minutes.

The capacity will be: (2x5x247x60) / (25 + 3.10x20) = 148.200/87 = 1,703 processes

That is, the ability of the office is:

- 1703 first consultations and
- 1703 x 3.10 = 5,282 successive consultations
- Total No of Queries: 6984
- Calculation medical staff
- This estimate is based on workloads supported, which are expressed in time-accredited medical assistance. About this time is also considered truancy and other slack time to adjust the target performance time (which we set at 85% considering that this is the best result contributes to optimum quality and competitiveness).

We believe that the time for the absence of care, it is "accredited". This time is calculated by multiplying the lost working days by the average time care of each. The latter is obtained from the analysis of the distribution of physician time, which in this case assumes that the average time devoted to attendance is 74% (75 in the first and second hypothesis). Absenteeism appears in the third hypothesis. In this scenario, the time has decreased to 35 hours and 45 minutes per week (7 hours and nine minutes each day) each day are 420 + 9 = 429 minutes, and 74% are 317 minutes for each workday lost by absenteeism will have this time as trusted. The corresponding time doctor approved is:

20 x 317/60 = 105 hours of TMA for absenteeism. The adjustment for the performance goal of care is to mean you want to avoid the pressure that fails to work overload and achieve an optimal level of medical care that enhances professional development. Empirically it is considered that this optimal performance is 85%. This means that the time taken for the welfare activity and absenteeism is only 85% of the time appointed for the same.

**Calculation of the Medical Staff: **

Accredited Medical Dividing Time (including for the absence from work) so that it is increased 85% (performance target), by the time average annual assistance provided by a physician, will the number of doctors needed. In the case of the third hypothesis that we handle, we have:

- Time credited 4686 hours care activity
- Time absenteeism accredited 105 hours
- TOTAL TIME CERTIFIED MEDICAL 4791 hours
- Time to hire health care (85% RENDT º) 5.636horas
- Time average medical care physician 1119 hours
- Necessary medical staff (8.918/1.119) 4.90 Doctors
- If only we consider the proven 4686 hours, the medical staff needed is 4.18. If absenteeism but also has not taken into account the optimal performance of 85%, staff physicians 4.28 is required.

**Summary, conclusions and recommendations**

- Abstract
- Resourcing and media is quite balanced.
- You need to set the basis for calculations of time of 36 hours per week the daily and annual conferences are not well calculated.
- The hypothesis of absence from work should be based on available statistical data. Here are estimated with ease.
- The criteria for distribution of medical time used must conform to the 80/20 average set by the new management model.
- The times specified for time-consuming doctor seem high to the specialty. 30 minutes for the first visit and 25 for the first consultation in internal medicine, seem adequate, but 25 minutes for successive visits and 20 for subsequent consultations, seem excessive.
- The occupancy rate considered optimal in Internal Medicine is around 85%. The office occupancy rate falls below 50%.
- According to data provided the squad to cope.

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