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Acad Med. 2013 Dec;88(12):1877-82. doi: 10.1097/ACM.0000000000000026.

The contribution of "plasticity" to modeling how a community's need for health care services can be met by different configurations of physicians.

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  • 1Dr. Holmes is associate professor, Department of Health Policy and Management, Gillings School of Global Public Health, and senior research fellow, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Ms. Morrison is a doctoral student, Department of Health Policy and Management, Gillings School of Global Public Health, and graduate research assistant, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Dr. Pathman is professor and director of research, Department of Family Medicine, University of North Carolina School of Medicine, and director, Program on Health Professions and Primary Care, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Dr. Fraher is assistant professor, Department of Family Medicine and Department of Surgery, University of North Carolina School of Medicine, and director, Program on Health Workforce Research and Policy, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Abstract

This article introduces the concept of "plasticity" to health care workforce modeling and policy analysis. The authors define plasticity as the notion that individual physicians within the same specialty each provide a different scope of service, while the scope of service of physicians in different specialties may overlap. This notion represents a departure from the current, silo-based conception of physician supply as physician headcounts by specialty; the implication is that multiple configurations of physicians (and, by further application, other health care professionals) can meet a community's utilization of health care services.Within-specialty plasticity and between-specialty plasticity are two facets of plasticity. Within-specialty plasticity is the idea that individual physicians within the same specialty may each provide a different mix and scope of services, and between-specialty plasticity is the idea that patterns of service provision overlap across specialties. Changes in physician specialty supply in a community affect both the between-specialty and within-specialty plasticity of that community's physicians. Notably, some physician specialties are more "plastic" than others.The authors demonstrate how to implement a plasticity matrix by assessing the sufficiency of physician supply in a specific community (Wayne County, North Carolina). Additional literature and data can provide further insights into the influences on (and of) plasticity, improving this approach and expanding it to include task-shifting across health care professions.

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