David christopher orthopedic surgeon case study

David Christopher, Orthopedic Surgeon, Case Study

David Christopher received his medical degrees from the University of Kentucky and the University of Virginia. He did his residency and early surgeries at Duke University Medical Center. Eight years ago he set up his own orthopedic surgery clinic in Atlanta, Georgia. Today, one other doctor has joined his clinic in addition to 12 support personnel such as X-ray technicians, nurses, accounting, and office support. The medical practice specializes in all orthopedic surgery except it does not perform spinal surgery. The clinic has grown to the point where both orthopedic surgeons are working long hours and Dr. Christopher is wondering whether he needs to hire more surgeons.

An orthopedic surgeon is trained in the preservation, investigation, and restoration of the form and function of the extremities, spine, and associated structures by medical, surgical, and physical means. He or she is involved with the care of patients whose musculoskeletal problems include congenital deformities; trauma; infections; tumors; metabolic disturbances of the musculoskeletal system; deformities; injuries; and degenerative diseases of the spine, hands, feet, knee, hip, shoulder, and elbows in children and adults. An orthopedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. Osteoporosis, for example, results in fractures, especially in the hips, wrists, and spine. Treatments have been very successful in getting the fractures to heal.

Exhibit 10.9 Orthopedic Surgeon One-Week Surgery Workload (This spreadsheet is available on the CourseMate Web site.)

Orthopedic Surgery Procedure

Surgeon Changeover Time (Minutes)

Surgery Time (Minutes)

Surgeon Identity

Demand (No. of Patients Scheduled Weekly)

Rotator cuff repair

45

45

B

2

Cartilage knee repair

45

30

B

1

Fracture tibia/fibula

45

60

B

1

Achilles tendon repair

20

30

B

3

ACL ligament repair

20

60

B

4

Fractured hip

45

80

A

0

Fractured wrist

45

60

A

2

Fractured ankle

45

70

A

1

Hip replacement

60

150

A

2

Knee replacement

60

120

A

3

Shoulder replacement

120

180

B

1

Big toe replacement

45

90

B

0

Dr. Christopher collected the data in Exhibit 10.9 as an example of the clinic's typical workweek. Both surgeons work 11 hours each day with 1 hour off for lunch, or 10 effective hours. All surgeries are performed from 7:00 a.m. to 12:00 noon, four days a week. After lunch from noon to 1:00 p.m., the surgeons see patients in the hospital and at the clinic from 1:00 p.m. to 6:00 p.m. Over the weekend and on Fridays, the surgeons rest, attend conferences and professional meetings, and sometimes do guest lectures at a nearby medical school. The doctors want to leave a safety capacity each week of 10 percent for unexpected problems with scheduled surgeries and emergency patient arrivals.

The setup and changeover times in Exhibit 10.8 reflect time allowed between each surgery for the surgeons to clean themselves up, rest, review the next patient's medical record for any last-minute issues, and prepare for the next surgery. Dr. Christopher feels these changeover times help ensure the quality of their surgery by giving them time between operations. For example, standing on a concrete floor and bending over a patient in a state of concentration places great stress on the surgeon's legs and back. Dr. Christopher likes to sit down for a while between surgeries to relax. Some surgeons go quickly from one patient to the next; however, Dr. Christopher thinks this practice of rushing could lead to medical and surgical errors. Dr. Christopher wants answers to the following questions.