Beyond clinical care: direct, indirect, and non-physician activities and their implications for workforce planning and postgraduate medical education in a university neurosurgical department

Background Realistic determination of physician staffing requirements is essential to ensure high-quality patient care and the long-term sustainability of healthcare systems under increasing financial constraints. However, empirical data on medical workforce planning remain scarce. Using a neurosurgical university department as an example, we sought to quantify physician staffing requirements and compare different approaches to workforce calculation. Methods Physician staffing requirements were assessed using three complementary approaches: (1) an economic–normative approach based on DRG reimbursement and the InEK (Institute for the Hospital Renumeration System/ Institut für das Entgeltsystem im Krankenhaus) cost matrix; (2) a deductive–institutional approach incorporating expected clinical workload as well as vacation and sick leave; and (3) an empirical time-motion analysis based on real-time recording of physicians’ activities. In addition to direct patient care, indirect medical tasks and non-physician duties were systematically documented. Results The DRG-based calculation yielded a reimbursable staffing requirement of 15.5–19.5 full-time equivalents (FTEs). After accounting for indirect clinical activities, vacation, and sick leave, the deductive–institutional approach estimated a requirement of 23.5 FTEs. However, the empirical analysis demonstrated that a substantial proportion of physicians’ working time was devoted to activities not directly related to patient care, particularly on-call duties (24.7%) and ward-related organizational tasks (15.6%). These activities were insufficiently captured by the economic and deductive models and would require additional staffing resources. Conclusion Physician staffing requirements are inadequately reflected by reimbursement-based DRG calculations. Realistic workforce planning requires consideration of indirect clinical activities, organizational duties, and institution-specific workflow analyses. Although these estimates were derived within the German healthcare system, neurosurgical departments internationally are likely confronted with similar demands arising from non-clinical and administrative responsibilities. Identifying and reducing such tasks may represent an important opportunity to improve efficiency and optimize physician workforce utilization.