David Christopher received his medical degree 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. Today, one other doctor has joined his clinic in additiona to 12 support personnel such as x-ray technicians, nurses, accounting and office support. The medical practice specilizes 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 preservatioin investigation and restoration of the form and function of the extremeties, 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, deformaties, injuries and degenerative diseases of the spince, 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 perpheral nervous system lesions of the muscoloskeletal 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.

Dr. Christopher collected the data in exhibit 10.8 as an example of the clinics 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 noon, 4 days a week. After lunch, the surgeons see patients in the hosptial and at the clinicfrom 1:00 pm to 6:00 pm. Over the weekend and on Fridays, the surgeons rest, attend conferences and professional meetings, and someties do guest lectures at a nearby medical school. The doctors want to leave a safety capacity each week of 10% for the 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 patients medical record for any last minute issues, and prepare for the next surgery. Dr. Christopher feels these changover 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 plces gerat stress on the surgeons 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 coluld lead to medical and surgical errors. Dr Christopher wants answers to the following questions:

Orthopedic Surgery Procedure	Surgeon Changeover Time (Min)	Surgery Time (Min)	Surgeon Identity	Demand (#ofPatientsSchduledWeekly)
Rotator Cuff Repair	20	45	B	2
Cartilage Knee Repair	20	30	B	1
Fractured Fibia/Tibia	20	60	B	1
Achilles Tendon Repair	20	30	B	3
ACL Ligament Repair	20	60	B	3
Fractured Hip	20	80	A	0
Fractured Wrist	20	60	A	2
Fractured Ankle	20	70	A	1
Hip Replacement	30	150	A	2
Knee Replacement	30	120	A	3
Shoulder Replacement	40	180	B	1
Big Toe Replacement	20	90	B	0

1) What is the clinic's weekly workload?

2) Should the clinic hire more surgeons, and if so, how many?

3) What other options and chnages could be made to maximize patient throughput and surgeries, and therefore revenue, yet not compromise the quality of medical care?

4) What are your final recommendations? Explain your reasoning.