David Christopher, Orthopedic Surgeon, Case Study Background: 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. Dr. Christopher collected the data in the table below 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 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 the table 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 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 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 could lead to medical and surgical errors. Dr. Christopher wants answers to the following questions.

Orthopedic Surgery Procedure	Surgeon Changeover Time (minutes)	Surgery Time (minutes)	Surgeon Identity	Demand (No. of Patients Scheduled this Week)
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

David Christopher, Orthopedic Surgeon Questions

1) How many days per week do the surgeons actually do surgeries?

2) How many hours per day do the surgeons allow for surgery, reduced of course for safety time?