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2019 HSR&D/QUERI National Conference Abstract

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4148 — Why are some VA primary care providers shifting away from women's health care?

Lead/Presenter: Alison Hamilton,  COIN - Los Angeles
All Authors: Hamilton AB (Center for the Study of Healthcare Innovation, Implementation & Policy), Canelo I (Center for the Study of Healthcare Innovation, Implementation & Policy), Oishi A (Center for the Study of Healthcare Innovation, Implementation & Policy) Yano E (Center for the Study of Healthcare Innovation, Implementation & Policy)

Objectives:
Women Veterans' experiences with outpatient health care are better when they receive care from women's health primary care providers (WH-PCPs). However, between FY15 and FY16, 19.7% of VA WH-PCPs left that role. In partnership with VA Women's Health Services (WHS), the objective of this operations project is to understand the experiences of those who no longer serve in the WH-PCP role but remain in VA.

Methods:
We recruited PCPs from sites participating in the WHS/QUERI Partnered Evaluation Initiative, and then expanded recruitment to the Women's Health Evaluation Initiative dataset. The interview guide focused on reasons for transitioning away from WH, probed for experiences of providing women's PC, and solicited suggestions to be shared anonymously with WHS. Interviews were conducted by phone, transcribed, and summarized; matrix analysis was used to categorize the range of reasons for attrition.

Results:
PCPs (n = 16) described several different and often complex reasons why they transitioned away from WH. Some were unable to do comprehensive WH care due to lack of resources and/or insufficient support. Some PCPs also described having challenging women patients, which contributed to staff turnover. For example, a PCP noted that patients who were "ready for battle" were hard on her PACT team, which had turned over twice in five years. Some LPNs were "resistant" to working in WH, partially because they weren't comfortable with/trained in WH care. A PCP suggested that those who leave WH might feel that the policy-mandated decrease in panel size does not compensate for the increased workload, which contributes to sense of "daily overwhelm." Some experienced insufficient opportunities for professional advancement in WH, while others found positions that were simply more convenient and, in some cases, less demanding.

Implications:
A complex picture is emerging of the experiences of PCPs who have transitioned away from WH. While many frustrations were voiced, much compassion for women Veterans and dedication to providing high quality care was also conveyed.

Impacts:
To achieve the VA priority of an optimized workforce, it is critical to identify steps that can ensure that PCPs experience satisfaction and support in their care of Veteran patients.