Health Services Research & Development

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IIR 15-084 – HSR&D Study

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IIR 15-084
Impact of New Physician Residents on Veterans' Access to Care
Terrell Michael Kashner PhD JD MPH
VA Loma Linda Healthcare System, Loma Linda, CA
Loma Linda, CA
Funding Period: June 2016 - June 2019

BACKGROUND/RATIONALE:
Since 1946, educating new clinical health professionals has been one of the four primary missions of the Department of Veterans Affairs (with patient care, research, and clinical backup to Defense). To further that mission, VA's Office of Academic Affiliations [OAA] manages affiliation agreements between 142 VA medical centers and 152 of the 170 medical schools (including 29 osteopathic) and over 1,800 other education programs, covering annually 40,420 physician residents, 21,541 medical students, and 56,585 nursing students, dental, and associated health trainees.
To ensure quality care for its veterans and education opportunities to future health professionals, VA is preparing to allocate 1,500 positions / 4,500 new residents who will rotate through VA medical centers as required under the Choice Act. This study will examine different methods to allocate those residents, and forecast potential implications to clinical workload, clinical learning opportunities, resident satisfaction of the clinical learning environment, and willingness of residents to consider VA as a future professional employer. The importance to VHA leadership in addressing both resident allocation and reporting requirements under the Choice Act is critical if the intended effect on improving accessibility of quality care to veterans, now, and in the future, is to be achieved.

OBJECTIVE(S):
The proposed study goes well beyond focusing on the consequences to VHA of allocating 1,500 new training slots under the Choice Act to VA medical centers. Our study addresses whether trainees actually contribute to clinical workload, by how much and to whom, and at what size and trainee to staff ratios do we find positive, or negative, impacts on the trainees' clinical learning environments. Such information is invaluable to VHA Office of Academic Affiliations as it oversees the supervision and costs for physician residents, fellows, and medical students to rotate through VA medical centers. Such information will also be of great value to all administrators of clinical teaching hospitals and education program directors, both of whom must resolve difficult residency training assignments and allocation decisions in a manner that best serves their patients and their students, residents, and fellows.

METHODS:
We will assess the impact of new residents (at the margin) on GME education outcomes (clinical opportunities for residents to engage in patient care, resident satisfaction with their learning experiences, and willingness to consider VA for future employment (employability) (AIM2). Data comes from: (1) VA administrative files, (2) Office of Academic Affiliations [OAA] paid slot file describing filled resident positions by specialty and academic year; (3) OAA's Learners' Perceptions Survey [LPS] data that provides trainee satisfaction data by facility, year, and trainee specialty, for FY2001 through FY2015, inclusive, (4) OAA administrative surveys assessing VA Medical Centers status with affiliate university and teaching institutions, and (5) NCOD All Employee Survey.

FINDINGS/RESULTS:
There are no findings at this time.

IMPACT:
There is no impact at this time.

PUBLICATIONS:
None at this time.


DRA: Health Systems
DRE: Treatment - Observational, TRL - Applied/Translational
Keywords: Organizational Planning, Outcomes - System, Provider Education
MeSH Terms: none