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IIR 15-363 – HSR Study

IIR 15-363
Identifying Value-Driven Approaches to Strengthening the VA Physician Workforce
Edwin S. Wong, PhD MA
VA Puget Sound Health Care System Seattle Division, Seattle, WA
Seattle, WA
Funding Period: March 2018 - February 2022
Primary care physician (PCP) shortages are a significant and growing problem confronting the US healthcare system. An overall shortage of up to 53,000 PCPs is projected in the US by 2025, and a shortage of PCPs in VA has recently come under increased focus due to the emphasis on improving Veterans' access to high quality and timely healthcare. As of May 2016, VA was reported to have been trying to fill up to 500 PCP positions, reflecting roughly 12% of the current VA PCP workforce. Prior research has not examined several important individual, economic, job and system-level factors associated with the recruitment and retention of PCPs by health systems, including components of pay and compensation, academic affiliation, elements of the patient-centered medical home model and workplace climate. In addition, no prior research has examined the relative importance of factors in explaining PCP recruitment and retention. Identifying and prioritizing key factors associated with PCPs' employment choices will help VA and other health systems with the strategic recruitment of PCPs and the development of evidence-based strategies to retain high quality PCPs.

The objectives of this study are to: 1) identify and prioritize individual, job, economic and system-level factors associated with the choice of VA for employment and selection of rural practice (i.e. recruitment) using existing VA data as well as new qualitative and survey data collected for this study; and 2) identify and prioritize individual, job, economic, and system-level factors associated with long-run retention of PCPs within VA and in rural VA clinics using administrative data and existing survey data.

To measure factors associated with VA recruitment and choice of rural practice setting (Aim 1), we will conduct structured interviews with current internal medicine residents exposed to VA settings during their training and new PCPs with a permanent VA position. We will then develop and administer a new survey instrument using key factors identified in qualitative interviews and factors of particular interest in this study. We will perform descriptive analyses to compare influential factors identified in interviews and surveys between residents and new PCPs. Multivariable analyses will be used to identify factors that are significantly associated with consideration of VA employment and rural practice among internal medicine residents. For Aim 2, we will use VA administrative databases to track the employment status of VA PCPs longitudinally. We will identify all full-time equivalent PCPs assigned to a panel of primary care patients at any time during the period 2003-2016. We will link administrative data with VA and public survey data to examine key factors of interest. Statistical methods for survival data analysis will be applied to assess the influence of hypothesized factors on quarterly retention probabilities and PCPs' expected duration of VA employment. Parallel analyses will assess PCP retention in rural VA facilities. We estimate examining approximately 10,000 PCPs in retrospective analyses of retention, 3,000-6,000 survey responses and 30-60 interviews.


This study is of current policy relevance given the shortage of VA PCPs and the emphasis on providing Veterans timely access to care in the VA FY 2018-2024 Strategic Plan. Findings from this study will inform strategic physician workforce planning in VA to ensure appropriate capacity to meet the health care needs of Veterans.

External Links for this Project

NIH Reporter

Grant Number: I01HX002121-01A2

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Journal Articles

  1. O'Connor AW, Helfrich CD, Nelson KM, Sears JM, Singh H, Wong ES. Changes in electronic notification volume and primary care provider burnout. The American journal of managed care. 2023 Jan 1; 29(1):57-63. [view]
  2. O'Connor AW, Helfrich CD, Nelson KM, Sears JM, Jensen PK, Engstrom C, Wong ES. Full practice authority and burnout among primary care nurse practitioners. Nursing Outlook. 2023 Oct 17; 71(6):102056. [view]
  3. Sterling R, Rinne ST, Reddy A, Moldestad M, Kaboli P, Helfrich CD, Henrikson NB, Nelson KM, Kaminetzky C, Wong ES. Identifying and Prioritizing Workplace Climate Predictors of Burnout Among VHA Primary Care Physicians. Journal of general internal medicine. 2022 Jan 1; 37(1):87-94. [view]
  4. O'Connor AW, Wong ES, Nelson KM, Sears JM, Helfrich CD. Patient Enrollment Growth and Burnout in Primary Care at the Veterans Health Administration. Journal of general internal medicine. 2023 May 1; 38(7):1689-1696. [view]
  5. Moldestad M, Sayre G, Rinne S, Kaboli PJ, Reddy A, Sanders KM, Mao J, Henrikson NB, Sterling R, Nelson KM, Wong ES. Perspectives on Training and Working in the VHA: Implications for Primary Care Physician Recruitment and Retention. Academic medicine : journal of the Association of American Medical Colleges. 2022 Aug 1; 97(8):1175-1183. [view]

DRA: Health Systems
DRE: Treatment - Implementation, TRL - Applied/Translational
Keywords: Guideline Development and Implementation, Organizational Planning, Organizational Structure
MeSH Terms: none

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