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Shared Values and VA's Mission-Driven Culture Strengthen VA Primary Care Physician Recruitment and Retention

Research has identified a current and expected future shortage of primary care physicians (PCPs) in the US. Factors contributing to shortages include retirement and burnout in current PCPs, and a dwindling interest in primary care careers among medical students/residents. However, there is a growing need for primary care services, rising chronic disease rates, and an expanding aging population. VA serves as the largest clinical site for physician residency training in the US, so is uniquely positioned to enhance its ability to recruit primary care physicians. Thus, this qualitative study sought to understand the experiences of resident and staff physicians within VA primary care to identify factors to guide health systems in improving recruitment/retention. From June 2018 to October 2019, investigators interviewed 24 newly hired internal medicine residents and 30 staff physicians in VA primary care to ascertain their perspectives about training and their employment preferences at VA and non-VA healthcare sites. Temporary and contract physicians, and physicians located at contract VA outpatient clinics, were excluded.


  • Four key themes emerged, centered around shared values and VA’s mission-driven culture:
    1. VA “community” was perceived as unique and a major contributor to job satisfaction. In addition, there were perceptions of a strong work-life balance in VA, more so than in non-VA settings.
    2. Facility-level leadership support was important to personal feelings of workplace culture around safety from harassment. One third of respondents mentioned being subjected to harassing or threatening remarks, most often from patients.
    3. VA’s primary care delivery model allowed physicians to get patients needed care (e.g., addressing social determinants of health) but did not always rise to its full potential. Lack of support staff and perceptions that nurses were not permitted to work to the full scope of their licenses were reported.
    4. VA employment was better than expected, but the hiring process was a challenge.
  • The Veteran population was repeatedly mentioned as the reason physicians loved working for VA.


  • VA could counteract challenges, including lower pay and slow hiring processes, by promoting the unique aspects of VA employment such as a mission-driven and community-based culture and the rewarding opportunity to serve a unique population.


  • Perspectives of VA training and employment may differ across occupations, including nurse practitioners and physician assistants. Investigation of these perspectives represents an area of future research.

This study was funded by HSR&D (IIR 15-363). Ms. Moldestad and Drs. Sayre, Reddy, Nelson, and Wong are part of HSR&D’s Center of Innovation for Veteran-Centered and Value-Driven Care; Dr. Rinne is with HSR&D’s Center for Healthcare Organization & Implementation Research; and Dr. Kaboli is part of HSR&D’s Center for Access & Delivery Research and Evaluation.

Moldestad M, Sayre G, Rinne S, Kaboli P, Reddy A, Sanders K, Mao J, Henrikson N, Sterling R, Nelson K, and Wong E. Perspectives on Training and Working in the VHA: Implications for Primary Care Physician Recruitment and Retention. Academic Medicine. February 8, 2022; online ahead of print.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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