Physician Turnover in the Veterans Health Administration Aigerim Kabdiyeva June 25, 2018 PE PEPR PReC eC Partnered Evidence-based Policy Resource Center A VA QUERI Program VETERANS HEALTH ADMINISTRATION
PE PEPR PReC eC Acknowledgements Partnered Evidence-based Policy Resource Center A VA QUERI Program • Funding: This work is funded by Workforce Management and Consulting (WMC) Office at the VA. Special thanks to Nicole Katikos and Whitney Henderson. • Collaborators: PEPReC: Steve Pizer, Austin Frakt, Taeko Minegishi, Kyle Barr, Gilbert Benavidez , Christine Yee Disclaimer: The contents of this presentation do not represent the views of the U.S. Department of Veterans Affairs or the United States Government. VETERANS HEALTH ADMINISTRATION 2
PE PEPR PReC eC Outline Partnered Evidence-based Policy Resource Center A VA QUERI Program • Background information about turnover • Research question • Regression specification • Descriptive statistics • Regression results • Interpreting the results VETERANS HEALTH ADMINISTRATION 3
PE PEPR PReC eC Why do we analyze physician turnover? Partnered Evidence-based Policy Resource Center A VA QUERI Program VETERANS HEALTH ADMINISTRATION 4
PEPR PEPReC eC Why do we analyze physician turnover? Partnered Evidence-based Policy Resource Center The VA (Veteran Affairs) Mission Act increases funding for VA employee retention incentives: • Education Debt Reduction Program (EDRP) awards to be increased from $120,000 to $200,000 over a total of 5 years. EDRP program total is projected to reach $90 million in 2019. • A new Specialty Education Loan Repayment program for physicians in specialties which are difficult to recruit and retain. $160,000 over a total of 4 years. • Increases funding for 3R: Retention, Recruitment, Relocation VETERANS HEALTH ADMINISTRATION 5
PE PEPR PReC eC Research question Partnered Evidence-based Policy Resource Center A VA QUERI Program • How is physician turnover at the VA affected by Education Debt Repayment Program and Recruitment, Retention and Relocation incentives? VETERANS HEALTH ADMINISTRATION 6
PEPReC PEPR eC Veteran Affairs vs. private sector from physician perspective Partnered Evidence-based Policy Resource Center • Less time spent hassling with insurance • More time spent with patients • Salaries are generally lower than in the private sector • Fewer support staff VETERANS HEALTH ADMINISTRATION 7
PEPR PEPReC eC What can be done about physician Partnered Evidence-based Policy turnover at the VA? Resource Center • Increase the number of support staff • Improve organizational culture • Increase physician salary • Provide recruitment/retention incentives • Provide education loan repayment assistance VETERANS HEALTH ADMINISTRATION 8
PEPReC PEPR eC Partnered Evidence-based Policy Regression specification Resource Center EDRP to salary ratio Recruitment to salary ratio Quit indicator (0 or 1) Relocation to salary ratio Retention to salary ratio VETERANS HEALTH ADMINISTRATION 9
PEPR PEPReC eC Partnered Evidence-based Policy Selection bias Resource Center • Physicians who are more likely to quit are more likely to receive incentive awards retention award ( − ) Quit indicator (0 or 1) unobserved propensity to quit ( + ) • Control mean quit rate of RNs VETERANS HEALTH ADMINISTRATION 10
PEPReC PEPR eC Partnered Evidence-based Policy Descriptive statistics Resource Center • 128 VA Medical Centers • 82,157 physician-year observations for Primary Care Physicians • 41,932 physician-year observations for Psychiatrists mean for mean for Variable PCPs Psychiatrists quit indicator 0.04 0.06 EDRP indicator 0.02 0.03 Relocation indicator 0.01 0.01 Recruitment indicator 0.03 0.05 Retention indicator 0.03 0.04 VETERANS HEALTH ADMINISTRATION 11
PEPR PEPReC eC Partnered Evidence-based Policy Regression results Resource Center Estimate Estimate for Variable For PCP Psychiatrists - ** - ** EDRP to salary ratio - * Recruitment to salary ratio - * Relocation to salary ratio - ** - ** Retention to salary ratio mean quit rate of nurses with up + * + * to 5 year tenure * significant at 5%, ** significant at 1% VETERANS HEALTH ADMINISTRATION 12
PEPReC PEPR eC Interpreting the effects of incentive Partnered Evidence-based Policy programs: PCPs Resource Center • Consider the effect of giving a $18,300 award Award type Decrease in probability of quitting EDRP 2.2% Retention 1.1% Relocation 2.6% VETERANS HEALTH ADMINISTRATION 13
PEPReC PEPR eC Interpreting the effects of incentive Partnered Evidence-based Policy programs: Psychiatrists Resource Center • Consider the effect of giving a $19,000 award Award type Decrease in probability of quitting EDRP 4.1% Recruitment 0.7% Retention 2.7% VETERANS HEALTH ADMINISTRATION 14
PEPR PEPReC eC Are EDRP funds used most where quit Partnered Evidence-based Policy rates are highest? Resource Center We don’t find a strong relationship between mean EDRP receipt and mean quit rates VETERANS HEALTH ADMINISTRATION 15
PEPReC PEPR eC Partnered Evidence-based Policy Can we predict quits? Resource Center Medical Center mean quit indicator predicted using • demographic variables • local labor market variables VETERANS HEALTH ADMINISTRATION 16
PEPR PEPReC eC Partnered Evidence-based Policy Discussion Resource Center • There is suggestive evidence that incentive programs are effective at reducing turnover • Program funds are not targeted at stations with high quit rates • We can predict station level quits based on demographic and labor market variables • We need to control for local healthcare market variables VETERANS HEALTH ADMINISTRATION 17
PEPR PEPReC eC Partnered Evidence-based Policy Next steps Resource Center Include other local healthcare market characteristics in predictive model: • Number of hospitals • Physicians per capita • Physician wages in private sector Incentive programs should be targeted based on factors which are not under medical centers’ control VETERANS HEALTH ADMINISTRATION 18
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