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VETERANS HEALTH ADMINISTRATION

Physician Turnover in the Veterans Health Administration

Aigerim Kabdiyeva

June 25, 2018

Partnered Evidence-based Policy Resource Center A VA QUERI Program

PE PEPR PReC eC

VETERANS HEALTH ADMINISTRATION

Partnered Evidence-based Policy Resource Center A VA QUERI Program

PE PEPR PReC eC

Acknowledgements

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• 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

• f the U.S. Department of Veterans Affairs or the United States

Government.

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Partnered Evidence-based Policy Resource Center A VA QUERI Program

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Outline

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• Background information about turnover
• Research question
• Regression specification
• Descriptive statistics
• Regression results
• Interpreting the results

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Why do we analyze physician turnover?

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VETERANS HEALTH ADMINISTRATION

Why do we analyze physician turnover?

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

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VETERANS HEALTH ADMINISTRATION

Partnered Evidence-based Policy Resource Center A VA QUERI Program

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Research question

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• How is physician turnover at the VA affected by Education Debt

Repayment Program and Recruitment, Retention and Relocation incentives?

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Veteran Affairs vs. private sector from physician perspective

• Less time spent hassling with insurance
• More time spent with patients
• Salaries are generally lower than in the private sector
• Fewer support staff

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What can be done about physician turnover at the VA?

• Increase the number of support staff
• Improve organizational culture
• Increase physician salary
• Provide recruitment/retention incentives
• Provide education loan repayment assistance

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Regression specification

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Quit indicator (0 or 1) Recruitment to salary ratio Relocation to salary ratio Retention to salary ratio EDRP to salary ratio

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Selection bias

• Physicians who are more likely to quit are more likely to receive incentive

awards

• Control mean quit rate of RNs

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Quit indicator (0 or 1) retention award ( − ) unobserved propensity to quit ( + )

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Descriptive statistics

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Variable mean for PCPs mean for 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

• 128 VA Medical Centers
• 82,157 physician-year observations for Primary Care Physicians
• 41,932 physician-year observations for Psychiatrists

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Regression results

* significant at 5%, ** significant at 1%

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Variable Estimate For PCP Estimate for 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 + * + *

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Interpreting the effects of incentive programs: PCPs

• Consider the effect of giving a $18,300 award

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Award type Decrease in probability of quitting EDRP 2.2% Retention 1.1% Relocation 2.6%

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Interpreting the effects of incentive programs: Psychiatrists

• Consider the effect of giving a $19,000 award

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PEPR PEPReC eC

Award type Decrease in probability of quitting EDRP 4.1% Recruitment 0.7% Retention 2.7%

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Are EDRP funds used most where quit rates are highest?

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We don’t find a strong relationship between mean EDRP receipt and mean quit rates

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Can we predict quits?

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Medical Center mean quit indicator predicted using

• demographic variables
• local labor market variables

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Discussion

• 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

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Next steps

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

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