By Vanessa M. Cross, J.D., LL.M.
By 2025 the national demand for physician services will exceed supply, according to the Health Resources and Services Administration, with certain types of specialty care physicians falling into a category that is among the most difficult to recruit and retain. A report of the Testimony Before the Subcommittee on Health, Committee on Veterans' Affairs, House of Representatives, which was released by the Government Accountability Office (GAO), includes the steps taken by the Department of Veterans Affairs (VA) Veterans Health Administration (VHA) to improve physician staffing, recruitment, and retention. It also identified the challenges that remain (GAO Report, No. GAO-18-623T, June 21, 2018).
Why. Over the past two decades, the GAO and others have expressed concerns regarding VHA's ability to secure a clinical workforce to meet the current and future demands of veterans. Attracting, hiring, and retaining talented physicians who provide and supervise a broad range of primary and specialty care to service members is critical to the VHA's mission to provide high quality and timely care for the nations veterans. Attrition among VHA physicians is of particular concern, in part, due to the number of service members returning from military operations in Afghanistan and Iraq, as well as the growing demands of an aging veteran population.
2017 GAO Findings, generally. The current GAO report is an update of its October 2017 report which examined VHA physician staffing, recruitment, and retention strategies and included improvement recommendations. The GAO report incorporates data secured from VHA officials in June 2018 related to steps the agency has made to implement its recommendations. Specifically, the October 2017 identified three areas of improvement:
- Incomplete data regarding the number of physicians providing care at VA medical centers.
- Insufficient VHA guidance to VA medical centers for making a determination of the number of physicians and support staff needed for its medical and surgical specialties.
- Lack of effectiveness reviews for physician recruitment and retention strategies.
Incomplete physician data. More than 11,000 physicians are employed at VA medical centers and about 2,800 provide fee-basis services, according to the GAO report of information maintained by VHA personnel databases. VHA, however, lacked data on the number of contract physicians and physician trainees providing services at VA medical centers. As a result, it could not determine how often contract physician and physician trainee services were used, which the GAO report found created a deficiency in workforce planning processes.
Of the six VA medical centers reviewed, the GAO found that many employed locally maintained information, such as spreadsheets, to track non-employee physicians. This information, however, was not readily accessible to VHA officials. The VHA did not concur in the GAO's recommendation that it create a centralized system readily accessible to VHA officials engaged in workforce planning that includes physicians not employed by VHA. Since the 2017 report, VHA officials have implemented HR Smart, a new human resources database, which it uses to track physician trainees. VHA officials, however, advised the GAO that they do not plan to enhance HR Smart to track contractors, but plan to continue to maintain this information as locally housed data.
Specialty staffing guidance. In the 2017 report, the GAO found that VHA relegated responsibility for determining staffing needs to its VA medical centers and provided them guidance through policies and directives. Based on a review of the guidance and directives provided by VHA, the GAO reported that VHA guidance was insufficient for medical and surgical specialties, including occupations such as gastroenterology and orthopedic surgery. VHA officials have reported that on November 27, 2017 it signed a specialty care workgroup charter with the primary goal of developing a specialty care staffing model that includes staffing information for all specialty care. It anticipates completing its work and issuing staffing guidance in these specialty areas by December 2018.
Evaluating staffing efforts. VHA recruitment and retention efforts includes securing assistance for mission-critical physician occupations through the National Recruitment Program; developing policies and guidance; providing financial incentives to enhance hiring and retention offers; and use of a national physician training program. Despite a large and expanding graduate medical training program, the VHA has experienced difficulties hiring physicians who received training through its residency and fellowship program, according to the report. This may be due, in part, to the VHA not sharing information on graduating physician trainees with VA medical centers for recruitment purposes.
Since the report, VHA has taken steps to include physician trainees information in its HR Smart database, and anticipates using this system to help fill vacancies across VA medical center. Another area identified as a barrier to recruitment was the reduction of financial incentive resources to physician candidates through the Education Debt Reduction Program (EDRP). Since the report, VHA officials are working internally to develop a systematic approach for better allocating workforce management resources, such as the EDRP.
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