The Impact Of VAs Intramural Research Program on Physician Recruitment and Retention

1
The Impact Of VAs Intramural Research Program on
Physician Recruitment and Retention

• Sylvia J. Hysong, PhDMichael E. DeBakey VA
  Medical Center
• Richard G. Best, PhDLockheed Martin Business
  Process Solutions
• Mary Bollinger, MPHSouth Texas Veterans
  Healthcare System

2
Acknowledgements

• This project was funded by VA Health Services
  Research and Developments (HSRD) Management
  Consultation Program (MRC 04-371) and conducted
  at the Veterans Evidence-Based Research
  Dissemination and Implementation Center.
• We would like to thank the Center for
  Organization, Leadership and Management Research
  in Boston (formerly the Management Decision
  Research Center) for granting us access to their
  National Survey of VA Researchers.
• We would also like to thank all the physicians
  who took the time, whether by phone or by survey,
  to give us their feedback on recruitment and
  retention in the VA.

3
Objectives

• Develop a theoretical model to better understand
  the role of VAs intramural research program on
  the recruitment and retention of highly skilled
  physicians and
• Design psychometrically sound measures of the
  factors hypothesized to influence the role of VA
  research in recruitment and retention for
  potential inclusion in the next National Survey
  of VA researchers.

4
Research Approach

• Literature Synthesis
• Physician Interviews
• Survey
• Design
• Pilot testing and refinement
• Deployment

5
Literature Synthesis

• Objective to identify factors theoretically
  related to recruitment and retention in general.
• Targeted literature that referenced physician
  recruitment and retention.
• Searched for references in the fields of
  industrial/organizational psychology, management
  and organizational behavior, and health services
  research. on the following databases
• PubMed,
• Psycinfo,
• Business Source Premier, and
• Academic Search Premier.
• Cited reference search on ISI Web of Science

6
From the Literature Factors Influencing
Recruitment and Retention

• Organization
• Reputation
• Decision Making
• Facility features (e.g., staffing, space,
  technology, size)
• Labor Market
• Community
• Quality of Life
• Characteristics
• Perceived Fit
• Psychological Contract

• Financial
• Pay
• Benefits
• Advancement
• Research
• University
• Protected time
• Autonomy
• Resources
• Mentor/training
• Synergy
• Personality

7
Semi-structured Interviews

• 11 Physicians from two VAMCs in two different
  VISNs
• Sample Questions
• What about the research program initially
  attracted you to the VA?
• What are some of the differences between what
  people expect when they take a job with the VA as
  a clinician researcher and what it is actually
  like to be a clinician researcher?
• Is there anything about the VA research program
  that might cause you to stop working at the VA?

8
MD Interviews Themes

• VA research program was the primary reason for
  accepting employment with and remaining in the
  VA, despite bureaucratic problems, administrative
  burdens, and pay levels
• Important features
• Availability of VA research funding
• Patient population
• Academic affiliation

9
Survey Development

• Adapted selected items from 2002 Survey of VA
  Researchers Source Center for Organizational
  Leadership Management Research.
• Developed additional items based on the
  conceptual definitions of the constructs as
  described in the literature.
• Piloted a draft of the survey instrument
  internally among physician researchers within our
  local facility.
• Revised and refined based on pilot.

10
Sample Survey Items

• The funding level for VA investigator initiated
  grants is adequate
• I am happy with the quality of researchers
  available for me to mentor
• It is important to surround yourself with people
  from diverse backgrounds and perspectives, even
  if we don't always agree.
• My facility leadership welcomes and considers my
  input when making decisions that may affect my
  work
• To what extent did each of the following
  influence your decision to accept a job offer
  with the VA facility in which you currently work?
  Were you influenced positively or negatively?
• a. Commute
• b. Quality of residential neighborhoods
• c. Opportunities to socialize
• d. Educational opportunities for my children

11
Survey Deployment

• Recruitment Strategy
• Queried Personnel and Accounting Integrated Data
  System (PAID) to identify currently employed
  physicians both with and without VA research
  funding in VA facilities throughout the system.
• Used Communities On Line Learning About
  Guidelines (COLLAGE) distribution capabilities to
  acquire physician e-mail addresses
• Invited 12,000 VA physicians via e-mail

12
Survey Deployment, cont

• Participants
• 1284 physicians
• predominantly white (63),
• male (73),
• between 40-59 years of age (62),
• clinicians (75)
• representing various medical specialties and
  research service affiliations

13
Data Analysis

• Randomly split sample into experimental and
  holdout sub-samples.
• Exploratory factor analysis with Varimax rotation
  on experimental sample
• Cross-validated factor loadings on holdout sample

14
Factor Structure
( of variance accounted for / reliability
estimate)
15
Predicting Physician Retention
plt.05 plt.01 plt.001
16
Conclusions

• Recruiting and retaining physicians is in part a
  function of the VA s ability to provide
• the necessary and expected resources to conduct
  productive research and clinical work
• an intellectually stimulating environment,
  including the opportunity to work with diverse
  and intellectually stimulating colleagues, and
• competitive salary and benefits packages.

17
Limitations

• Outcome measure limited to present and
  retrospective perceptions
• Clinicians over-represented in survey sample
• Holdout sample is non-independent

18
Future Directions

• Developing appropriate measures of the criteria,
  i.e., recruitment, retention, and physician
  quality
• Test hypotheses about the relative importance of
  these factors in recruitment and retention
• Intervention design