Well being care programs nationwide face challenges in recruiting and retaining physicians, resulting in excessive turnover and affect on affected person care. Analysis additionally reveals that new workers are sometimes much less productive than extra skilled colleagues. If newly employed physicians take a very long time to achieve full productiveness, the prices and results of turnover on affected person entry could also be higher than anticipated. Well being programs will not be doing sufficient to make sure secure care throughout these transitions. Little analysis has examined how doctor tenure impacts productiveness, leaving gaps in workforce planning and affected person care methods.
New Analysis
A current retrospective cohort evaluation printed within the Journal of Normal Inside Medication examined the connection between doctor tenure and scientific productiveness within the Veterans Well being Administration (VHA). The paper explored how tenure size impacts productiveness (i.e., the variety of affected person encounters per clinic day) amongst attending physicians. It additionally in contrast productiveness tendencies between internally employed physicians—those that had any residency or fellowship coaching inside the VHA—and externally employed physicians.
Strategies
Researchers used the VHA’s Company Information Warehouse to gather detailed information on doctor employment traits, specialty, and month-to-month affected person encounters. Information was analyzed from 34,878 attending physicians throughout 27 specialties, protecting over 1.5 million physician-months of outpatient encounters between October 1, 2017, and August 1, 2023. They used statistical fashions to look at productiveness variations over time, adjusting for elements equivalent to specialty, facility, and time results, and sensitivity analyses to check the robustness of the outcomes. The analyses have been carried out for each the whole pattern together with all 27 specialties and 4 specialty subgroups—major care, psychiatry, massive medical specialties, and huge surgical specialties.
Primary Findings
Newly employed physicians had on common 1.72 fewer affected person encounters per clinic day throughout their first quarter in comparison with their extra skilled colleagues who had labored at VHA for greater than two years. Nevertheless, this productiveness hole shrunk over time, with new hires having solely 0.44 fewer encounters per clinic day by their eighth quarter. Among the many specialty subgroups, medical and surgical specialty new hires reached productiveness equal to extra skilled workers by their eighth quarter. Moreover, physicians who had any residency or fellowship coaching inside VHA (“inner hires”) had larger preliminary productiveness and a faster adjustment to full productiveness than these employed externally, significantly in major care and huge surgical specialties.
Conclusion
These findings recommend that whereas newly employed attending physicians initially exhibit decrease productiveness, they expertise vital enchancment inside the first two years. Furthermore, these with prior VHA coaching adapt extra rapidly, highlighting the potential advantages of inner coaching packages. These insights are essential for well being care programs assessing the long-term prices and entry implications related to doctor turnover and onboarding. Understanding these dynamics can support in growing methods to help new physicians, optimize coaching packages, and finally improve affected person care inside VHA and comparable well being care settings.
