# Presentation: 838286

## The Impact Of VA’s Intramural Research Program on Physician Recruitment and Retention

**Sylvia J. Hysong, PhD****Michael E. DeBakey VA Medical Center**
**Richard G. Best, PhD****Lockheed Martin Business Process Solutions**
**Mary Bollinger, MPH****South Texas Veterans Healthcare System**

## Acknowledgements

- This project was funded by VA Health Services Research and Development’s (HSR&D) 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.

## Objectives

- Develop a theoretical model to better understand the role of VA’s 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.

**Notes:**
Conduct a focused review of the research literature on recruitment and retention of professionals, with particular emphasis on academic physicians;
Conduct semi-structured interviews with clinician researchers in the VA to substantiate and supplement the findings of the literature review;

## Research Approach 

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

## 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

## From the Literature:  Factors Influencing Recruitment and Retention

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

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

## 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?

## 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

## 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.

## 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

## 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

## 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

## 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

## Factor Structure

- (% of variance accounted for / reliability estimate)

## Predicting Physician Retention

|  | Tenure in VA | Non-VA Research Career | VA Career w/o Research |
| --- | --- | --- | --- |
| R-sq: Covariates only | .267 | .035 | .001 |
| R-sq: Covariates + Factors | .294 (.027) | .235 (.200) | .205 (.204) |
| Significant Factors (Beta Weights) |  |  |  |
| Satisfaction with Research Support | .146*** | .202*** | -.45*** |
| Intellectual Stimulation | -.147*** | .187*** |  |
| Perceived Organizational Support |  | .078** |  |
| Satisfaction with Compensation |  | .203*** | -.116** |
| Diversity of Colleagues |  | -.062* | .194*** |
| Community Characteristics | -.053* |  |  |

- *p<.05;  **p<.01; ***p<.001

## 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.

## Limitations

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

## 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