Tenso Kertu, Li Yufei, Legler Aaron, Sadej Izabela, Kabdiyeva Aigerim, Garrido Melissa M, Pizer Steven D
Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts, USA.
Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA.
Health Serv Res. 2025 Feb;60(1):e14364. doi: 10.1111/1475-6773.14364. Epub 2024 Jul 24.
The objective of this analysis was to evaluate the effect of resident program training size on clinician productivity and turnover in the Veterans Health Administration (VHA), the largest education and training platform for medical professionals in the United States.
We retrieved administrative data on training programs and training facilities from the VA Office of Academic Affiliations and the VHA Corporate Data Warehouse. Data on primary care physician shortage areas were retrieved from the Health Resources and Services Administration.
We used a quasi-experimental instrumental variables 2SLS design and constructed an exogenous predicted training allocation treatment variable as a function of the total national training program allocation. The outcome was clinical staff productivity and turnover. Secondary analyses stratified results using Health Professional Shortage Areas data (HPSA).
DATA COLLECTION/EXTRACTION METHODS: Data were obtained for a national dataset of 141 VHA medical facilities and 26 specialties that hosted training programs across 11 years from 2011 to 2021 (N = 132,177).
Instrumental variables results showed that on average, an increase of one training slot in a specialty leads to a decrease of 0.039 visits per standardized clinic day (p < 0.001) and a 0.02 percentage point increase in turnover (p < 0.001). The direction of this association varied by specialty: while psychiatry and psychology specialties saw a decline in productivity, fields such as primary care and cardiology experienced an increase in productivity. HPSA stratified results indicate that negative effects on productivity and turnover are driven by areas with little to no primary care physician shortage, whereas shortage areas experienced a small increase in productivity and no effect on turnover.
This quasi-experimental evaluation indicates that resident training program size is associated with reduced productivity and increased turnover in specialties such as psychiatry and in facilities with high baseline productivity. However, in specialties like primary care and cardiology, as well as areas with shortages of primary care, larger training programs are associated with increased productivity.
本分析的目的是评估住院医师培训项目规模对美国最大的医学专业教育和培训平台——退伍军人健康管理局（VHA）中临床医生生产力和人员流动率的影响。
我们从VA学术附属办公室和VHA企业数据仓库中检索了关于培训项目和培训设施的行政数据。从卫生资源与服务管理局获取了初级保健医生短缺地区的数据。
我们采用了准实验性工具变量两阶段最小二乘法设计，并构建了一个外生预测培训分配处理变量，该变量是全国培训项目总分配的函数。结果变量是临床工作人员的生产力和人员流动率。使用卫生专业人员短缺地区数据（HPSA）进行分层的二次分析得出了结果。
数据收集/提取方法：获取了2011年至2021年11年间141个VHA医疗设施和26个设有培训项目专业的全国数据集的数据（N = 132,177）。
工具变量结果表明，平均而言，某一专业培训名额增加一个会导致每标准化门诊日就诊量减少0.039次（p < 0.001），人员流动率增加0.02个百分点（p < 0.001）。这种关联的方向因专业而异：精神病学和心理学专业的生产力下降，而初级保健和心脏病学等领域的生产力则有所提高。HPSA分层结果表明，对生产力和人员流动率的负面影响是由几乎没有或没有初级保健医生短缺的地区驱动的，而短缺地区的生产力略有提高，对人员流动率没有影响。
这项准实验性评估表明，住院医师培训项目规模与精神病学等专业以及基线生产力较高的机构中生产力降低和人员流动率增加有关。然而，在初级保健和心脏病学等专业以及初级保健短缺的地区，规模较大的培训项目与生产力提高有关。
