Henrikson Nora B, Moldestad Megan, Maynard Charles, Kaboli Peter J, Reddy Ashok, Rinne Seppo T, Sanders Karen M, Sterling Ryan A, Wong Edwin S
Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, United States.
Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States.
Front Health Serv. 2024 Jul 18;4:1394072. doi: 10.3389/frhs.2024.1394072. eCollection 2024.
Health systems like the Veterans Health Administration (VA) face challenges in recruiting and retaining a primary care physician workforce. This cross-sectional study of recent or current VA medical residents sought to identify determinants of intent to pursue primary care practice in VA after residency training.
Residents were identified from administrative data between 2020 and 2021 and recruited via an emailed self-administered survey. Multivariable logistic regression, accounting for survey non-response, was applied to examine the association between intent to pursue VA practice and two sets of measures: VA training experiences and individual preferences for work conditions.
Of 268 responses received, 141 (56%) of the sample reported inclination to consider VA employment post-residency. Experiences with training in VA were rated more positively in the VA-inclined group compared to the not-inclined group. In the multivariable model, intent to practice primary care was the strongest predictor (OR 4.04, < 0001). Preceptors' modeling of work-life balance (OR 3.23, = 0.009) and perceptions of quality of clinical staff and services (OR 2.64, = 0.004), ability to get patients the care they need (OR 2.51, = 0.017), and quality of patient care (OR 2.30, = 0.075) were independent predictors of being in the VA inclined group.
Overall, we found that intent to practice primary care and the quality of VA training experiences are important determinants of inclination to consider VA for employment. These results provide an important perspective relevant to medical education, the hiring and retention of the United States (U.S). primary care workforce.
像退伍军人健康管理局（VA）这样的医疗系统在招募和留住基层医疗医生队伍方面面临挑战。这项针对近期或现任VA住院医师的横断面研究旨在确定住院医师培训后有意在VA从事基层医疗工作的决定因素。
从2020年至2021年的行政数据中识别住院医师，并通过电子邮件进行自我管理的调查进行招募。应用多变量逻辑回归分析（考虑调查无应答情况）来检验有意在VA执业与两组指标之间的关联：VA培训经历和对工作条件的个人偏好。
在收到的268份回复中，141名（56%）样本表示倾向于考虑在住院医师培训后受雇于VA。与不倾向的组相比，倾向于VA的组对在VA培训经历的评价更高。在多变量模型中，从事基层医疗工作的意愿是最强的预测因素（比值比[OR]4.04，P<0.0001）。带教老师对工作与生活平衡的示范（OR 3.23，P=0.009）、对临床工作人员和服务质量的看法（OR 2.64，P=0.004）、为患者提供所需护理的能力（OR 2.51，P=0.017）以及患者护理质量（OR 2.30，P=0.075）是倾向于VA组的独立预测因素。
总体而言，我们发现从事基层医疗工作的意愿和VA培训经历的质量是考虑在VA就业倾向的重要决定因素。这些结果为医学教育、美国基层医疗劳动力的招聘和留用提供了一个重要视角。
