BACKGROUND

Fewer physicians are pursuing careers in internal medicine due to workload, work-life integration, and documentation pressures. Integrated health systems like the Department of Veterans Affairs (VA) offer an alternative work model that may affect physicians' experiences differently compared to the private sector.

OBJECTIVE

To examine and compare the self-reported workplace experiences among VA and non-VA internists.

DESIGN

A cross-sectional survey.

PARTICIPANTS

A random sample of 1421 internal medicine physicians across the USA, with oversampling of hospitalists and VA physicians. Surveys were completed between June 2023 and May 2024. Of the total of 629 (44.3%) physicians responding, 618 indicated working in a VA or non-VA hospital.

MAIN MEASURES

Our primary outcomes were several professional environment factors. Multivariable logistic regression was used to assess relationships between professional environment factors and practicing at the VA (vs. non-VA). All models were adjusted for sex, race, and years practicing as an internist.

KEY POINTS

The odds of time engaging with health insurance companies (OR = 0.26; P < 0.001), medical record issues (OR = 0.44; P < 0.001), and malpractice concerns (OR = 0.56; P < 0.001) were significantly lower among VA internists compared with non-VA internists. VA internists were significantly less likely to report issues concerning work-life balance (OR = 0.63; P = 0.01).

CONCLUSIONS

VA internists had reduced odds of some non-clinical administrative tasks and greater odds of better work-life balance. The VA's minimal engagement with insurance tasks and litigation concerns appears to present a compelling work environment.