Medical training program size and clinical staff productivity and turnover

Area of Science:

• Medical Education
• Health Services Research
• Clinician Productivity

Background:

• The Veterans Health Administration (VHA) is a major medical training platform in the U.S.
• Understanding the impact of training program size on clinician productivity and turnover is crucial for healthcare system efficiency.

Purpose of the Study:

• To evaluate the effect of resident program training size on clinician productivity and turnover within the VHA.
• To analyze how these effects vary by specialty and geographic area.

Main Methods:

• A quasi-experimental instrumental variables 2SLS design was employed.
• National administrative data from 141 VHA facilities across 26 specialties (2011-2021) were analyzed.
• Secondary analyses stratified results by Health Professional Shortage Areas (HPSA).

Main Results:

• An increase in training slots was associated with decreased productivity (0.039 fewer visits/day) and increased turnover (0.02 percentage points).
• Effects varied by specialty: psychiatry/psychology saw decreased productivity, while primary care/cardiology saw increased productivity.
• Negative impacts were concentrated in areas without primary care physician shortages; shortage areas saw increased productivity and no turnover change.

Conclusions:

• Resident training program size influences clinician productivity and turnover in the VHA.
• Specialty and HPSA status modify these effects, with some areas benefiting from larger programs.
• Findings suggest targeted strategies for optimizing training program size based on specialty and local needs.