Commentary

I*DEA in the VA: Optimizing the Physician Workforce to Enhance Quality of Care

Fed Pract. 2024 August;41(8):236-241 | doi:10.12788/fp.0492

Author(s):

Background: The demographic characteristics of veterans has changed significantly in recent years and continues to become more diverse. To enhance the quality of health care for the current community of enrolled veterans, it is critical that the physicians and health care leaders of the Veterans Health Administration (VHA) understand the changing demographics and health care needs of the veteran population.

Observations: Studies have shown that increased inclusion, diversity, and equity among clinicians are associated with improved clinical outcomes. Diversity encompasses more than race and gender. Although the VHA workforce is relatively diverse, the same cannot be said about its leadership. The I*DEA (inclusion, diversity, equity, and access) Council is a new program that aims to eliminate gaps in VHA care and benefits to ensure that historically underserved veteran communities receive fair treatment.

Conclusions: Optimizing I*DEA strategies—inclusion of diverse perspectives and ideas, equity of opportunities and accessibility within the VHA workforce—may help to enhance the quality of health care for veterans.

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References

1. US Department of Veterans Affairs, Office of Research & Development. Health equity. Accessed July 1, 2024. https://www.research.va.gov/topics/health_equity.cfm

2. US Department of Veterans Affairs. Equity action plan. Accessed July 1, 2024. https://department.va.gov/wp-content/uploads/2024/02/Department-of-Veterans-Affairs-Equity-Action-Plan.pdf

3. Schaeffer K. The changing face of America’s veteran population. Pew Research Center. March 2021. Updated November 8, 2023. Accessed May 23, 2024. https://www.pewresearch.org/short-reads/2021/04/05/the-changing-face-of-americas-veteran-population/

4. US Department of Labor, Veterans’ Employment and Training Service. 2021 employment situation of women veterans. Accessed May 23, 2024. http://www.dol.gov/agencies/vets/womenveterans/womenveterans-employment

5. US Department of Veterans Affairs, National Center for Veteran Analysis and Statistics. National survey of veterans (NSV9503). Accessed June 20, 2024. https://www.va.gov/vetdata/docs/surveysandstudies/vetpop.pdf

6. US Census Bureau. Veterans Day 2022: November 11. News release. October 26, 2022. Updated April 4, 2024. Accessed May 23, 2024. https://www.census.gov/newsroom/facts-for-features/2022/veterans-day.html

7. ADA National Network. Employment data for veterans with disabilities. 2017. Accessed June 23, 2024. https://adata.org/factsheet/employment-data-veterans-disabilities

8. LGBTQ+ Veterans. DAV. Accessed July 26, 2024. https://www.dav.org/get-help-now/veteran-topics-resources/lgbtq-veterans/

9. US Department of Veterans Affairs, Office of Rural Health. Rural Veterans. Updated May 14, 2024. Accessed June 20, 2024. https://www.ruralhealth.va.gov/aboutus/ruralvets.asp

10. Mikton C, de la Fuente-Núñez V, Officer A, Krug E. Ageism: a social determinant of health that has come of age. Lancet. 2021;397(10282):1333-1334.
doi:10.1016/S0140-6736(21)00524-9

11. Heise L, Greene ME, Opper N, et al. Gender inequality and restrictive gender norms: framing the challenges to health. Lancet. 2019;393(10189):2440-2454.
doi:10.1016/S0140-6736(19)30652-X

12. Egede LE. Race, ethnicity, culture, and disparities in health care. J Gen Intern Med. 2006;21(6):667-669. doi:10.1111/j.1525-1497.2006.0512.x

13. Carratala S, Maxwell C. Health disparities by race and ethnicity. Center for American Progress. Updated May 11, 2020. Accessed June 23, 2024. https://www.americanprogress.org/article/health-disparities-race-ethnicity/

14. Clemente KAP, Silva SVD, Vieira GI, et al. Barriers to the access of people with disabilities to health services: a scoping review. Rev Saude Publica. 2022;56:64.
doi:10.11606/s1518-8787.2022056003893

15. Krehely J. How to close the LGBT health disparities gap. Center for American Progress. December 21, 2009. Accessed May 23, 2024. https://www.americanprogress.org/article/how-to-close-the-lgbt-health-disparities-gap/

16. Dawson L, Frederiksen B, Long M, Ranji U, Kates J. LGBT+ people’s health and experiences accessing care. KFF. July 22, 2021. Accessed May 23, 2024. https://www.kff.org/womens-health-policy/report/lgbt-peoples-health-and-experiences-accessing-care

17. Disabled American Veterans. DAV report spotlights issues facing women veterans. September 12, 2018. Accessed June 23, 2024. https://www.dav.org/learn-more/news/2018/new-report-spotlights-continuing-challenges-facing-women-veterans/

18. Sheahan KL, Goldstein KM, Than CT, et al. Women veterans’ healthcare needs, utilization, and preferences in veterans affairs primary care settings. J Gen Intern Med. 2022;37(Suppl 3):791-798.
doi:10.1007/s11606-022-07585-3

19. Habeshian S. VA denied Black veterans health benefits more often than White vets, data shows. Axios. June 23, 2023. Accessed June 20, 2024. https://www.axios.com/2023/06/23/veterans-benefits-black-white-rate-disproportionate

20. Shipherd JC, Darling JE, Klap RS, Rose D, Yano EM. Experiences in the Veterans Health Administration and impact on healthcare utilization: comparisons between LGBT and non‐LGBT women veterans. LGBT Health. 2018;5(5):303‐311. doi:10.1089/lgbt.2017.0179

21. Gomez LE, Bernet P. Diversity improves performance and outcomes. J Natl Med Assoc. 2019;111(4):383-392. doi:10.1016/j.jnma.2019.01.006

22. Gill GK, McNally MJ, Berman V. Effective diversity, equity, and inclusion practices. Healthc Manage Forum. 2018;31(5):196-199. doi:10.1177/0840470418773785

23. Balinda IG, Reza N. Diversity, equity, inclusion, and belonging in cardiovascular disease fellowship training. Methodist DeBakey Cardiovasc J. 2022;18(3):67-77. doi:10.14797/mdcvj.1080

24. Parsons SK, Fineberg IC, Lin M, Singer M, Tang M, Erban JK. Promoting high-quality cancer care and equity through disciplinary diversity in team composition. J Oncol Pract. 2016;12(11):1141-1147. doi:10.1200/JOP.2016.013920

25. Stanford FC. The importance of diversity and inclusion in the healthcare workforce. J Natl Med Assoc. 2020;112(3):247-249. doi:10.1016/j.jnma.2020.03.014

26. US Department of Veterans Affairs. Diversity and inclusion strategic plan, fiscal years 2021-2022. Accessed May 23, 2024. https://www.va.gov/ORMDI/docs/StrategicPlan.pdf

27. US Department of Veterans Affairs (VA). US EEOC. Accessed July 1, 2024. https://www.eeoc.gov/federal-sector/department-veterans-affairs-va-0

28. US Department of Veterans Affairs, Office of Resolution Management, Diversity & Inclusion (ORMDI). Individuals with disabilities employment program. Updated August 15, 2022. Accessed June 20, 2024. https://www.va.gov/ORMDI/DiversityInclusion/IWD.asp

29. US Department of Veterans Affairs, Office of Resolution Management, Diversity & Inclusion (ORMDI). VA workforce diversity: FY 2022. Accessed July 1, 2024. https://www.va.gov/ORMDI/Diversity_Inclusion.asp

30. US Department of Veterans Affairs. Same mission, new I-DEA: VA supports inclusion, diversity, equity and access. News release. April 28, 2023. Accessed June 20, 2024. https://news.va.gov/118609/same-mission-va-supports-inclusion-diversity/

31. US Department of Veterans Affairs, Office of Resolution Management, Diversity & Inclusion. Inclusion, diversity, equity, & access (I-DEA) action plan. September 2021. Accessed June 20, 2024. https://www.va.gov/ORMDI/docs/VA_I-DEA_Action_Plan-SIGNED.pdf

32. Sue DW, Alsaidi S, Awad MN, Glaeser E, Calle CZ. Disarming racial microaggressions: microintervention strategies for targets, White allies, and bystanders. Am Psychol. 2019;74(1):128-142. doi:10.1037/amp0000296

33. Cruz D, Rodriguez Y, Mastropaolo C. Perceived microaggressions in health care: a measurement study. PLoS One. 2019;14(2):e0211620. doi:10.1371/journal.pone.0211620

" class="smart-paging drupal-content" src="/sites/all/modules/contrib/smart_paging/plugins/wysiwyg/smart_paging/images/spacer.gif" title="<--pagebreak-->">34. Ehie O, Muse I, Hill L, Bastien A. Professionalism: microaggression in the healthcare setting. Curr Opin Anaesthesiol. 2021;34(2):131-136. doi:10.1097/ACO.0000000000000966

35. US Department of Veterans Affairs. VA all employee survey. Accessed May 23, 2024. https://www.data.va.gov/stories/s/VA-All-Employee-Survey-AES-/r32e-j4vj/

36. US Department of Veterans Affairs, Office of Resolution Management, Diversity & Inclusion. Special emphasis programs (ORMDI). Updated May 3, 2023. Accessed June 20, 2024. https://www.va.gov/ORMDI/DiversityInclusion/Special_Emphasis_Programs.asp

37. US Department of Veterans Affairs, Office of Resolution Management, Diversity & Inclusion (ORMDI). Federal women’s program. Updated August 9, 2022. Accessed June 20, 2024. https://www.va.gov/ORMDI/DiversityInclusion/FWP.asp

39. US Department of Veterans Affairs, Office of Resolution Management, Diversity & Inclusion (ORMDI). American Indian & Alaska Native Program. Updated September 27, 2023. Accessed June 20, 2024. https://www.va.gov/ORMDI/DiversityInclusion/AIAN.asp

40. US Department of Veterans Affairs, Office of Resolution Management, Diversity & Inclusion (ORMDI). Asian American, Native Hawaiian and Pacific Islander program. Updated September 27, 2023. Accessed June 20, 2024. https://www.va.gov/ORMDI/DiversityInclusion/AAPI.asp

41. US Department of Veterans Affairs, Office of Resolution Management, Diversity & Inclusion (ORMDI). Black/African American program. Updated May 3, 2023. Accessed June 20, 2024. https://www.va.gov/ORMDI/DiversityInclusion/Black_African_American.asp

42. US Department of Veterans Affairs, Office of Resolution Management, Diversity & Inclusion (ORMDI). LGBTQ+ program. Updated May 21, 2024. Accessed June 20, 2024. https://www.va.gov/ORMDI/DiversityInclusion/LGBT.asp

43. US Department of Veterans Affairs, Office of Resolution Management, Diversity & Inclusion (ORMDI). Diversity, equity and inclusion training. Updated March 18, 2024. Accessed June 20, 2024. https://www.va.gov/ORMDI/DiversityInclusion/Diversity_Inclusion_Training.asp

44. Rotenstein LS, Reede JY, Jena AB. Addressing workforce diversity - a quality-improvement framework. N Engl J Med. 2021;384(12):1083-1086. doi:10.1056/NEJMp2032224

45. Beeler WH, Mangurian C, Jagsi R. Unplugging the pipeline - a call for term limits in academic medicine. N Engl J Med. 2019;381(16):1508-1511. doi:10.1056/NEJMp1906832

46. Smith DG. Term limits in academic public health administration. Public Health Rep. 2020;135(6):859-863. doi:10.1177/0033354920954495

47. Kaiser J. Shake-up at NIH: Term limits for important positions would open new opportunities for women, minorities. science.org. May 2, 2019. Accessed May 23, 2024. https://www.science.org/content/article/shakeup-nih-term-limits-important-positions-would-open-new-opportunities-women

48. Giacalone RA, Jurkiewicz CL, Knouse SB. Exit surveys as assessments of organizational ethicality. Public Pers Manage. 2003;32(3):397-410. doi:10.1177/009102600303200306

49. Bonifacino E, Ufomata EO, Farkas AH, Turner R, Corbelli JA. Mentorship of underrepresented physicians and trainees in academic medicine: a systematic review. J Gen Intern Med. 2021;36(4):1023-1034. doi:10.1007/s11606-020-06478-7

50. Brown IM. Diversity matters: mentorship is the missing ingredient in DEI. Emergency Medicine News. 2021;43(8):28. doi:10.1097/01.EEM.0000771148.76632.35

51. Sinha A, Kuy S. The future of surgery - increasing diversity, equity, and inclusion through early mentorship. Am J Surg. 2023;225(4):800-802. doi:10.1016/j.amjsurg.2022.12.011

Enhancing the quality of care for the evolving American veteran population is critical: many are vulnerable as a result of unique psychological and physical exposures, and many are increasingly coming from populations the federal government considers “potentially vulnerable.”¹ To ensure that the needs of veterans enrolled in the Veterans Health Administration (VHA) are met, the US Department of Veterans Affairs (VA) workforce must be aware of shifts in the demographics of those who served.

The I*DEA (inclusion, diversity, equity, and access) Council is a new VHA equity team that aims to eliminate gaps in health care and benefits to ensure that historically underserved veteran communities receive the treatment they need. The Council is the oversight body for veteran and employee-facing I*DEA programs, policies, and initiatives.² One strategy to achieve better health outcomes for enrolled veterans is to prioritize the VA health care workforce. In this capacity, the I*DEA Council examines obstacles to hiring, promoting, and retaining employees from underserved communities.

This article discusses how diversity encompasses more than gender and ethnicity and proposes applying the following I*DEA strategies to leadership positions within the VA health care workforce: inclusion of diverse perspectives and ideas, equity of opportunities, and accessibility to leadership roles within VHA facilities. Implementing these actions may help attract and retain qualified clinicians as health care leaders and enable the VHA to better serve the diverse veteran population.

Veteran Demographics

Characteristics of the current population of veterans differ significantly from those of individuals who served in previous eras. Since 2016, Gulf War era veterans have comprised the largest share of the veteran population, even larger than the share of Vietnam War era veterans.³ Among Gulf War veterans, 47% of women and 39% of men are aged < 35 years.⁴ Another notable change is the increase in the number of female veterans. In 1992, only 4% of veterans were female.⁵ Now, about 11% of veterans are female, a number projected to grow to 18% by 2046 (Table 1).³

With respect to race and ethnicity, about 74% of the current veteran population identifies as White, 13% as Black, 8% as Hispanic or Latino, and 2% as Asian.^3,6 In addition, about 30% of veterans have ≥ 1 disability.⁷ About 1 million current veterans (3%) identify as lesbian, gay, bisexual, transgender, queer, and/or questioning (LGBTQ+).⁸ Almost 1 in 4 veterans—about 4.4 million—reside in rural communities, and 55% of these rural veterans are aged > 65 years.⁹ Of the 4.4 million veterans who live in rural areas, 61% are enrolled in VA health care, and among those individuals 8% are women and 10% are minorities.⁹

Studies have found that age, sex, race and ethnicity, disability status, and LGBTQ+ identification all significantly affect health care access and outcomes in the general population.^10-16 Female patients are more likely to have their symptoms downplayed or dismissed, and are often less likely to receive aggressive treatments when compared with male patients. They are also frequently underrepresented or even excluded from clinical trials.¹¹ Female veterans have unique health care needs and report preferences for being treated by female clinicians.^17,18

Higher rates of chronic health conditions and reduced access to mental health services are found among Black Americans compared to White Americans.¹³ Black veterans are also denied VHA benefits more often than White veterans.¹⁹ Patients with disabilities have barriers to accessing care, including difficulty with transportation and a lack of knowledge among clinicians regarding the best course of care.¹⁴Additionally, veterans who identify as LGBTQ+ are less likely than veterans who are cisgender and heterosexual to access Veterans Health Administration (VHA) care.²⁰ Veterans in rural communities experience more challenges to accessing health care; up to one-third of veterans in this population are unable to access the internet at home.⁹

To optimize care for the evolving veteran population, VHA clinicians and leaders need to be aware of the changing demographic characteristics and unique health care needs of the veteran population. Increased inclusion, diversity, and equity within the health care workforce is associated with improved quality of care, improved clinical outcomes, and have had positive financial effects on health care institutions.^21-25

References

1. US Department of Veterans Affairs, Office of Research & Development. Health equity. Accessed July 1, 2024. https://www.research.va.gov/topics/health_equity.cfm

2. US Department of Veterans Affairs. Equity action plan. Accessed July 1, 2024. https://department.va.gov/wp-content/uploads/2024/02/Department-of-Veterans-Affairs-Equity-Action-Plan.pdf

3. Schaeffer K. The changing face of America’s veteran population. Pew Research Center. March 2021. Updated November 8, 2023. Accessed May 23, 2024. https://www.pewresearch.org/short-reads/2021/04/05/the-changing-face-of-americas-veteran-population/

4. US Department of Labor, Veterans’ Employment and Training Service. 2021 employment situation of women veterans. Accessed May 23, 2024. http://www.dol.gov/agencies/vets/womenveterans/womenveterans-employment

5. US Department of Veterans Affairs, National Center for Veteran Analysis and Statistics. National survey of veterans (NSV9503). Accessed June 20, 2024. https://www.va.gov/vetdata/docs/surveysandstudies/vetpop.pdf

6. US Census Bureau. Veterans Day 2022: November 11. News release. October 26, 2022. Updated April 4, 2024. Accessed May 23, 2024. https://www.census.gov/newsroom/facts-for-features/2022/veterans-day.html

7. ADA National Network. Employment data for veterans with disabilities. 2017. Accessed June 23, 2024. https://adata.org/factsheet/employment-data-veterans-disabilities

8. LGBTQ+ Veterans. DAV. Accessed July 26, 2024. https://www.dav.org/get-help-now/veteran-topics-resources/lgbtq-veterans/

9. US Department of Veterans Affairs, Office of Rural Health. Rural Veterans. Updated May 14, 2024. Accessed June 20, 2024. https://www.ruralhealth.va.gov/aboutus/ruralvets.asp

10. Mikton C, de la Fuente-Núñez V, Officer A, Krug E. Ageism: a social determinant of health that has come of age. Lancet. 2021;397(10282):1333-1334.
doi:10.1016/S0140-6736(21)00524-9

11. Heise L, Greene ME, Opper N, et al. Gender inequality and restrictive gender norms: framing the challenges to health. Lancet. 2019;393(10189):2440-2454.
doi:10.1016/S0140-6736(19)30652-X

12. Egede LE. Race, ethnicity, culture, and disparities in health care. J Gen Intern Med. 2006;21(6):667-669. doi:10.1111/j.1525-1497.2006.0512.x

13. Carratala S, Maxwell C. Health disparities by race and ethnicity. Center for American Progress. Updated May 11, 2020. Accessed June 23, 2024. https://www.americanprogress.org/article/health-disparities-race-ethnicity/

14. Clemente KAP, Silva SVD, Vieira GI, et al. Barriers to the access of people with disabilities to health services: a scoping review. Rev Saude Publica. 2022;56:64.
doi:10.11606/s1518-8787.2022056003893

15. Krehely J. How to close the LGBT health disparities gap. Center for American Progress. December 21, 2009. Accessed May 23, 2024. https://www.americanprogress.org/article/how-to-close-the-lgbt-health-disparities-gap/

16. Dawson L, Frederiksen B, Long M, Ranji U, Kates J. LGBT+ people’s health and experiences accessing care. KFF. July 22, 2021. Accessed May 23, 2024. https://www.kff.org/womens-health-policy/report/lgbt-peoples-health-and-experiences-accessing-care

17. Disabled American Veterans. DAV report spotlights issues facing women veterans. September 12, 2018. Accessed June 23, 2024. https://www.dav.org/learn-more/news/2018/new-report-spotlights-continuing-challenges-facing-women-veterans/

18. Sheahan KL, Goldstein KM, Than CT, et al. Women veterans’ healthcare needs, utilization, and preferences in veterans affairs primary care settings. J Gen Intern Med. 2022;37(Suppl 3):791-798.
doi:10.1007/s11606-022-07585-3

19. Habeshian S. VA denied Black veterans health benefits more often than White vets, data shows. Axios. June 23, 2023. Accessed June 20, 2024. https://www.axios.com/2023/06/23/veterans-benefits-black-white-rate-disproportionate

20. Shipherd JC, Darling JE, Klap RS, Rose D, Yano EM. Experiences in the Veterans Health Administration and impact on healthcare utilization: comparisons between LGBT and non‐LGBT women veterans. LGBT Health. 2018;5(5):303‐311. doi:10.1089/lgbt.2017.0179

21. Gomez LE, Bernet P. Diversity improves performance and outcomes. J Natl Med Assoc. 2019;111(4):383-392. doi:10.1016/j.jnma.2019.01.006

22. Gill GK, McNally MJ, Berman V. Effective diversity, equity, and inclusion practices. Healthc Manage Forum. 2018;31(5):196-199. doi:10.1177/0840470418773785

23. Balinda IG, Reza N. Diversity, equity, inclusion, and belonging in cardiovascular disease fellowship training. Methodist DeBakey Cardiovasc J. 2022;18(3):67-77. doi:10.14797/mdcvj.1080

24. Parsons SK, Fineberg IC, Lin M, Singer M, Tang M, Erban JK. Promoting high-quality cancer care and equity through disciplinary diversity in team composition. J Oncol Pract. 2016;12(11):1141-1147. doi:10.1200/JOP.2016.013920

25. Stanford FC. The importance of diversity and inclusion in the healthcare workforce. J Natl Med Assoc. 2020;112(3):247-249. doi:10.1016/j.jnma.2020.03.014

26. US Department of Veterans Affairs. Diversity and inclusion strategic plan, fiscal years 2021-2022. Accessed May 23, 2024. https://www.va.gov/ORMDI/docs/StrategicPlan.pdf

27. US Department of Veterans Affairs (VA). US EEOC. Accessed July 1, 2024. https://www.eeoc.gov/federal-sector/department-veterans-affairs-va-0

28. US Department of Veterans Affairs, Office of Resolution Management, Diversity & Inclusion (ORMDI). Individuals with disabilities employment program. Updated August 15, 2022. Accessed June 20, 2024. https://www.va.gov/ORMDI/DiversityInclusion/IWD.asp

29. US Department of Veterans Affairs, Office of Resolution Management, Diversity & Inclusion (ORMDI). VA workforce diversity: FY 2022. Accessed July 1, 2024. https://www.va.gov/ORMDI/Diversity_Inclusion.asp

30. US Department of Veterans Affairs. Same mission, new I-DEA: VA supports inclusion, diversity, equity and access. News release. April 28, 2023. Accessed June 20, 2024. https://news.va.gov/118609/same-mission-va-supports-inclusion-diversity/

31. US Department of Veterans Affairs, Office of Resolution Management, Diversity & Inclusion. Inclusion, diversity, equity, & access (I-DEA) action plan. September 2021. Accessed June 20, 2024. https://www.va.gov/ORMDI/docs/VA_I-DEA_Action_Plan-SIGNED.pdf

32. Sue DW, Alsaidi S, Awad MN, Glaeser E, Calle CZ. Disarming racial microaggressions: microintervention strategies for targets, White allies, and bystanders. Am Psychol. 2019;74(1):128-142. doi:10.1037/amp0000296

33. Cruz D, Rodriguez Y, Mastropaolo C. Perceived microaggressions in health care: a measurement study. PLoS One. 2019;14(2):e0211620. doi:10.1371/journal.pone.0211620

34. Ehie O, Muse I, Hill L, Bastien A. Professionalism: microaggression in the healthcare setting. Curr Opin Anaesthesiol. 2021;34(2):131-136. doi:10.1097/ACO.0000000000000966

35. US Department of Veterans Affairs. VA all employee survey. Accessed May 23, 2024. https://www.data.va.gov/stories/s/VA-All-Employee-Survey-AES-/r32e-j4vj/

36. US Department of Veterans Affairs, Office of Resolution Management, Diversity & Inclusion. Special emphasis programs (ORMDI). Updated May 3, 2023. Accessed June 20, 2024. https://www.va.gov/ORMDI/DiversityInclusion/Special_Emphasis_Programs.asp

37. US Department of Veterans Affairs, Office of Resolution Management, Diversity & Inclusion (ORMDI). Federal women’s program. Updated August 9, 2022. Accessed June 20, 2024. https://www.va.gov/ORMDI/DiversityInclusion/FWP.asp

38. US Department of Veterans Affairs, Office of Resolution Management, Diversity & Inclusion (ORMDI). Hispanic Employment program. Updated May 16, 2024. Accessed June 20, 2024. https://www.va.gov/ORMDI/DiversityInclusion/HEP.asp

39. US Department of Veterans Affairs, Office of Resolution Management, Diversity & Inclusion (ORMDI). American Indian & Alaska Native Program. Updated September 27, 2023. Accessed June 20, 2024. https://www.va.gov/ORMDI/DiversityInclusion/AIAN.asp

40. US Department of Veterans Affairs, Office of Resolution Management, Diversity & Inclusion (ORMDI). Asian American, Native Hawaiian and Pacific Islander program. Updated September 27, 2023. Accessed June 20, 2024. https://www.va.gov/ORMDI/DiversityInclusion/AAPI.asp

41. US Department of Veterans Affairs, Office of Resolution Management, Diversity & Inclusion (ORMDI). Black/African American program. Updated May 3, 2023. Accessed June 20, 2024. https://www.va.gov/ORMDI/DiversityInclusion/Black_African_American.asp

42. US Department of Veterans Affairs, Office of Resolution Management, Diversity & Inclusion (ORMDI). LGBTQ+ program. Updated May 21, 2024. Accessed June 20, 2024. https://www.va.gov/ORMDI/DiversityInclusion/LGBT.asp

43. US Department of Veterans Affairs, Office of Resolution Management, Diversity & Inclusion (ORMDI). Diversity, equity and inclusion training. Updated March 18, 2024. Accessed June 20, 2024. https://www.va.gov/ORMDI/DiversityInclusion/Diversity_Inclusion_Training.asp

44. Rotenstein LS, Reede JY, Jena AB. Addressing workforce diversity - a quality-improvement framework. N Engl J Med. 2021;384(12):1083-1086. doi:10.1056/NEJMp2032224

45. Beeler WH, Mangurian C, Jagsi R. Unplugging the pipeline - a call for term limits in academic medicine. N Engl J Med. 2019;381(16):1508-1511. doi:10.1056/NEJMp1906832

46. Smith DG. Term limits in academic public health administration. Public Health Rep. 2020;135(6):859-863. doi:10.1177/0033354920954495

47. Kaiser J. Shake-up at NIH: Term limits for important positions would open new opportunities for women, minorities. science.org. May 2, 2019. Accessed May 23, 2024. https://www.science.org/content/article/shakeup-nih-term-limits-important-positions-would-open-new-opportunities-women

48. Giacalone RA, Jurkiewicz CL, Knouse SB. Exit surveys as assessments of organizational ethicality. Public Pers Manage. 2003;32(3):397-410. doi:10.1177/009102600303200306

49. Bonifacino E, Ufomata EO, Farkas AH, Turner R, Corbelli JA. Mentorship of underrepresented physicians and trainees in academic medicine: a systematic review. J Gen Intern Med. 2021;36(4):1023-1034. doi:10.1007/s11606-020-06478-7

50. Brown IM. Diversity matters: mentorship is the missing ingredient in DEI. Emergency Medicine News. 2021;43(8):28. doi:10.1097/01.EEM.0000771148.76632.35

51. Sinha A, Kuy S. The future of surgery - increasing diversity, equity, and inclusion through early mentorship. Am J Surg. 2023;225(4):800-802. doi:10.1016/j.amjsurg.2022.12.011

I*DEA in the VA: Optimizing the Physician Workforce to Enhance Quality of Care

References

Veteran Demographics

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