Erik C. von Rosenvinge, MDa,b; Stacie A. Vela, MDc,d; Elizabeth R. Paine, MDe,f; Michael F. Chang, MDg,h; Brian J. Hanson, MDi,j; Tamar Taddei, MDk,l; Walter E. Smalley, MDm,n; Kerry B. Dunbar, MD, PhDo,p; Nabeel H. Khan, MDq,r; Lyn Sue Kahng, MDs,t; Jennifer Anwar, MHAu; Robert Zing, RNv; Andrew Gawron, MDw,x; Jason A. Dominitz, MDv,y; Gyorgy Baffy, MD, PhDz,aa
Correspondence: Erik von Rosenvinge (erik.vonrosenvinge@va.gov)
Author affiliations
aVeterans Affairs Maryland Health Care System, Baltimore
bUniversity of Maryland School of Medicine, Baltimore
cPhoenix Veterans Affairs Health Care System, Arizona
dUniversity of Arizona College of Medicine, Phoenix
eG.V. (Sonny) Montgomery Department of Veterans Affairs Medical Center, Jackson, Mississippi
fUniversity of Mississippi School of Medicine, Jackson
gPortland Veterans Affairs Medical Center, Oregon
hOregon Health Sciences School of Medicine, Portland
iMinneapolis Veterans Affairs Health Care System, Minnesota
jUniversity of Minnesota Medical School, Minneapolis
kWest Haven Veterans Affairs Medical Center, Connecticut
lYale School of Medicine, New Haven, Connecticut
mNashville Veterans Affairs Medical Center, Tennessee
nVanderbilt University School of Medicine, Nashville, Tennessee
oVeterans Affairs North Texas Health Care System, Dallas
pUniversity of Texas Southwestern Medical School, Dallas
qVeterans Affairs Philadelphia Healthcare System, Pennsylvania
rUniversity of Pennsylvania School of Medicine, Philadelphia
sVeterans Affairs Chicago Healthcare System, Illinois
tUniversity of Illinois College of Medicine, Chicago
uVeterans Affairs Long Beach Healthcare System, California
vVeterans Affairs Puget Sound Health Care System, Seattle, Washington
wVeterans Affairs Salt Lake City Healthcare System, Utah
xUniversity of Utah School of Medicine, Salt Lake City
yUniversity of Washington School of Medicine, Seattle
zVeterans Affairs Boston Healthcare System, Massachusetts
aaHarvard Medical School, Boston, Massachusetts
Author disclosures
Brian Hanson served as a consultant for Motus GI. The other authors have no conflicts to disclose.
Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies.
Ethics and consent
This internal Department of Veterans Affairs quality improvement project was not designed to develop orcontribute to generalizable knowledge. As such, it does not meet the definition of human subjects research according to the US Code of Federal Regulations (45 CFR 46, Sec §46.102) and institutional review board approval was not required.
Background: Having a sufficient number of gastroenterologists is important for protecting the digestive health of veterans. However, gastroenterology is among the most difficult medical specialties for recruitment at the US Department of Veterans Affairs (VA).
Methods: We surveyed VA gastroenterology section chiefs to learn about current barriers to recruitment and retention and to identify opportunities for improvement.
Results: Of 131 VA gastroenterology section chiefs at VA medical centers who received the survey, 55 responded (42%). Thirty-six respondents (65%) reported current vacancies at their facilities (range, 1-4). Low salary and human resources challenges were the most frequently reported barriers to recruitment. Low salary and administrative burden, including lack of sufficient support staff, were the most frequently reported barriers to retention.
Conclusions: While salary is the most frequently reported barrier to recruitment and retention, human resources challenges represent the second-most frequently reported barrier to recruitment. Administrative burden linked to suboptimal staffing support is the second most frequently reported barrier to retention. Efforts to raise salaries (higher than the current $400,000 ceiling), streamline human resources processes, and reduce administrative burden are needed to ensure a thriving VA gastroenterology workforce.
Veterans have a high burden of digestive diseases, and gastroenterologists are needed for the diagnosis and management of these conditions.1-4 According to the Veterans Health Administration (VHA) Workforce Management and Consulting (WMC) office, the physician specialties with the greatest shortages are psychiatry, primary care, and gastroenterology.5 The VHA estimates it must hire 70 new gastroenterologists annually between fiscal years 2023 and 2027 to provide timely digestive care.5
Filling these positions will be increasingly difficult as competition for gastroenterologists is fierce. A recent Merritt Hawkins review states, “Gastroenterologists were the most in-demand type of provider during the 2022 review period.”6 In 2022, the median annual salary for US gastroenterologists was reported to be $561,375.7 Currently, the US Department of Veterans Affairs (VA) has an aggregate annual pay limit of $400,000 for all federal employees and cannot compete based on salary alone.
Retention of existing VA gastroenterologists also is challenging. The WMC has reported that 21.6% of VA gastroenterologists are eligible to retire, and in 2021, 8.2% left the VA to retire or seek non-VA positions.5 While not specific to the VA, a survey of practicing gastroenterologists conducted by the American College of Gastroenterology found a 49% burnout rate among respondents.8 Factors contributing to burnout at all career stages included administrative nonclinical work and a lack of clinical support staff.8 Burnout is also linked with higher rates of medical errors, interpersonal conflicts, and patient dissatisfaction. Burnout is more common among those with an innate strong sense of purpose and responsibility for their patients, characteristics we have observed in our VA colleagues.9
As members of the Section Chief Subcommittee of the VA Gastroenterology Field Advisory Board (GI FAB), we are passionate about providing outstanding gastroenterology care to US veterans, and we are alarmed at the struggles we are observing with recruiting and retaining a qualified national gastroenterology physician workforce. As such, we set out to survey the VA gastroenterology section chief community to gain insights into recruitment and retention challenges they have faced and identify potential solutions to these problems.
Methods
The GI FAB Section Chief Subcommittee developed a survey on gastroenterologist recruitment and retention using Microsoft Forms (Appendix). A link to the survey, which included 11 questions about facility location, current vacancies, and free text responses on barriers to recruitment and retention and potential solutions, was sent via email to all gastroenterology section chiefs on the National Gastroenterology and Hepatology Program Office’s email list of section chiefs on January 31, 2023. A reminder to complete the survey was sent to all section chiefs on February 8, 2023. Survey responses were aggregated and analyzed by the authors using descriptive statistics.
