Health care systems nationwide face challenges in recruiting and retaining physicians, leading to high turnover and impact on patient care. Research also shows that new employees are often less productive than more experienced colleagues. If newly hired physicians take a long time to reach full productivity, the costs and effects of turnover on patient access may be greater than expected. Health systems may not be doing enough to ensure stable care during these transitions. Little research has examined how physician tenure affects productivity, leaving gaps in workforce planning and patient care strategies.
New Research
A recent retrospective cohort analysis published in the Journal of General Internal Medicine examined the relationship between physician tenure and clinical productivity in the Veterans Health Administration (VHA). The paper explored how tenure length affects productivity (i.e., the number of patient encounters per clinic day) among attending physicians. It also compared productivity trends between internally hired physicians—those who had any residency or fellowship training within the VHA—and externally hired physicians.
Methods
Researchers used the VHA’s Corporate Data Warehouse to collect detailed data on physician employment characteristics, specialty, and monthly patient encounters. Data was analyzed from 34,878 attending physicians across 27 specialties, covering over 1.5 million physician-months of outpatient encounters between October 1, 2017, and August 1, 2023. They used statistical models to examine productivity differences over time, adjusting for factors such as specialty, facility, and time effects, and sensitivity analyses to test the robustness of the results. The analyses were conducted for both the entire sample including all 27 specialties and four specialty subgroups—primary care, psychiatry, large medical specialties, and large surgical specialties.
Main Findings
Newly hired physicians had on average 1.72 fewer patient encounters per clinic day during their first quarter compared to their more experienced colleagues who had worked at VHA for more than two years. However, this productivity gap shrunk over time, with new hires having only 0.44 fewer encounters per clinic day by their eighth quarter. Among the specialty subgroups, medical and surgical specialty new hires reached productivity equivalent to more experienced employees by their eighth quarter. Additionally, physicians who had any residency or fellowship training within VHA (“internal hires”) had higher initial productivity and a quicker adjustment to full productivity than those hired externally, particularly in primary care and large surgical specialties.
Conclusion
These findings suggest that while newly hired attending physicians initially exhibit lower productivity, they experience significant improvement within the first two years. Moreover, those with prior VHA training adapt more quickly, highlighting the potential benefits of internal training programs. These insights are important for health care systems assessing the long-term costs and access implications associated with physician turnover and onboarding. Understanding these dynamics can aid in developing strategies to support new physicians, optimize training programs, and ultimately enhance patient care within VHA and similar health care settings.
