4122 — State of the Women's Health Primary Care Provider Workforce

Lead/Presenter: Yasmin Romodan,  COIN - Palo Alto
All Authors: Romodan Y (VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA), Haskell S (Women's Health Services, VA Central Office, Washington, DC; VA Connecticut Health Care System, West Haven, CT; Yale University School of Medicine, New Haven, CT), Hayes P (Women's Health Services, VA Central Office, Washington, DC) Iqbal, S (Women's Health Services, VA Central Office, Washington, DC; Medical Service, VA Palo Alto Health Care System, Palo Alto, CA; Stanford University School of Medicine, Stanford, CA) Saechao F (VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA) Phibbs C (VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA; Health Economics Research Center (HERC), VA Palo Alto Health Care System, Menlo Park, CA; Stanford University School of Medicine, Stanford, CA) Frayne S (VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA; Medical Service, VA Palo Alto Health Care System, Palo Alto, CA; Stanford University School of Medicine, Stanford, CA)

Objectives:
To increase comprehensive primary care for women Veterans, 2010 VHA policy (Handbook 1330.01) established designated Women's Health Primary Care Providers (WH-PCPs), trained in women's primary care and preferentially assigned women patients. We characterized the current state of the national WH-PCP workforce as of the end of Fiscal Year 2017 (FY17).

Methods:
The Women Veteran Program Manager at each VHA facility participated in a national assessment in early FY18 (response rate 100%), identifying and characterizing the facility's WH-PCPs. Assessment data were linked to national FY17 VHA administrative data, to characterize patients assigned to these providers.

Results:
Contrasting with the previously-reported 1,716 WH-PCPs VA-wide during the first year of policy implementation, number of WH-PCPs at the end of FY17 was 2,616; among them, 75% were female and 70% were MDs (with the remainder NPs/PAs). While nearly all (97%) provided comprehensive (gender-specific plus gender-neutral) care, only 16% worked in a Women's Clinic, likely contributing to the large proportion (61%) with < 100 women in their panels and the finding that, across WH-PCPs, median number of PC encounters with women in FY17 was 125. Among WH-PCPs, 60% have completed the Women's Health Mini-Residency, and 97% meet at least one of the requirements to be a qualified WH-PCP. Every Health Care System (HCS), 98% of VA Medical Centers and 90% of Community-Based Outpatient Clinics (CBOCs) had at least one WH-PCP, but only half of CBOCs had at least two.

Implications:
The workforce of WH-PCPs has grown substantially, to meet the goals of women's health policy; nearly all have Miniresidency or other relevant training/experience. However, many have relatively few women in their panels. Half of CBOCs have zero or one WH-PCP (meaning they lack either any capacity or backup capacity for provider absences or turnover).

Impacts:
This evaluation of policy implementation will help to shape the next strategic phase. Now that most VA points of care have at least one WH-PCP, attention can shift to ensuring site-level staffing is sufficient for volume of women seen.