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Study Suggests Psychiatrists' Workplace Satisfaction Improved Despite Significant Changes in VA Mental Healthcare Services

The VA healthcare system underwent significant changes during the last several years by augmenting mental health resources, while increasing direction and accountability for their use. In 2004, VA introduced the Comprehensive Mental Health Strategic Plan which required greater integration and coordination of mental health services into overall healthcare treatment. In 2008, VA introduced an update to the Uniform Mental Health Services handbook, totaling more than 200 initiatives and 400 mental health services to be offered nationwide. Large-scale changes in work roles and responsibilities have been generally associated with greater stress, dissatisfaction, and turnover among employees. Moreover, individual reactions to organizational change and the specific targets of the change can have complex effects on attitudes and behaviors. This study examined whether VA psychiatrists' self-reported outcomes for work satisfaction and work environment perceptions changed during VA's period of transformation. Facility-level turnover rate also was examined. Investigators analyzed data from more than 7,000 psychiatrists, practicing at 139 VA facilities, who had responded to the annual All Employee Survey between 2004 and 2010 (excluding 2005). Covariates analyzed included demographics, supervisory level, practice location, facility complexity, and network effects.


  • Extensive reorganization of VA mental health services was associated with improvements in psychiatrists' workplace satisfaction, and these increases were sustained over time. Most of the increases in survey measures occurred between 2004 and 2006, with gains maintained thereafter.
  • Pay satisfaction showed the strongest trend increase, and was significantly higher in all years subsequent to 2004.
  • Ratings of management practices were also higher over time.
  • Both skill development and workplace civility were higher in all years except 2007.
  • Intention to leave, job autonomy, and turnover rates did not significantly change over the study period. However, the patterns for satisfaction with work amount and overall job satisfaction differed; values increased from 2004 to 2006 but declined significantly between 2006 and 2010, ending up close to their baseline levels.


  • Because the surveys were conducted anonymously, investigators did not know the overlap between individual respondents over multiple years and could not control for repeated measurements by individual psychiatrists.
  • This study did not assess how changes, such as in job roles or responsibilities, directly impacted staff or the extent of provider involvement or openness to change.
  • Investigators did not directly assess the extent of the changes occurring within VA facilities, or whether some changes led to greater variation in workplace perceptions and attitudes.

This study was funded by HSR&D (IIR 10-314). All authors are part of HSR&D's Center for Organization, Leadership and Management Research, VA Boston Healthcare System.

PubMed Logo Mohr D, Bauer M, and Penfold R. Changes in Veterans Affairs Psychiatrists’ Work Environment Perceptions, Satisfaction and Turnover during Resource Enhancement. Psychiatric Services March 15, 2013;e-pub ahead of print.

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