Impact of the Department of Veterans Affairs Health Care Personnel Enhancement Act of 2004 on VA physicians' salaries and retention

Objective: To enhance the VA's ability to recruit and retain physicians, the United States Congress passed the Department of Veterans Affairs Health Care Personnel Enhancement Act (the Act), which was enacted in 2006 and designed to achieve VA physician salary parity with American Academy of Medical Colleges (AAMC) Associate Professors.

Methods: Using VA human resources datasets and publicly available data on Associate Professor's annual incomes from the AAMC for 2005-2007, we compared specialty-specific VA to Associate professors' annual incomes, before and after passage of the Act.

Results: We found that many VA specialties (family medicine, general internal medicine, neurology, psychiatry, pathology, PM&R, and medical subspecialties) had salaries that were comparable to their AAMC Associate Professor counterparts, prior to enactment of the Act. These specialties obtained substantial increases in incomes after the Act's enactment, frequently surpassing their AAMC Associate Professor counterparts' annual salaries. However, higher income specialties' salaries (Emergency Medicine, Ophthalmology, Dermatology, Urology, General Surgery, Orthopedic Surgery, Anesthesiology, and Diagnostic Radiology) lagged their AAMC counterparts both before and after the Act's enactment; over the three year period examined, these specialties remained below the 25th percentile of AAMC Associate Professors' incomes. Assuming that VA salary increases continued at the same pace, it would take decades for VA salaries to achieve AAMC benchmarks for several of these specialties, while equity will never be achieved for Emergency Medicine, Urology, and Orthopedic Surgery. Further, we found a negative correlation between both absolute and relative salary increases and growth of the full-time specialty-specific physician workforce (r=-0.13, p<0.05).

Conclusions: While VA offers comparable salaries for primary care physicians, psychiatrists, and medical subspecialists, despite substantial salary increases that resulted from the Act's passage, the VA does not appear to be able to offer competitive salaries for surgical specialties, anesthesiologists and radiologists. Recent attempts to increase salaries for surgical specialties, anesthesiologists, and radiologists have been inadequate and were associated with a decline in the physician workforce for these specialties. Our findings suggest that VA will continue to have difficulties maintaining an adequate workforce necessary to safely provide surgical care. For a variety of reasons, including low volumes, poor surgical outcomes, inability to offer competitive salaries, and an increasingly inadequate surgical workforce, VA should consider outsourcing surgical services.