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. 2025 Sep 4.
doi: 10.1007/s11606-025-09797-9. Online ahead of print.

Comparing Work Experiences of Internal Medicine Physicians in Veterans Affairs and Non-Federal Hospitals: A National Survey

Sarah K Gualano  1   2   3 , M Todd Greene  4   5 , Nathan Houchens  6   4 , Richard J Schildhouse  6   4 , David Ratz  5 , Karen E Fowler  5 , Sanjay Saint  6   4   5
Affiliations

Comparing Work Experiences of Internal Medicine Physicians in Veterans Affairs and Non-Federal Hospitals: A National Survey

Sarah K Gualano et al. J Gen Intern Med. .

Abstract

Background: Fewer physicians are pursuing careers in internal medicine due to workload, work-life integration, and documentation pressures. Integrated health systems like the Department of Veterans Affairs (VA) offer an alternative work model that may affect physicians' experiences differently compared to the private sector.

Objective: To examine and compare the self-reported workplace experiences among VA and non-VA internists.

Design: A cross-sectional survey.

Participants: A random sample of 1421 internal medicine physicians across the USA, with oversampling of hospitalists and VA physicians. Surveys were completed between June 2023 and May 2024. Of the total of 629 (44.3%) physicians responding, 618 indicated working in a VA or non-VA hospital.

Main measures: Our primary outcomes were several professional environment factors. Multivariable logistic regression was used to assess relationships between professional environment factors and practicing at the VA (vs. non-VA). All models were adjusted for sex, race, and years practicing as an internist.

Key points: The odds of time engaging with health insurance companies (OR = 0.26; P < 0.001), medical record issues (OR = 0.44; P < 0.001), and malpractice concerns (OR = 0.56; P < 0.001) were significantly lower among VA internists compared with non-VA internists. VA internists were significantly less likely to report issues concerning work-life balance (OR = 0.63; P = 0.01).

Conclusions: VA internists had reduced odds of some non-clinical administrative tasks and greater odds of better work-life balance. The VA's minimal engagement with insurance tasks and litigation concerns appears to present a compelling work environment.

Keywords: burnout; well-being; work environment; work experience; workload.

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Conflict of interest statement

Declarations:. Conflict of Interest:: The authors declare that they do not have a conflict of interest. Ethics Approval and Consent to Participate:: Not applicable. Disclaimer:: The funder had no role in the design, execution, analyses, interpretation of data, or decision to publish results.

References

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