TABLE 1.
Number of VA Clinic Facilities,1 Clinic-Weeks,2 Encounters, and RVU Workload, By Operating Status and Clinic Specialty8
| Operating Status | P.C. | Surg. | Psych. | Neur. | Rehab. | Diag. | E.M. | S.C. | MSubS. |
|---|---|---|---|---|---|---|---|---|---|
| Clinic Facilities | 130 | 128 | 130 | 126 | 130 | 130 | 123 | 130 | 130 |
| with Residents3 | 120 | 107 | 113 | 93 | 109 | 124 | 107 | 117 | 106 |
| 92.3% | 83.6% | 86.9% | 73.8% | 83.8% | 95.4% | 87.0% | 90.0% | 81.5% | |
| who are Productive4 | 103 | 101 | 95 | 83 | 86 | 118 | 91 | 106 | 94 |
| 85.8% | 94.4% | 84.1% | 89.2% | 78.9% | 95.2% | 85.0% | 90.6% | 88.7% | |
| who are Efficient5 | 86 | 87 | 83 | 61 | 69 | 107 | 31 | 95 | 86 |
| 71.7% | 81.3% | 73.5% | 65.6% | 63.3% | 86.3% | 29.0% | 81.2% | 81.1% | |
| Clinic-Weeks (in 10,000s) | 9.39 | 8.96 | 9.37 | 8.26 | 9.34 | 9.40 | 8.49 | 9.37 | 9.22 |
| with Residents3 | 6.11 | 5.76 | 5.28 | 4.23 | 3.78 | 7.01 | 5.11 | 6.52 | 5.55 |
| 65.1% | 64.3% | 56.3% | 51.2% | 40.5% | 74.6% | 60.2% | 69.6% | 60.2% | |
| who are Productive4 | 4.90 | 4.70 | 4.48 | 3.89 | 3.03 | 5.96 | 3.87 | 5.65 | 4.63 |
| 80.2% | 81.6% | 84.9% | 92.1% | 80.0% | 85.0% | 75.7% | 86.6% | 83.4% | |
| who are Efficient5 | 3.88 | 3.69 | 3.51 | 2.58 | 2.43 | 5.14 | 1.40 | 4.98 | 3.70 |
| 63.5% | 64.0% | 66.5% | 60.9% | 64.2% | 73.3% | 27.4% | 76.3% | 66.7% | |
| Encounters (in 1,000,000s) | 119.88 | 27.06 | 41.92 | 6.17 | 29.55 | 14.36 | 22.34 | 83.16 | 32.09 |
| with Residents3 | 5.06 | 6.07 | 3.38 | 1.05 | 1.10 | 19.02 | 2.73 | 17.83 | 4.62 |
| 4.2% | 22.4% | 8.1% | 17.0% | 3.7% | 13.2% | 12.2% | 21.4% | 14.4% | |
| RVUs (in 1,000,000s) | 272.20 | 184.58 | 121.87 | 16.91 | 56.28 | 394.95 | 59.68 | 263.62 | 179.73 |
| Residents engaged6 | 13.62 | 62.32 | 10.99 | 3.30 | 4.00 | 56.51 | 7.15 | 64.76 | 26.19 |
| 5.0% | 33.8% | 9.0% | 19.5% | 7.1% | 14.3% | 12.0% | 24.6% | 14.6% | |
| Residents contributed7 | 25.10 | 20.42 | 13.50 | 2.60 | 2.75 | 95.47 | 2.79 | 48.46 | 21.56 |
| 9.2% | 11.1% | 11.1% | 15.4% | 4.9% | 24.2% | 4.7% | 18.4% | 12.0% |
Clinic facilities are counted if they provide at least 1 patient encounter during the 14-year study period.
Clinic-weeks include all unique patients treated and all procedures produced at a given outpatient clinic in a given facility during a given calendar week. There are a possible 94,640 clinic-weeks: 130 facilities × 14 years/facility × 52 weeks/year.
With Residents means a resident was assigned to a patient’s care as indicated by having been named as 1 of the care providers in the electronic health record.
Productive means the resident contributed a positive amount to clinical workload net of supervision as measured in RVUs.
Efficient means the resident's productive contribution net of supervision was sufficient to cover the resident's salary and fringe benefits.
Residents engaged includes RVUs of procedures listed in patient encounters where a resident was named as one of the care providers in the electronic health record.
Residents contributed is RVUs a resident is estimated to have contributed to workload net of supervision based on econometric methods explained in the text.
Clinics are classified into 1 of 9 specialty groups defined as follows: While listing over 700 classifications, clinics were only included if physicians were engaged. Although not named here, listed clinics were often subdivided into Individual and Group sessions, Telehealth and In -Person, Hospital-based, Home-care, and Hospital-based-Home-Care, and by Patient Groups (Women, Homeless Veterans, Selected Disorders). Primary Care (PC) includes among others: General Medicine, General Internal Medicine, Family Practice, Post-Deployment Integrated Care, Health and Well Being Services, Hospital Based Home Care, Observation Medicine, Chronic Infectious Disease Primary Care, Women’s Primary Care Clinic, Primary Care Medicine, and Geriatric Primary Care, and Immunization. Surgery (Surg.) includes among others: General Surgery, Cardiac Surgery, Hand Surgery, Neurosurgery, Orthopedics, Plastic Surgery, Thoracic Surgery, Cardiothoracic Surgery, Bariatric Surgery, Surgical oncology, Vascular Surgery, Ambulatory Surgery, Observation Surgery, Obstetrics, Otolaryngology Surgery, Anesthesia pre-op consult, Pre-Surgery Evaluation – MD, Post-Surg Routine Aftercare, Spinal Surgery, and Ambulatory Surgery Services. Behavioral Health (Psych.) includes among others: Mental Health, Mental Hygiene, Drug and Alcohol Dependence, Neurobehavioral, Smoking Cessation, Observation Psychiatry, Mental Illness Outreach Psychiatry – MD, Post Traumatic Stress Disorder, Methadone Maintenance, Opioid Substitution, Opioid Safety Education, Sexual Trauma, Mental Health Primary Care, Psychosocial Rehabilitation, Gambling Addictions, and Mental Health Compensated Work and Supported Employment. Neurology (Neur.) includes Neurology and Observation Neurology. Rehabilitation Medicine (Rehab.) includes among others: Rehabilitation Medicine, Polytrauma, Polytrauma Transitional Rehabilitation Program, Physical Medicine and Rehabilitation services, and if a physician were present Recreation, Physical, and Occupational Therapy, Audiology, Spinal Cord Injury, Amputation Follow-up, Kinesiotherapy, Blind Rehabilitation, Traumatic Brain Injury, Outpatient Visual Impairment, Cardio-pulmonary rehabilitation, Wheelchair and Advanced Mobility, Observational Medicine Rehabilitation, Cardiac Rehabilitation, and Residential Rehabilitation Treatment Programs. Diagnostic Medicine (Diag.) includes among others: x-ray, E.E.G., E.K.G., Laboratory, Nuclear Medicine, Ultrasound, Echocardiogram, Sing Photon Emiss Tomography, Health Screening, Evoked Potential, Topographical Brain Mapping, Hypertension screening, Mammogram, Cervical Cancer Screening, PAP Test, Myocardial Perfusion studies, Positron Emission Tomography, Computerized Tomography Scans, Magnetic Resonance Imaging, Angiogram Catheterization, Magnetoencephalography, Computer Aided Design / Modeling Unit, Comprehensive Fundoscopy Exam, Diabetic Retinal Screening, Pathology, and Interventional Radiology. Emergency Medicine (E.M.) includes among others: Emergency Unit, Urgent Care, Emergency Department, Observation Emergency Room, and Crisis Emergency. Specialty Care (S.C.) includes among others: Oncology, Gynecology, Obstetrics/Gynecology, Ophthalmology, Proctology, Urology, Visually Impaired, Prosthetics/Orthotics, Chemo Clinic, Nutrition/Dietetics, Dermatology, Parkinson’s Disease, Genomic Care, Pediatrics, Multiple Sclerosis, Hospital at Home, War Related Illness and Injury Study Center, Electrophysiology Laboratory, Otolaryngology Clinic (non-surgery), Hemodialysis, Peritoneal Dial Treatment. Subspecialties of Medicine (MSubS.) includes among others: Cardiology, Gastroenterology, Hematology, Hypertension, Diabetes, Infectious Diseases, Nephrology, Rheumatology, Pulmonology, Cardiovascular Nuclear Medicine, Endocrinology/Metabolic, Liver, Hepatology Clinic, Renal/Nephrology, Chemotherapy Procedures Unit Medicine, Cardiac Catheterization, Cardiac Stress Test, Geriatric Clinic, Alzheimer and Dementia Clinic, Sleep Medicine, and Palliative Care.
RVU indicates relative value unit.