Retaining VA Women’s Health Primary Care Providers: Work Setting Matters



When an experienced provider opts to leave a healthcare workforce (attrition), there are significant costs, both direct and indirect. Turnover of healthcare providers is underreported and understudied, despite evidence that it negatively impacts care delivery and negatively impacts working conditions for remaining providers. In the Veterans Affairs (VA) healthcare system, attrition of women’s health primary care providers (WH-PCPs) threatens a specially trained workforce; it is unknown what factors contribute to, or protect against, their attrition.


Based on evidence that clinic environment, adequate support resources, and workload affect provider burnout and intent to leave, we explored if such clinic characteristics predict attrition of WH-PCPs in the VA, to identify protective factors.


This analysis drew on two waves of existing national VA survey data to examine predictors of WH-PCP attrition, via logistic regression.


All 2,259 providers from 140 facilities VA-wide who were WH-PCPs on September 30, 2016.

Main Measures

The dependent variable was WH-PCP attrition in the following year. Candidate predictors were clinic environment (working in: a comprehensive women’s health center, a limited women’s health clinic, a general primary care clinic, or multiple clinic environments), availability of co-located specialty support resources (mental health, social work, clinical pharmacy), provider characteristics (gender, professional degree), and clinic workload (clinic sessions per week).

Key Results

Working exclusively in a comprehensive women’s health center uniquely predicted significantly lower risk of WH-PCP attrition (adjusted odds ratio 0.40; CI 0.19–0.86).


A comprehensive women’s health center clinical context may promote retention of this specially trained primary care workforce. Exploring potential mechanisms—e.g., shared mission, appropriate support to meet patients’ needs, or a cohesive team environment—may inform broader efforts to retain front-line providers.

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Figure 1



Women’s Health Primary Care Provider


Comprehensive Women’s Health Center


Women’s Assessment Tool for Comprehensive Health survey


Designated Women’s Health Provider Assessment of Workforce Capacity survey


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We would like to thank Fay Saechao, M.P.H., for her help with analyses and project support.


This program evaluation work was supported by Women’s Health Services in the VA Central Office through the Women’s Health Evaluation Initiative (WHEI), and Dr. Schwartz’s time was supported by a VA Office of Academic Affairs Advanced Fellowship in Health Services Research.

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Correspondence to Rachel Schwartz PhD.

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The authors received salary support from the Department of Veterans Affairs. All of the authors report no conflicts of interest.


The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

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Prior Presentations

Components of this work were presented at the AMA American Conference on Physician Health on September 21, 2019.

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Schwartz, R., Frayne, S.M., Friedman, S. et al. Retaining VA Women’s Health Primary Care Providers: Work Setting Matters. J GEN INTERN MED (2020).

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  • workforce turnover
  • Veterans Health Administration
  • organizational context
  • women’s health
  • burnout