Burnout Among Primary Care Practitioners and Staff in VA Clinics Using Virtual Contingency Staffing.

Importance: Primary care practitioners (PCPs) and staff in Veterans Health Administration (VHA) clinics with staffing shortages have reported higher rates of burnout that may be associated with higher workloads. Introducing PCPs through the Clinical Research Hub (CRH) virtual contingency staffing program into these clinics may help reduce burnout but may also disrupt workflows and increase burnout. Objective: To understand how rates of burnout among VHA PCPs and staff vary by staffing level and CRH program use. Design, Setting, and Participants: This survey study used annual, repeated, cross-sectional VHA employee survey data from fiscal years 2018 to 2022 to examine associations between staffing and burnout before and after implementation of the CRH program. Exposure: Clinical Research Hub virtual contingency PCP visits. Main Outcome and Measures: The main outcome was burnout as measured using multilevel, mixed-effects logistic regression to estimate the association between health care system-level PCP staffing and individual-level PCP and staff burnout before and after implementation of the CRH program. An interaction term was used to test the association between program use and burnout in health care systems with full and less-than-full PCP staffing, controlling for PCP, staff, and health care system characteristics. Estimated marginal means of burnout were calculated from model results. Results: Survey responses from 134 640 PCPs and staff (53% younger than 49 years; 70% female) in 139 VHA health care systems were analyzed. From fiscal years 2018 to 2022, 38% of PCPs and staff experienced burnout, and CRH visits ranged from a median of 0 to 127.6 (IQR, 76.7-237.4) visits per 1000 patients at the health care system level. In estimations derived from the full model, the probability of burnout was higher in clinics without full PCP staffing before program implementation (34.3% [95% CI, 33.4%-35.2%] without full staffing vs 36.5% [95% CI, 35.3%-37.8%] with full staffing) and in the lowest tertile of CRH visits (37.4% [95% CI, 36.4%-38.4%] without full staffing vs 40.2% [95% CI, 38.3%-42.1%] with full staffing). However, burnout did not differ by staffing at higher levels of CRH visits. Conclusions and Relevance: In this survey study of VHA PCPs and staff, the association between low staffing and burnout was mitigated at higher levels of CRH program use, suggesting that contingency PCPs may alleviate high workload in short-staffed clinics.