Clinical Staffing and Veterans' Access to Primary Care

The media has criticized the Veterans Health Administration (VHA) for long wait times to see a clinician. While long wait times could be solved in private healthcare delivery systems by hiring more clinicians, this may not be possible in public systems that are often subject to more stringent budget approval processes. In this study, we develop theoretical and empirical models of monthly average wait times for new patients seeking an appointment at a VHA facility. Using an instrumental variables approach to handle simultaneity issues of supply and demand, we investigate the effect of supply changes on new patient wait times. We use data on veteran enrollment, wait times, VHA clinician supply, and local market factors for 129 VHA medical centers in the U.S. between fiscal years 2009 and 2014. Our results indicate that, on average, hiring one primary care clinician (per 1,000 enrollees) leads to a 3.41-day reduction in wait times for new patient primary care appointments. The wait time reduction from additional clinicians varies across facilities; the demand for appointments is more elastic in some areas than in other areas, depending on potential access to alternative health insurance options, such as employer-sponsored health insurance. Given limited resources, the VHA could use this information to strategically hire clinicians in areas that will yield the highest return in terms of reductions in wait times.