title: Readying the workforce: evaluation of VHA's comprehensive women's health primary care provider initiative.
abstract: BACKGROUND
  Veterans Health Administration (VHA) primary care providers (PCPs) often see few women, making it challenging to maintain proficiency in women's health (WH). Therefore, VHA in 2010 established Designated WH Providers, who would maintain proficiency in comprehensive WH care and be preferentially assigned women patients.
  
  
  OBJECTIVE
  To evaluate early implementation of this national policy.
  
  
  METHODS
  At each VHA health care system (N=140), the Women Veterans Program Manager completed a Fiscal Year 2012 workforce capacity assessment (response rate, 100%), representing the first time the national Designated WH Provider workforce had been identified. Assessment data were linked to administrative data.
  
  
  RESULTS
  Of all VHA PCPs, 23% were Designated WH Providers; 100% of health care systems and 83% of community clinics had at least 1 Designated WH Provider. On average, women veterans comprised 19% (SD=27%) of the patients Designated WH Providers saw in primary care, versus 5% (SD=7%) for Other PCPs (P<0.001). For women veterans using primary care (N=313,033), new patients were less likely to see a Designated WH Provider than established women veteran patients (52% vs. 64%; P<0.001).
  
  
  CONCLUSIONS
  VHA has achieved its goal of a Designated WH Provider in every health care system, and is approaching its goal of a Designated WH Provider at every hospital/community clinic. Designated WH Providers see more women than do Other PCPs. However, as the volume of women patients remains low for many providers, attention to alternative approaches to maintaining proficiency may prove necessary, and barriers to assigning new women patients to Designated WH Providers merit attention.
authors.affiliation: *Women's Health Evaluation Initiative (WHEI), Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA †Women's Health Services, VA Central Office, Washington, DC ‡Health Economics Resource Center §Women's Health Service, Medical Service, VA Palo Alto Health Care System, Palo Alto, CA ∥Division of General Medical Disciplines ¶Department of Pediatrics #Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA.
authors.forename: Natalya C
authors.initials: NC
authors.lastname: Maisel
authors.forename: Sally
authors.initials: S
authors.lastname: Haskell
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Hayes
authors.forename: Vidhya
authors.initials: V
authors.lastname: Balasubramanian
authors.forename: Anupama
authors.initials: A
authors.lastname: Torgal
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Ananth
authors.forename: Fay
authors.initials: F
authors.lastname: Saechao
authors.forename: Samina
authors.initials: S
authors.lastname: Iqbal
authors.forename: Ciaran S
authors.initials: CS
authors.lastname: Phibbs
authors.forename: Susan M
authors.initials: SM
authors.lastname: Frayne
mesh_terms: D000293:Adolescent; D000328:Adult; D003191:Comprehensive Health Care / Q000458:organization & administration*; D005260:Female; D006291:Health Policy; D006297:Health Services Accessibility; D006787:Hospitals, Veterans / Q000458:organization & administration*; D006801:Humans; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health; D016387:Women's Health