Health Professions’ Retention- Accession Incentives Study ...

1 4825 Mark Center Drive Alexandria, Virginia 22311-1850 CRM March 2002 Health professions retention - Accession Incentives Study Report to Congress (Phases II & III: Adequacy of Special Pays and Bonuses for Medical Officers and Selected Other Health Care Professionals)Shayne Brannman Richard Miller Theresa Kimble Eric ChristensenThis document represents the best opinion of CNA at the time of does not necessarily represent the opinion of the Department of the for Public Release. Distribution Unlimited. Specific authority: copies of this document call: CNA Production Services 2002 The CNA CorporationApproved for distribution:March 2002 Laurie J. May, DirectorHealth Care ProgramsResource Analysis DivisioniContentsSummary.

2 1 Introduction .. 1 Approach .. 2 Major findings and recommendations .. 5 General .. 5 Physicians .. 9 Dentists .. 11 Other Health care professionals .. 12 Historical perspective .. 17 Background.. 17 Evolution of the military Health care benefit .. 18 The transition to TRICARE .. 21 Beneficiary demographic mix .. 26 MHS force structure .. 30 Focus of the 1980s was readiness.. 30 Consolidation of defense Health program resources . 31 Inventory and infrastructure .. 33 Conclusions.. 35 Physicians .. 37 Introduction .. 37 Personnel planning .. 38 Understanding the process.. 38 Accession sources.. 38 Force structure .. 42 Overall medical corps inventory .. 42 Grade structure .. 44 Comparing force structure with requirements by specialty 45 Primary care physicians.

3 47 Internal medicine subspecialties.. 49 Surgical specialties .. 51 Other specialties .. 56iiSummary .. 61 Attrition of military physicians.. 63 Continuation rates .. 63 retention analysis.. 65 Assessing special pay proposals .. 94 Methodology .. 94 Proposal 1: Increase entitlement special pays .. 96 Proposal 2: Increase caps on discretionary special pays98 Proposal 3: Grant Accession bonus authority .. 99 Proposal 4: Index entitlement special pays .. 99 Proposal 5: Offer critical skills retention bonus (CSRB) .. 100 Recommendations on current pay proposals .. 100An alternative: Future physician compensation strategies based on performance .. 101 Background .. 101 What pay practices are being used in the private sector for physicians?

4 102 What can the MHS use to measure physician performance? .. 103 Conclusions .. 108 Physician data management.. 108 Findings.. 109 Recommendations .. 111 Dentists.. 113 Introduction .. 113 Force structure .. 113 Inventory .. 113 Grade structure .. 115 Years of experience.. 118 retention analyses .. 119 Survival (continuation) rates.. 119 retention rates .. 123 Findings retention analyses.. 128 Effect of pay on retention .. 128 Earnings.. 128 Method for assessing the effect of pay on retention . 134 Results.. 136iiiAdequacy of military compensation.. 139 Billet authorizations .. 140 Readiness requirements .. 141 Dental corps distribution.. 143 Findings .. 144 Special pay proposals.. 145$30,000 direct Accession bonus.

5 145FY 2003 ASP proposal.. 146 Critical skills retention bonus (CSRB).. 147 Future dentist compensation strategies based on performance .. 148 Findings.. 150 Recommendations .. 151 AFHPSP accessions .. 151 ASP increase.. 151 Target experienced dentists .. 156 Critical skills retention bonus .. 156 Inflationary adjustments .. 156 Track initial OSD .. 157 Other Health care professionals .. 159 Introduction .. 159 Pharmacists.. 160 Inventory .. 160 Grade structure .. 161 Years of experience.. 164 Accession and attrition trends .. 165 retention .. 166 Manning.. 169 Pharmacist Accession bonus .. 170 Pharmacist special pay proposal .. 172 Optometrists .. 175 Inventory .. 175 Grade structure .. 176 Years of experience.

6 178 Accessions and attrition trends.. 179 retention .. 180 Manning.. 182 Optometry retention bonus .. 183ivClinical psychologists.. 186 Inventory .. 186 Grade structure .. 186 Years of experience.. 188 Accessions and attrition trends.. 188 retention .. 189 Manning.. 191 Physician Assistants.. 192 Inventory .. 192 Grade structure .. 192 Years of experience.. 194 Accession and attrition trends .. 196 retention .. 196 Manning.. 197 General Registered Nurses.. 198 Inventory .. 198 Grade structure .. 199 Years of experience.. 201 Accession and attrition trends .. 201 retention .. 202 Manning.. 204 Nurse Accession bonus .. 205 Certified Registered Nurse Anesthetists (CRNAs) .. 208 Inventory .. 208 Grade structure.

7 209 Years of experience.. 211 Accession and attrition trends .. 212 retention .. 212 Manning.. 214 Findings and recommendations.. 215 Overall.. 215 Pharmacists .. 215 Optometrists .. 216 Clinical Psychologists .. 217 Physician Assistants .. 217 General Registered Nurses .. 218 Certified Registered Nurse Anesthetists .. 218 Conclusions .. 219vAppendix A: Descriptive statistics for physician cohorts included in the duration analyses .. 221 Appendix B: Uniformed and private-sector registered nurse cash compensation comparisons .. 227 References.. 231 List of figures .. 235 List of tables .. 241 Distribution list .. 2471 Summary IntroductionThe Military Health System (MHS), one of the largest and oldesthealth care delivery systems in the United States, must execute twinmissions.

8 The primary mission of the MHS and the three Service med-ical departments is force Health protection. This readiness missioninvolves providing medical support in combat and other military oper-ations and maintaining the day-to-day Health of about million menand women who serve in the Army, Air Force, Navy, and MarinesCorps. The second mission is to provide a Health care benefit to million other people who are eligible to use the the Department of Defense (DoD) relies on a single force tomeet these sometimes disparate missions, it must cultivate a work-force that is dedicated to caring for patients, committed to continu-ous improvement in performance and productivity, and competentin both wartime and peacetime.

9 This challenge is particularly difficultbecause uniformed Health care professionals are costly to access andtrain, and they have skills that are in demand in the private sector. Congressional awareness of this mandate and competition from theprivate sector for qualified Health care professionals resulted in thefollowing committee language in the National Defense AuthorizationAct for Fiscal Year 2001:The committee directs the Secretary of Defense to conducta review and to report to the Committee on Armed Servicesof the Senate and the House of Representatives on the ade-quacy of special pays and bonuses for medical corps officersand other Health care professionals. The committee directsthis review because of the level of competition within theeconomy for Health care professionals and the potentialdevaluation of current special pays and bonuses, whichcould have a significant impact on recruiting and retentionof Health care a result of this language, the TRICARE Management Agency(TMA) at DoD asked the Center for Naval Analyses (CNA) to conducta Study to address the concerns voiced by Congress.

10 Historically, therehas been a single underlying objective to DoD s Health professionsspecial pay program namely, the need to attract and retain a suffi-cient number of qualified Health professionals to meet the healthcare demands of the armed forces [1]. How does one know if uniformed Health care professionals are being ade-quately compensated? We believe the answer lies in the MHS s ability tofill both its peacetime and active component readiness requirementswith the right professionals, the right skill mix, and the right years ofexperience from today s force and future accessions. If one of theseattributes is missing or significantly deficient, the current special paysand bonuses may need adjusting to help achieve the required inven-tory for a given specialty requirement.