Date of Conferral

8-6-2026

Date of Award

August 2026

Degree

Doctor of Healthcare Administration (D.H.A.)

School

Health Sciences

Advisor

Miriam Ross

Abstract

The shortage of primary care physicians (PCPs) in the Veterans Health Administration (VHA) hospital system highlights the need for strategies to effectively mitigate this issue. The purpose of this integrative review was to examine the literature on primary care physician shortages in VHA hospital-based outpatient clinics and determine evidence-based solutions. The review question centered on strategies and best practices that can be implemented to address PCP shortages in VHA outpatient clinics. The Donabedian Model provided the framework for analyzing structural factors, processes, and patient outcomes. A comprehensive review of the literature resulted in 40 articles being screened for quality and relevance using the Johns Hopkins evidence-based practice model appraisal tools, with 25 sources selected for inclusion in the study. Thematic analysis identified four main themes and seven subthemes related to problem-solving strategies for physician retention. The four main themes were: enhancing workplace morale, improving ways to recruit physicians, expanding physician retention strategies, and strengthening physician communication. Key subthemes were: workplace flexibility, create teamwork, improve job satisfaction, enhance career development, and optimize priority-based scheduling. The analysis yielded three recommendations: (a) Adapt PCP schedules to reduce overload and enhance wellness, (b) Implement multidisciplinary teams for patient care and documentation, and (c) Strengthen leadership support across the organization. Implementing targeted workforce strategies and Donabedian quality processes can improve the sustainability, adaptability, and collaborative capacity of VHA primary care practices. These enhanced workforce strategies may contribute to positive social change for patients, staff, and families.

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