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Recruiting and retaining dental labor in federal facilities: Harder than pulling teeth? (Richards & Wang, 2019)

Absence of conflict of interest.

Citation

Richards, M. R., & Wing, C. (2019). Recruiting and retaining dental labor in federal facilities: Harder than pulling teeth? Health Economics, 28(11), 1356–1369. https://doi.org/10.1002/hec.3949

Highlights

  • The study’s objective was to examine the impact of the Health Care Personnel Enhancement Act’s (HCPEA) authorization of flexible, and potentially more generous, pay packages for U.S. Veterans Administration (VA) dentists on job separation, hiring rates, and part-time employment. 

  • The authors compared changes in the outcomes of VA dentists to those of federal occupations that were not affected by HCPEA. The authors used administrative data on federal employees from 2002 to 2012 from the Office of Personnel Management’s Central Personnel Data File. In addition to analyzing the full sample, the authors examined findings for early- and later-career employees.  

  • The authors found that, among the full sample, the announcement of HCPEA was associated with a higher job separation rate, while the enactment of HCPEA was associated with a lower new-hire rate and lower likelihood of transitions from full-time to part-time employment. 

  • The quality of causal evidence presented in this report is low because the authors did not ensure that the groups being compared were similar before the intervention. This means we are not confident that the estimated effects are attributable to the HCPEA; other factors are likely to have contributed.  

Intervention Examined

Health Care Personnel Enhancement Act

Features of the Intervention

Congress provided funding to the VA under the HCPEA of 2004 to address potential staffing shortages among VA health care providers. HCPEA enabled the VA to offer health care providers, including dentists, more flexible pay packages that were partly based on local market prices. VA managers were allowed greater discretion in setting compensation and had two years to compare their VA provider pay levels to those of non-VA providers and implement pay changes. 

Features of the Study

The authors conducted a nonexperimental analysis to compare changes in outcomes for VA dentists with those for other federal occupations that were not affected by the flexible pay packages introduced in the HCEPA, specifically, all federal employees excluding physicians and nurses. The outcomes examined were annual salaries, job separation rates, new-hire rates, and part-time employment status. The authors also examined the likelihood of transitions from full-time to part-time employment by analyzing changes for each individual over time in a fixed-effects analysis. To analyze employment outcomes, the authors used administrative data on 1,767,762 federal employees, excluding dentists younger than 25, from 2002 to 2012 from the Central Personnel Data File at the Office of Personnel Management. The sample size for analyses of annual salary was not reported.   

Findings

  • The authors found that the announcement of HCPEA was associated with a higher job separation rate, while the enactment of HCPEA was associated with a lower new-hire rate and lower likelihood of transitions from full-time to part-time employment. There were no other statistically significant associations between other employment outcome variables and HCPEA announcement or enactment among the full sample. 

  • For early-career employees, the authors found that the enactment of HCPEA was associated with a lower job separation rate, a lower new-hire rate, and a lower part-time work rate. There were no other statistically significant associations between other employment outcome variables and HCPEA enactment, or between any employment outcome variable and HCPEA announcement, among the early-career subgroup.  

  • For later-career employees, the authors found that the enactment of HCPEA was associated with a higher part-time work rate. There were no other statistically significant associations between other employment outcome variables and HCPEA enactment, or between any employment outcome variable and HCPEA announcement, among the later-career subgroup. 

Considerations for Interpreting the Findings

The authors did not demonstrate that the groups were similar in required demographic characteristics before the intervention began, nor did they control for the characteristics in their analysis. These potential preexisting differences between the groups—and not the intervention—could explain the observed differences in outcomes. 

Causal Evidence Rating

The quality of causal evidence presented in this report is low because the authors did not ensure that the groups being compared were similar before the intervention. This means we are not confident that the estimated effects are attributable to the HCPEA; other factors are likely to have contributed. 

Reviewed by CLEAR

May 2021