National Survey Finds VA Internists Report Fewer Administrative Burdens and Better Work-Life Balance Compared to Non-VA Counterparts

The study, published in the Journal of General Internal Medicine and led by Dr. Sarah Gualano of VA Ann Arbor Healthcare System, provides a comparative look at the environments in which internists practice and the challenges that shape their daily work.

The survey included 629 respondents nationwide, with nearly one in three working in the VA and the remainder in non-VA hospitals or clinics. When asked about administrative burdens, VA physicians were much less likely to cite time spent dealing with insurance companies. In fact, compared to their non-VA peers, VA internists were about 75 percent less likely to say insurance requirements were a significant part of their workload. They also reported fewer frustrations with the Computerized Patient Record System (CPRS), which many physicians nationally identify as a leading source of stress.

Concerns about malpractice also differed. VA physicians were significantly less likely to report worries about lawsuits—though the actual rates of being sued were similar between the two groups. On measures of work-life balance, VA respondents described fewer disruptions of personal activities and fewer stressors related to childcare or finances.

VA internists also said they typically worked fewer hours per week, an average difference of nearly 10 hours compared to non-VA physicians. According to the study, this gap may be explained by structural differences in VA’s integrated system. Physicians in the VA spend less time navigating insurance authorizations, billing documentation, and other administrative requirements, which allows them to devote more of their working hours directly to patient care.

The authors also highlighted compensation as a key difference. VA physicians are salaried employees, with emphasis on team-based patient care rather than excessive productivity targets, billing requirements, or incentives tied to the number of patients seen. In contrast, many non-VA internists work in fee-for-service or productivity-based systems, where pay is more directly linked to patient volume or procedures performed. 

Despite these contrasts, burnout levels were strikingly similar. Roughly 60 percent of physicians in both groups reported at least one sign of burnout, and around 10 percent met criteria for extreme burnout. These findings underscore how widespread burnout remains across health care, even in settings with fewer administrative demands.

The authors suggest that features of an integrated health system like the VA—particularly reduced insurance paperwork and fewer EHR burdens—may make careers in the VA more appealing. At the same time, the persistence of burnout across both groups shows that broader systemic changes are needed to fully address physician well-being.

Also Contributing to the Study

In addition to Dr. Gualano, co-authors of the study include:

• M. Todd Greene, PhD, MPH
• Nathan Houchens, MD
• Richard J. Schildhouse, MD
• David Ratz, MS
• Karen E. Fowler, MPH
• Sanjay Saint, MD, MPH