Scholarly Activity Among VA Podiatrists: A Cross-Sectional Study
Background: US Department of Veterans Affairs (VA) podiatrists advance clinical practices and ensure expert foot and ankle care for veterans. Quantifying the research expertise of VA podiatrists will enhance the confidence of the veteran population regarding the care they receive from highly knowledgeable and research-active clinicians, and provide podiatrists insight into their professional development.
Methods: This cross-sectional analysis aimed to describe the expertise of VA podiatrists; those with a history of peer reviewed publications were analyzed. Sex, region of practice, salary, academic appointment, number of publications, and h-index were recorded. Descriptive statistics were reported, and associations between variables were assessed. The threshold for statistical significance was set at P ≤ .05.
Results: Of 819 podiatrists, 157 met the selection criteria for final analysis, with most being male and located primarily on the West Coast. Significant differences were found in the median number of publications and the Hirsch index among academic ranks, but no relationship was observed between salary and these metrics. No statistically significant difference was noted in average salary among different academic appointments, although compensation did vary.
Conclusions: A substantial proportion of VA podiatrists have published their research, providing advanced foot and ankle care to veterans. These findings underscore the expertise available to veterans and highlight its role in enhancing clinical practices and professional growth among VA podiatrists.
The US Department of Veterans Affairs (VA) delivers care to > 9 million veterans, including primary and specialty care.1 While clinical duties remain important across the health system, proposed productivity models have included clinician research activity, given that many hold roles in academia.2 Within this framework, research plays a pivotal role in advancing clinical practices and outcomes. Studies have found that physicians who participated in research report higher job satisfaction.3
As a specialty within the VA, podiatrists diagnose, treat, and prevent foot and ankle disorders. In addition to clinical practice, various scholarly activities are shared among these physicians.4 Reasons for scholarly pursuits among podiatrists vary, including participation in research for academic promotion or to establish expertise in a given area.4-7 Although research remains a component associated with promotion within the VA, little is known about the scholarly activity of VA podiatrists. Specifically, there remains a paucity of data concerning their expertise, as evidenced through peer-reviewed publications, among these physicians and surgeons. To date, no analysis of scholarly activity among VA podiatrists has been conducted.
The primary aim of this investigation was to describe the scholarly productivity among podiatrists employed by the VA through an analysis of the number of peer-reviewed publications and the respective h-index of each physician. The secondary aim of this investigation was to assess the effect of academic productivity on compensation. This study describes research activities pursued by VA physicians and provides the veteran patient population with the confidence that their foot health care remains in the hands of experts within the field.
MATERIALS AND METHODS
The Feds Data Center (www.fedsdatacenter.com) online database of employees was used to identify VA podiatrists on June 17, 2024. All GS-15 physicians and their respective salaries in fiscal year 2023 were recorded. Administratively determined employees, including residents, were excluded. The h-index and number of published documents from any point during a physician’s training or career were reported for each podiatrist using Scopus; podiatrists without an h-index or publication were excluded. 8 Among podiatrists with scholarly activity, this analysis collected academic appointment, sex, and region of practice.
Statistical Analysis
Descriptive statistics, presented as counts and frequencies, were used. The median and IQR were used to describe the number of publications and h-index due to their nonnormal distribution. A Kruskal-Wallis test was used to compare median publication counts and h-index values among for junior faculty (JF), which includes instructors and assistant professors; senior faculty (SF), which includes associate professors and professors; and those with no academic affiliation (NF). Salary was reported as mean (SD) as it remained normally distributed and was compared using analysis of variance with posthoc Tukey test to increase statistical power. Additionally, this analysis used linear regression to investigate the relationship between scholarly activity and salary. The threshold for statistical significance was set at P < .05.
RESULTS
Among 819 VA podiatrists, 150 were administratively determined and excluded, and 512 were excluded for no history of publications, leaving 157 eligible for analysis (Table). A statistically significant difference was found in median (IQR) publication count by faculty appointment. JF had 6.0 (9.5), SF had 12.5 (22.3), and NF had 1.0 (2.0) publication(s) (P < .001) (Figure 1A). There was a statistically significant difference in h-index by faculty appointment. The median (IQR) h-index for JF was 2.0 (3.5), for SF was 5.5 (4.25), and for NF was 1.0 (2.0) (P = .002) (Figure 1B). Salary was not significantly associated with publication count (P = .20) or h-index (P = .62) (Figure 2). No statistically significant difference was found between academic appointment and mean (SD) salary. JF had a median (IQR) salary of $224,063 (27,989), SF of $234,260 (42,963), and NF of $219,811 (P = .35).
(B) h-index.a
aBox sizes indicate IQR (bottom, IQR 1; top, IQR 3); whiskers indicate minimum and maximum within 1.5 x IQR; Xs indicate means; white
lines indicate medians; and dots indicate outliers.
(B) h-index.a
aBox sizes indicate IQR (bottom, IQR 1; top, IQR 3); whiskers indicate minimum and maximum within 1.5 x IQR; Xs indicate means; white
lines indicate medians; and dots indicate outliers.
DISCUSSION
Focused on providing high-quality care, VA physicians use their expertise to practice comprehensive and specialized care.9,10 A cornerstone to this expertise is scholarly activity that contributes to the body of knowledge and, ultimately, the evidence-based medicine by which these physicians practice.11 With veterans considering VA care, it is important to highlight the commitment and dedication to the science and the practice of medicine. This analysis describes the scholarly activity of VA podiatrists and underscores the expertise veterans will receive for the diagnosis and treatment of their foot and ankle pathology.
were not part of an academic facility, a finding that may encourage further action to increase academic productivity in this specialty. For example, collaboration through academic affiliations has been seen throughout VA medical and surgical specialties and provides many benefits. Beginning with graduate medical education, the VA serves as a tremendous resource for resident training.12 Additionally, veterans who sought emergency care at the VA had a lower risk of death than those treated at non-VA hospitals.13 In podiatric medicine and surgery, scholarly activity has been linked to improved outcomes, particularly in the study of ulceration development and its role in either prolonging or preventing amputation.14
Beyond improving clinical outcomes and patient care, engagement in research and inquiry offers other benefits. A cross-sectional study of 7734 physicians within the VA found that research involvement was associated with more favorable job characteristics and job satisfaction perceptions. 3 While this analysis found that about 19% of podiatrists have published once in their career, it remains likely that more may continue to engage in research during their VA tenure. Although this finding shows that an appreciable number of VA podiatrists have published in their field of study, it also encourages departments to provide resources to engage in research. Similar to previous research among foot and ankle surgeons, this analysis also found an increase in publications and h-index as tenure increased.4 Unlike previous research, which found h-index and academic appointment to be contributors to VA dermatologists’ salaries, no significant difference in salary was found in this study associated with publications, h-index, or academic role.15 Although the increase was not statistically significant, salary tended to rise as these variables increased.
Limitations
This analysis was confined to the most recent year of available data, which may not fully capture the longitudinal academic contributions and trends of individual podiatrists. Academic productivity can fluctuate significantly over time due to various factors, including changes in research focus and administrative responsibilities. The study also relied on Scopus to identify and quantify academic productivity. This database may not include all publications relevant to podiatrists, particularly those in niche or nonindexed journals. Additionally, name variations and potential misspellings could lead to missing data for individual podiatrists’ publications. Furthermore, this study did not account for other significant contributors to salary and career advancement within the federal system. Factors such as clinical performance, administrative duties, patient satisfaction, and contributions to teaching and mentoring are critical elements that also influence career progression and compensation but were not captured in this analysis. The retrospective design of this study inherently limits the ability to establish causal relationships. While associations between academic productivity and certain outcomes may be identified, it is not possible to definitively determine the direction or causality of these relationships. Future research may examine how scholarly activity continues once a clinician is part of VA.
CONCLUSIONS
This study highlights the significant academic contributions of VA podiatrists to research and the medical literature. By fostering an active research environment, the VA can ensure veterans receive the highest quality of care from knowledgeable and expert clinicians. Future research should aim to provide a more comprehensive analysis, capturing long-term trends and considering all factors influencing career advancement in VA.
