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A Word From the President: The VA: A Vital Partner for Academic Medicine

AAMC Reporter: July/August

Darrell G. Kirch, M.D., AAMC President and CEO

Like so many of my fellow physicians, a key part of my clinical training occurred at Department of Veterans Affairs (VA) hospitals and clinics. As a medical student and resident, I performed more clinical work at the Denver VA Hospital than at any other single institution. At times, the system was cumbersome, but the professional training opportunities I had were invaluable. Some years later, I found myself serving as the dean of two medical schools with VA training affiliations. I was pleased to see the VA had made many improvements, such as increasing its emphasis on quality of care and introducing patient-centered care teams—long before many of us were thinking about the concept of “medical homes.”

My positive experiences with the VA make it all the more painful for me to see the VA system confronting such difficult issues today. Our medical schools and teaching hospitals have had a unique partnership with the VA since the end of World War II, when academic medicine stepped in to help treat the overwhelming numbers of returning servicemen and women. What started as a simple idea in a time of need developed into an unprecedented private-public partnership grounded in our shared missions of research, education, and patient care.

Today, 127 VA facilities have affiliation agreements for physician training with 130 U.S. medical schools. The VA has become the largest provider of health care training in the United States, sponsoring approximately 10 percent of all residency training positions. In 2013, more than 40,000 medical residents and 20,000 medical students received some or all of their clinical training at a VA facility, and 70 percent of VA physicians had a faculty appointment at a medical school.

This partnership with academic medicine also has helped many VA hospitals become leaders in improving the quality of patient care. The first successful liver transplants were performed at VA facilities, and advances such as the pacemaker and CAT scans were pioneered by VA research. The VA also was among the first hospital systems to adopt electronic medical records to manage data—now a best practice throughout medicine.

Given our long history of working together, I am gratified that more than 160 of our medical schools and teaching hospitals have told us they and their faculty physicians have the capacity to provide care for our veterans once the VA determines how our community can best assist with the backlog of VA patients waiting for care.

While the current delays at the VA are commanding national headlines, slowdowns in care are not a total surprise to those of us in health care who are aware of the emerging doctor shortage. The VA has taken steps to increase resident and physician staff over the last decade, but veterans of the Iraq and Afghanistan wars, along with aging baby boomer veterans, have been placing greater demands on the VA for medical and mental health services. As early as 2007, the AAMC testified to Congress about physician staffing challenges at the VA and the looming national physician shortage. The AAMC is predicting a shortage of 130,600 primary and specialty care physicians by 2025. What is happening now at the VA is a microcosm of what the entire country may experience in the relatively near future. The most vulnerable among us—in this case, our veterans—are feeling the impact first.

At a Capitol Hill briefing in July, AAMC and VA leaders discussed the physician shortage and how medical schools and teaching hospitals partner with the VA. We also sent a letter to Congress urging swift passage of legislation that would allow veterans to seek medical care outside the VA system if facing long wait times. We are encouraged that Congress just approved a bill to overhaul the VA, which includes the addition of 1,500 new VA-funded residency training slots. The bill is an important first step to address the shortage, but the AAMC remains concerned that this legislation does not improve or expedite contracting with non-VA hospitals that treat VA patients.

The new VA positions also will require corresponding Medicare-supported residencies at affiliate teaching hospitals to satisfy residency training requirements. Unless Congress raises the 1997 cap on Medicare-funded training positions, shortages will persist in the VA system and throughout the entire health care system. Medical schools have done their part by increasing enrollments, but without more federally supported residency positions, new M.D.s will not be able to complete their training. The AAMC-supported legislation introduced in both houses of Congress would increase residency slots by 15,000 over the next five years. In addition, to help make better use of all members of the health care team, medical schools and teaching hospitals are training doctors to work in teams and developing innovative, more efficient care delivery models.

There is no question that some VA hospitals experienced failures that must be addressed. The VA needs to establish a culture of accountability to prevent future breakdowns in service. At the same time, I’m proud that our 70-year partnership and entwined missions of research, education, and patient care remain strong, and academic medicine stands ready to help the VA provide the care our country’s veterans need and deserve.

The VA is a vital national resource and an essential partner for academic medicine. All of us must do what we can to educate legislators about the importance of the VA to our nation’s health care system, its role as a major training ground for physicians and health care professionals, and the need to act now to prevent the dire consequences of a nationwide physician shortage. The delays in care at VA hospitals should be the only warning Congress needs to increase funding for graduate medical education so no American dies waiting for health care ever again.

Darrell G. Kirch, MD

Darrell G. Kirch, MD