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A Word From the President: The Veterans Administration—Rising to the Challenge

AAMC Reporter: November 2015

Like two-thirds of America’s physicians, I trained at a Veterans Administration (VA) hospital, in my case during both medical school and residency. The practical training I received at the VA was invaluable, and it was a privilege to care for those who served and to work alongside the health professionals and staff who carry out the VA’s mission on a daily basis. In the years since my residency, the VA has made remarkable improvements to its systems and processes by introducing patient-centered care teams, pioneering the use of electronic medical records to monitor effective care, and working with the Liaison Committee on Medical Education to heighten the quality of supervision of our learners in VA settings.

My VA training was possible because of the 70-year partnership between the VA and academic medicine, which began in response to the overwhelming number of service men and women returning from World War II in need of care, many with lifelong injuries and illnesses. The establishment of VA-academic affiliations provided extra physicians to alleviate the shortage. Since then, the VA and academic medicine have built an unprecedented public-private partnership, grounded in our shared duty to care for veterans. The VA now is the largest provider of medical training in the United States, sponsoring approximately 10 percent of graduate medical education trainee positions.

We have decades of evidence demonstrating the benefits of this partnership. Just as VA hospitals provide our medical schools and training hospitals with robust educational venues, our trainees and faculty supplement VA hospital capacity and help make it possible for the VA to deliver high-quality, cost-effective patient care. VA training also provides a vital pipeline for future health professionals. The students and residents who train at the VA are significantly more likely to practice there. Together, we conduct valuable research on the illnesses and treatments that have the greatest impact on our nation’s veterans, such as prosthetics technology, brain and spinal cord injury, pain management, and post-traumatic stress disorder.

Knowing first-hand how much good the VA does, and how many people rely on it for care, the crisis of care at the VA over the last few years has been painful to witness. But I have been heartened by recent efforts to provide more care options for veterans and remove inefficiencies in the VA health care contracting system. In July, Congress passed the VA Budget and Choice Improvement Act, which directs the VA to develop a plan to consolidate all non-VA providers under a single program and requires presidential budgets from fiscal 2017 onward to include provisions for non-VA provider programs. This legislation expands on the Veterans Access, Choice, and Accountability Act of 2014 (Choice Act), which gave veterans greater flexibility to receive care outside the VA and expanded the number of residency slots within the VA by 1,500 over a five-year period. While the Choice Act sought to address the immediate crisis, the more recent legislation calls for a path forward to improve veteran care in the long term.

As the VA works out the details of how it will reform its contracting processes, we have been working with our VA colleagues to determine how to enhance our longstanding partnership to meet the medical needs of veterans by preserving access to care at our academic medical centers and leveraging the VA’s educational and research missions. Under the new plan, we expect academic affiliates to remain an integral part of the VA’s core network of providers. We also expect the VA to make strides in streamlining contracting, increasing automation, and enhancing quality of care. In return, we must commit to ensuring that our medical students and residents acquire a clinical cultural competency for veterans, military service members, and their families. We can encourage this through high-quality VA training opportunities and active participation in programs such as Joining Forces Wellness Week and veteran-recruitment initiatives under the AAMC Aspiring Docs program.

The VA is not only a lifeline for our veterans—it plays a leadership role in educating the next generation of physicians and defining the future of health care delivery in the United States. The VA is now at a crossroads, but the future looks hopeful. Under the unified program required by Congress, the VA has a timely opportunity not only to address access issues, but also to reinvest in patient care, research, and medical education and to make the VA an employer of choice. As we honor our veterans on Nov. 11, we are committed to working closely with the VA secretary’s office to help deliver health care for veterans in a timely fashion. My fervent hope is that the VA and academic medicine can again rise to the challenge and strengthen our 70-year partnership to create a better future for veteran care.

Darrell G. Kirch, MD

Darrell G. Kirch, MD