News and perspectives from AAMC's Chief Public Policy
Officer, Atul Grover, M.D., Ph.D.
June 6, 2014
VA Wait Time Delays: Case Study in Physician Shortage
back on my residency training, I remember a man with a little discomfort
who, after much convincing from his wife, drove several hours to the
Francisco VA. He came in and we quickly diagnosed a massive heart
attack-one where the typical patient would have been dying in front of
us, or at
least screaming in pain.
day, that veteran got the care he needed. And over the years, the VA
hard to improve the care they provide. For example, the VA was among
the first to implement electronic health records, now a best practice
medicine, as well as the patient-centered medical home.
The VA also plays an important role
in medical innovation. The first successful liver transplants were
performed at VA facilities, and advances such as the pacemaker and CAT
pioneered by VA research. These and many other innovations have
improved the lives of veterans and patients around the country and
VA hospitals also are major sites of health care training. About 70 percent of the nation's
practicing physicians are educated in a VA facility. According to the VA's Office of Academic Affiliations, in 2013, more than
20,000 medical students and 40,000 medical residents received some of their education in VA hospitals.
recent news about tragic delays in care at VA facilities shows, there is
clearly more that needs to be done to improve health care for our
veterans. And a large part of making sure our veterans get the care
they need depends on having timely access to a physician.
Veterans of the Iraq and Afghanistan wars, along with Baby Boomer veterans, are placing challenging demands on the VA for health
care services. As National Public Radio correspondent Quil Lawrence
recently said, "Especially in the last three
years, you've seen a 50 percent... jump in (VA) primary care visits, but
only a nine percent increase in the number of physicians. That's
Iraq and Afghanistan veterans. It's also because Vietnam veterans are
hitting the age where they need a lot more medical care."
In recent media coverage,
some have begun to question whether the problems at
the VA reflect, in part, a larger, national problem: a looming physician
shortage that threatens access to care for all Americans. With the
a shortage of more than 91,000 doctors in 2020-almost
evenly divided between primary care physicians and specialists-the most
vulnerable among us, including our veterans, will feel the impact first.
Certainly as the VA faces growing challenges in meeting that demand, the
situation will only be exacerbated by a nationwide shortage of all
many years, veterans' advocates and health care professionals have
expressed strong concern about
the shortage of physicians serving veterans, the lengthening wait times
they experience, and the health risks such delays pose. In 2007, the AAMC testified to Congress that "(c)oncerns about physician
staffing at the VA come at a time when the nation faces a pending shortage of physicians." The Independent
Budget, supported by more than 50 veterans' service organizations, has said veterans' access to care is a major concern.
the specific obstacles to veterans' access to care may be, a physician
shortage is surely one of them, as several witnesses
observed at last month's Senate hearing.
VA already has
made a concerted effort to grow the numbers and improve the training and
distribution of physicians serving veterans. Between 2001 and 2012,
efforts increased the number of residency training positions at VA
facilities by nearly 1,500. The VA reports it "is the only U.S. Federal payer
that is increasing funding for physician residents (GME Enhancement Initiative)."
But the VA faces ongoing
budget pressures at a time when it also faces an increasingly
competitive market in which the shortage of physicians drives both
compensation for physicians. That's especially true for specialists
trained to treat the highly complex physical and psychological
found among injured veterans. And the growing national shortage makes
the competition even more demanding.
for more physicians, as well as new systems of care in the VA,
illustrate not only the impact of physician shortages overall, but also
shortages are not evenly distributed over time, geography, and need.
Vulnerable populations-defined by geographic location, income status, or
complexity of needs-are often the first and hardest hit by physician
the time has
come for a multi-pronged strategy to address the national shortage of
physicians-one that includes team-based care and innovative delivery
well as more physicians to provide care. Congress must do its part by lifting the federal cap
on the number of residency
training positions supported through Medicare, the nation's single
largest funder of physician training. Without these residency
positions, all new
M.D.s graduating from the nation's medical schools may soon not be able
to complete their training and begin practicing independently.
Passage of legislation to lift the cap (S.577, H.R. 1180, or H.R. 1201) would be a critical step toward solving the
national shortage of physicians.
news about tragic delays in care at the VA is disturbing on many
levels. But it also should serve as a warning about the urgent need to
increase federal support for residency training so that our veterans-and
growing, aging population-can receive the care they need when they need
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