i hear what you’re saying, and I don’t mean to damn to whole system. However, I do believe that the money spent on the VA woule be better spent, e.g., on giving all vets private health insurance that they can use to choose a private physician, obtain emergency care, etc., just like any other job. Of course, I realize that fighting over in iraq ISN’T like another job. But being in the military IS a job, and is voluntary. The system we have now definitely has elements of waste, costs taxpayers a fortune, and I would think it’d be a hell of a lot cheaper to give everyone aetna, or oxford, or whomever bids the lowest to the gov’t.

And as far as TBI centers, I think all vets who suffer a TBI deserve the best of treatment, which no matter how much money is thrown at the VA system, they’d be better off at NY-Presbyterian or another large academic center.

And you said “With my three years …(a reason they took the job at afraction of pay of private practice docs)”

Are you kidding? the primary care attendings at the VA make well into six figures, and have the most amazing expensive benefits for LIFE. This isn’t too different from a community pcp, without all the hassles / call / managed care / etc.

Just ask yourself this – If your brother were military and also had commercial insurance, and got injured, would you want him treated at a VA or by the same facility that treats your RICHEST patients?

Our vets deserve the best possible care, and if that means dismantling the VA system & saving taxpayers money at the same time, i’m all for it!

The issue of lack of accountability is an issue and was addressed by the writer. A question, do you think a “brief stint” in the hem/onc clinic really qualifies you to damn the whole system? I spent three years in training there and I don’t claim to know the system completely. With my three years of experience I do know that many attendings have research days (a reason they took the job at a
fraction of pay of private practice docs). Perhaps that is where the other docs went. Also, as a fellow/resident I regularly saw consults without the attending (at least initally). I agree with you there needs to be accountability/incentives for the staff. It is time to clear dead wood from the VA. However, your statement about cutting funds from the VA shows a gross lack of knowledge as to what is going on the the system right now. Over a
hundred of thousand vets are coming back to the states evey year. Many, whom will use VA services. Many whom have been severely wounded (though their lives saved thanks to our excellent emergency care, moreso than in previous wars). The VA needs increased funding for these vets not decreased. There are only 4 TBI (traumatic brain injury) centers in the VA now. Given the number of vets coming back with IED-caused head injuries you propose to decrease funding? (actually plans are to increase the number of centers). I think you need to think this through happy. I don’t argue that VA money should be better spent and staff should be more accountable. But if you think that this will make the needed money magically appear…you are deluding yourself.
PS: For every lazy doc/RN I saw at the VA (and there are plenty) I saw one that worked every bit as I do in private practice.

It was created to provide the large contingent of veterans of the world wars with a basis for a continued sense of dependency on and gratitude towards the federal government and thereby guarantee the founding congressmen job security.

It was phenomenally successful in, together with the rest of the entitlement complex, creating an institutional congress with remarkable job security–so much that the re-election rates were higher than in the single party soviet union!

Inefficiency actually contributes to the real goal. 3 lazy ineffective deadbeats on the payroll who don’t deserve to be gains the appreciation of them and the relatives whose hands they are now off. Getting the job of those three done by one competent person with a work ethic provides no poltical benefit from the “jobs for my district” point of view as that person is earning their keep and can do so elsewhere and knows it (no gratitude!).

“Most of the issues right now relate to the fact that the system is overloaded and not adequately funded (and it is not using it’s funds effectively at times. ie. employee accountability and expectation of excellence).”

During my brief stint at a VA’s hematology-oncology division, on any given day:

1- half of the office staff (including attending physicians) were out

2- new consults were not seen by the attending

3- 20% of staff could be found after 4pm (3pm on fridays)

4- a full one-quarter of patients seen in the outpatient clinics were there just to pick up meds prescribed by their private md(since the oncology drugs, being expensive, are picked up by the taxpayers even though these guys have commercial health benefits)

I would say it’s not an issue of underfunding, but rather OVERfunding of benefits for a lazy workforce, with no performance incentive whatsoever.

As far as the posts about errors at the VA, so true!!! As someone wise once said:

“There’s no such thing as sick patients, only sick charts!!!”

- HOLY Cow! And I thought my experience with lazy mental health “professionals” and bureaucrats were bad enough…
-almost got caught holding the ‘hot potato’ of a patient who killed herself as psychiatry continued to turf her to primary care; ‘good thing’ she shot herself after she was just discharged from their 7 day program [of what, i don't know]

-at least I did not get PCN lost in pharmacy transcription to prednisone; i did get vehement, angry denials from a chief of pharmacy about errors…until showed him how a veteran brought me meds mailed to him for diabetes when he did not have even traces of it; but still no apologies, but scorn!

Reminds me of the line “Are you going to believe your lying eyes or what I tell you?”

I have never found a cold dead patient with fresh vital signs charted anywhere but the VA. I have never known a patient on 1:1 suicide precautions to hang themselves while the unit staff held a fish fry anywhere but at the VA. I have never had one of my patients ge 3 weeks of IV prednisone when they were supposed to get IV penicillin anywhere but at the VA. Yes, these things could happen anywhere. But they didn’t happen anywhere. In 25 years in medicine, they only happened in the few months that I was at the VA. Do I believe their stats or my “lying eyes”.

You need to keep in perspective that the viewpoint of harried residents during inpatient training rotations does not reflect the totality of VA care. Most VA care is now outpatient based.

When I worked for the VA, I could generally always get my patient a specialty referral, though not always as soon as we wanted. Just as in the private sector, it was a matter of taking the time to establish professional relationships with colleagues and calling them personally – without abusing it (not everyone needs their stress test TODAY).

Now, in the private sector, if a patient is uninsured, I know that they may NEVER be able to see any specialists, unless they are having a crisis situation, drive to a larger city tertiary care ER and are admitted.

They also will not be able to afford many of the medications that may help. As an internist, the VA at least made my job easier by knowing that patients could get their medications. And, the emphasis on tried and true generics (and pill splitting) has been invaluable for me in trying to prescribe lower cost alternatives for my patients.

I do agree, though, about the top-heavy bureaucracy using too many resources that should be going to patient care.

Fully agree with the title “The VA exaggerates its achievement” – just be on at least one VA around [i mean at least 6 mos] a JCAHO visit, you will observe the enormous efforts exerted to windowdress the site and sights…

Although the VA is in existence for >75 yrs, it just might implode on itself yet. It would have taken this long because of a few astute veterans who got themselves entrenched in the heirarchy, they are able to skim the cream of VA care to their advantage; for others, unfortunately they are “overqualified” for VA care – not having worn the uniform, or got so rich wearing the uniform, they are on the elite tricare tracts…
Fortunately or not, if a single payer system patterned after the VA becomes reality, it might take just as long, longer or not before it implodes; hopefully the VA implodes first before this becomes a pattern…
The only real redeeming value to the VA is the EMR [CPRS - not VISTA that they want to share ware, after abandoning it - what's up with that?]; but then again, the OIG still found how the clever window dressers manipulated it to their advantage…