The new VA secretary, Robert A. McDonald, speaking to a room-full of reporters, acknowledged for the first time that the department needed to hire “tens of thousands of new doctors, new nurses, new clinicians.” It is now accepted that a shortage of employees directly involved in treating patients was a main driver in the waiting-list scandal that rocked the agency this year.
The second, and equally important driver, was the artificially created benchmarks, that managers tried to satisfy in order to reap financial rewards, despite the lack of adequate clinical caregivers.
Those of us involved in real patient care already know that the doctor, nurse, pharmacist, therapist, and others directly involved in caring for patients are the cornerstone of a well-functioning health care system. Unfortunately, neither the VA nor the civilian health care systems fulfill this important criteria. Instead, most health care dollars are spent supporting salaries of administrators, managers, insurance company executives, bureaucrats and politicians, middlemen, who have somehow become the bosses of the industry.
It took Mr. McDonald, a leader from the private retail industry, to explain to the VA that you cannot care for sick people using managers and administrators. In July, the VA had more than 9,000 registered nurse vacancies and almost 4,000 physician vacancies — good luck finding all these highly-trained professionals.
What we really need, both in the VA and in civilian health care, is a real free market for health care professionals, and a drastic cutback on dollars spent on all types of middlemen: bureaucrats, administrators, executives, bean-counters, and others. Let health care dollars be used to pay those that provide the care. This is the most important lesson for the new VA secretary.
This is also the time for all health care professionals to come together like never before and reassert their rightful place, as the engines that drive health care. I call on my physician and nursing colleagues, and all other health professionals, to work together to create a patient-centric health care system, free of expensive middlemen and useless mandates. Secretary McDonald, are you willing to take on this opportunity?
Arvind Cavale is an endocrinologist who blogs at Rebel.MD.
