Not your grandfather’s (or even your father’s) Veterans Affairs

A guest column by the American Society of Anesthesiologists, exclusive to

“To care for him who shall have borne the battle and for his widow, and his orphan.”
– Abraham Lincoln

With these words, President Lincoln affirmed the government’s obligation to care for those injured during war and to provide for the families of those who perished on the battlefield. This deeply ingrained sense of obligation and duty lives on within the staff of more than 168 VA medical centers, including over 800 physician anesthesiologists and 800 nurse anesthetists. I am honored to serve veterans at VA Boston Healthcare System (VABHS) as a physician anesthesiologist.

For many years, public perception of the VA was characterized by Oliver Stone’s 1989 movie “Born on the Fourth of July.” The movie shows a VA hospital with disillusioned physicians, failing infrastructure, outdated equipment, and poor patient care. In recent years, the image of the VA was further tarnished by highly publicized concerns about delays and access to health care in VA hospitals.

My personal experience has been very different. I’ve had the privilege of working at VABHS, but have also been able to visit several VA facilities in other states. Each facility may be unique, but it is easy to observe that VA’s health care system has undergone a systematic transformation since the 1990s. VA has modernized its’ infrastructure and facilities, and implemented an electronic medical record (EMR) system in the late 1990s, which propelled VA to become a leader in health care quality, patient safety, systems redesign, and change management. As a national, fully integrated health care system, VA is responsible for a lifelong service to eligible veterans and has become a true accountable care organization with a capitative reimbursement system that rewards investments in disease prevention, best medical practices, and quality, rather than volume.

There are many benefits for physician anesthesiologists employed at VA hospitals including innovative clinical practices, outstanding research and funding opportunities, teaching residents through academic affiliations, a great work-life balance, competitive salaries, a very robust benefits package, comprehensive professional and leadership development, government malpractice insurance and of course the best patients in the world.

In recent years, VA physician anesthesiologists have significantly contributed to advances in perioperative medicine, including published best practices for the development and implementation of the Perioperative Surgical Home (PSH) model of care. Regional anesthesia and opioid-sparing modern anesthesia techniques, including enhanced recovery after surgery (ERAS) pathways, are being developed and implemented throughout the VA. Physician anesthesiologists, surgeons, nurses, administrators, and other support staff are partners and work as a team, not as competitors. This creates a stable environment which enables clinicians to do their work, rather than worry about hospital contracts and takeovers by mega-groups.

Real work gets done in our VA operating rooms (OR), non-OR locations, intensive care units, and pain clinics every day. VA offers cutting-edge opportunities to utilize our skills. Physician anesthesiologists and nurse anesthetists work in close, harmonic teams to get the job done. Disease processes in veterans are more severe than the general population, therefore, VA physician anesthesiologists require a full set of outstanding clinical skills. It never ceases to impress me how complex and challenging anesthesia care for our patient population typically is. Few cases are straightforward, but this is the original reason why I went into medicine. I want to make a difference for patients. At the VA I do so every day.  Here just a few notable patients from the recent past:

  • A veteran of the Korean War was with a massive abdominal aortic aneurysm (AAA) and tight aortic stenosis (AS). Following a meeting between the cardiac surgeons, cardiologist, cardiac physician anesthesiologist, and vascular surgeon, it was the physician anesthesiologist who made the final decision whether to fix the AAA or the AS first.
  • A veteran of Operation Enduring Freedom developed serotonin syndrome after a urology procedure requiring methylene blue.
  • A Vietnam War veteran with a 100 percent service-connected disability due to Agent Orange exposure recovering from a heroin addiction wanted an opioid-free anesthetic for exploratory laparotomy.
  • A patient with extremely low lung capacity was discharged two days after open colectomy following our colorectal ERAS protocol.
  • A patient who had a traumatic limb amputation in Iraq was treated in our pain clinic and is now able to stay off opioids with periodic injections and acupuncture.
  • Perhaps most moving to me was treating a 94-year-old veteran of WWII, who was patiently sitting in the emergency department (ED) waiting his turn. I met him after an urgent intubation in the ED. He told me his story of D-Day, parachuting behind enemy lines, getting into friendly fire by the French resistance, fighting his way back to the beaches of Normandy. When I thanked him for his service, he thanked me for mine. I can honestly say there are few things as rewarding to a physician than the appreciation of a WWII hero.

The modernization of the VA continues as public focus makes us seek better care and higher value for our patients. VA is implementing a national network of medical and surgical homes, has adopted the concept of patient-centered care, and has begun the deployment of telemedicine to render care more conveniently. Grassroots-based efforts help us with the process of systems redesign, patient safety, efficiency, and employee satisfaction. This is not your grandfather’s VA, or even your father’s. The VA today is a constantly modernizing, innovative health care system.

Writing an article about the VA from my office in Boston, I am reminded of a quote by President John F. Kennedy: “As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them.” His words still resonate today – to guide generations to step up and serve our country and those who defended it. Please come and join us. Today’s VA is truly the best place to work.

Kay Leissner is an anesthesiologist.

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