The Doctors Are In… Or Are They? Why VA Cannot Hire Enough Physicians
If you have been to VA for a checkup, surgery, or really any medical concern in your life, you have probably suspected that there were not enough people around to help you, especially at the top. Where is your doctor? Why are there so many patients for such a scant handful of medical professionals?
The endless waiting, the inattentive nature of the staff. Perhaps you have needed to debrief your physician about your medical history when they should already have had it, but of course, you have not seen the same VA physician twice.
You should know, it is not only your suspicion. The VA has trouble hiring enough doctors in the first place, but also has trouble retaining the ones they have, which worsens the problem. The VA has over 33,000 total staff vacancies at present, 90 percent of those in health services.
Over 1,600 of these vacancies must be filled by doctors. That amounts to 32 doctors per U.S. state.
But why, you might ask? What is so hard about making sure American veterans have a good doctor?
Like many issues that plague the VA healthcare system, this one is linked to underfunding. Working for VA as a licensed physician does not pay the kind of money that licensed physicians are content to earn.
Medicine is supposed to be high-paying… especially in light of how indebted most medical students are when they graduate. The shortage of physicians causes enormous workloads, which in turn prompts fewer people to pursue medicine and perpetuates the shortage. So we had better make being a doctor worth the hassle.
Private hospitals have this issue to some degree as well, but when funding enters the mix in such a big way, you know VA will struggle. Even highly skilled specialists can easily find jobs that pay almost twice as much as the VA is offering, if they choose to prioritize the money.
For example, a VA hospital chief cardiac surgeon making $395,000 a year recently left his VA location for a private hospital in the same town that could pay him $700,000 a year instead.
Doctors who have not practiced medicine for as long and/or do not have a specialized area of practice do not make as much as this; nobody is saying that every doctor needs $700,000 a year. This example is a specialist in a high-stakes field of surgery who also holds a leadership role.
But ask yourself this: if VA cannot retain someone as important to patient outcomes as that, what is their hope for retaining young doctors? How can they offer a first-year practitioner the career support needed to achieve a residency? What kind of doctor honestly looks forward to a future with VA?
VA is also dealing with management issues; they consistently underestimate how many physicians are needed. When doctors work with VA on a contract basis, that paperwork gets lost in the shuffle. How many contractor physicians are working with VA right now? Literally, no one knows.
Oversights like that can throw off a hospital’s estimated recruitment needs, and once again, poor retention only widens the gulf.
Peter Shelby, former assistant secretary of the VA Office of Human Resources and Administration, tried to publicize VA’s poor retention in a more “positive” light. It is doubtful that his tactics went over well, however, as he has since left VA under mysterious circumstances.
“The scope and scale make vacancy numbers often quoted in the media seem very high,” he has said. “Taken in context, VA’s vacancy and turnover rates are very low.” I might not be reading this correctly, I suppose… is 32 doctors per U.S. state somehow a low number?
“We fluctuate between 9 and 10 percent, which compares very favorably with the private sector.” But does it, though? Was Shelby honestly trying to sell us on this idea?
Sure, it sounds acceptable that nine or ten percent of the VA’s workforce is in turnover. But a lot of those workers are headed toward the private sector and out of VA’s calculations altogether.
When a private-sector healthcare professional is between jobs, they typically intend to return to the healthcare private sector in some capacity. Departing VA doctors, on the other hand, are not coming back to that pool.
How much turnover in VA is acceptable? Obviously, it will never be zero, but we have seen that the VA’s “nine or ten percent” is not the private sector’s “nine or ten percent.” We need to insist to people in power that the raw numbers a) are bad and b) do not tell the full story.
As always, let us know your thoughts in the comments, especially if you work in healthcare.
Thanks to T’s post above, I was reminded to look at Dr.Elaina George’s blog and I found this topical piece: “https://drelainageorge.com/the-doctor-shortage-fact-or-fiction/”.
“The Doctor Shortage: Fact or Fiction
The Association of American Medical Colleges in a recent study has projected that there will be a doctor shortage between 42,000 and 120,300 by 2030. This is a stunning number when you break down the fact that the shortage will affect primary care doctors (14,800 – 49,300); specialists (33,800 – 72,700); and surgical sub specialists (20,700 – 30,500). The looming crisis is magnified by the fact that increasing demand from a both a growing and an aging population must be considered.
How did we get to this point? Perhaps it is because Congress passed The Balanced Budget Act of 1997 which limited the number of residency positions in the US. Because of this, there are doctors who graduate from medical school each year, who cannot be licensed to practice medicine because they cannot find a residency. Physicians must complete at least one year of residency to be eligible to practice medicine. Instead of taking care of patients in underserved communities, these doctors are unnecessarily sidelined.
The solution to the problem has been a movement towards changing the healthcare workforce. The delivery of healthcare has morphed into a team approach where nurses and physician assistants and now artificial intelligence have become the drivers in the belief that each member of the healthcare system is interchangeable. However, is this belief based on fact or convenience?
In the haste to control costs and expand access, basic questions have been virtually ignored: Are physicians really interchangeable? Will patient care be affected by the absence of the physician? Will moving towards virtual medicine (such as telemedicine) and precision medicine based in population, artificial intelligence and algorithms work for the individual patient? Will using allied health professionals with a different scope of training lead to better outcomes for a patient with a complicated medical problem?
People may not realize that a physician’s training is unique. Over the course of 4 years of undergraduate education, 4 years of medical school, depending on the specialty 2-10 years of post graduate training (residency), and the practice of medicine, thousands of hours of training create a fund of knowledge that is invaluable in teaching a physician to see the patient as more than a collection of symptoms. To think outside of the box and to individualize patient care.
Time will tell, but the answers are becoming clearer. In the attempt to ‘fix’ the problem there has been a doubling down on the very things that are at the heart of it. There continues to be a steady increase in healthcare costs, patients are waiting longer to seek healthcare, and access to healthcare has decreased especially in rural areas. Whether you want a single payer system or free market medicine it won’t fix the current system which is controlled and manipulated by forces that thrive on lack. In order to control resources monopolies run by Big Pharma, pharmacy benefit management (PBMs) companies (a third party that ‘negotiates’ drug prices for pharmacies, drug manufacturers and insurance companies which makes approximately 300 billion in revenues each year); corporate hospitals, which have on average a 16:1 ratio of administrators to physicians; and commercial insurance companies which have increasingly shifted healthcare costs to its members in out-of-pocket expenses have integrated themselves into the healthcare system.”
Can’t speak for every MSN (nor every VA Hospital) but what I have been told candidly by the doctors that come and go in my area is that the directors and admin staff that often get paid more than the doctors (even though they are not even required to have anything more than a HS diploma) they get in the way of the doctors giving veterans the best possible treatment, because the administration tells the doctor what they can & can’t do. The doctors get tired of not being able to treat veterans with the best care of their training and judgment, not the pay.
I was a combat medic and when I got out worked for the VA for a year. I really liked working with vets and treated them the way I would someone in my family. VA management is what drives away many good docs, PAs and NPs. It’s why I left. It’s not only money that drives folks away but dealing with uncaring and stupid upper management is a huge problem. Ask any resident physician who has rotated through a VA what they think and you’ll hear most say the same thing I just did.
Seven Hundred thousand after taxes, paying for staff, equipment, office overhead, lease or mortgage, MP insurance, that VA pay is looking extremely attractive. As well, I wouldn’t have to do much. Thanks for the info guys. See ya soon.
It’s always based about budgetary constraints. So why is there such lack of concern over the $ TRILLIONS $ being stashed, hoarded and down right stolen from the American Tax Payer. Just recently there was talk of $2.x TRILLION of Social Security being found and being voted on to be put up for grabs or not, the VA being given $ Billions $ of money not earmarked for anything. And what about the banks being “Bailed In” to the tune of $ 85 Billion Per MONTH INDEFFINITLY under a program called Quantitative Easing, that germinated under the W. Bush regime. That my friend is $ 1.2 Trillion $ per year, indefinitely; and for what?
Remember the uproar when Obamacare was being forecast as potentially costing a $ Trillion $ over a 10 year period?
And why, every time we would like our travel reimbursement do we have to jump through hoops,? Wouldn’t that be understood without all the hoop jumping, which as a SC100%er, because the pain afflicts me all day every day and has been for nearly 50 years, it is as if I am still serving in the military every day any way. And yet I am not qualified to fly Space-A.
As a DRAFTED, accomplished and decorated 100% SC disabled and thereafter enlightened, Conscientious Objecting Veteran, I always wondered at the question, “Do you have any problems with killing or being killed?”
Just remember, For every Dollar Paid is another bullet made!
Remember, All Gave Some and Some Gave All, but let us not forget Those Who Cannot Stop Giving.
Jes Askin
Use active duty personnel for hospital admin and staff- and hold Admin and Staff accountable under the UMCJ. Start with Dereliction of Duty charges for current and past Operations. VA Heads and Dept Heads could be awarded Bouncing Bettys. Not fully kidding, the way the VA has been handle often amounts to Treason.
Black Veteran Murdered by Police over bogus misdemeanor warrant.
Body Cam Footage At: “https://www.theadvocate.com/video/player/?video_id=31199″
A forensic pathologist hired by the parish had said in a report that manual strangulation was the primary cause of Frank’s death. The video shows Spillman mount the tractor behind Frank and apply a choke hold while another officer tries to pull him down. For a time, Frank is doubled-over while resisting. Officers had to carry Frank to a patrol car after his body went limp.
Gilbertson said Frank’s questions as to what he was being arrested for, and who signed the warrant, were reasonable.
“There’s no exigent circumstance here,” Gilbertson said Thursday. “He’s not attempting to flee, he’s not assaulting anybody, he’s sitting on a tractor and he’s asking reasonable questions they are refusing to answer.”
The hold that Spillman used, known as a lateral vascular neck restraint, is typically a last resort, given the potential to restrict airflow, Gilbertson said.”
Full Article At: “https://www.theadvocate.com/acadiana/news/crime_police/article_4489ee48-95f3-11e8-b9f2-c3f1746e0adc.html”
Military update: VA rips ‘Blue Water’ Agent Orange bill, urges Senate to sink it
Tom Philpott, Pensacola news journal, Published 3:00 p.m. CT Aug. 4, 2018
“Department of Veterans Affairs officials say they strongly oppose passage of the Blue Water Navy Vietnam Veterans Act (HR 299), which would extend Agent Orange disability benefits and health care to between 70,000 and 90,000 veterans who served aboard ships in territorial waters off Vietnam during the war, and today suffer ailments associated with herbicides sprayed across its jungles for years.
The Blue Water Navy bill passed the House unanimously in late June and seemed certain to fly through the Senate, given reports of close coordination on the bill between veterans’ affairs committees, and the House having negotiated a plan to pay for the benefits with major veteran service organizations.
On Wednesday, however, with Robert Wilkie installed two days earlier as VA secretary, his undersecretary for benefits, Paul R. Lawrence, delivered a blistering attack on the Blue Water Navy bill, and on a proposal to test providing routine dental care to veterans, during a Senate Veterans Affairs Committee hearing.”
Full Article about the Stabbing Veterans in the back at: “https://www.pnj.com/story/news/2018/08/04/va-rips-blue-water-agent-orange-bill-urges-senate-sink/889367002/”
“VA officer’s Facebook post causes concern”
By Andrew Caplan, The Gainesville Sun, 8/4/2018
“A federal law enforcement officer with the U.S. Department of Veterans Affairs posted what some considered a threatening image on social media directed at a Newberry resident who called for Newberry Commissioner Rick Coleman’s resignation.
The officer, Gary Boothby, a former Alachua County Sheriff’s Office deputy, posted the image on Facebook around 1:20 p.m. Thursday, defending Coleman.”
“The image posted shows a soldier falling to the side while shooting a handgun. The text on the image states, “Beware of an old man … in a profession where men usually die young.””
Full Article At: “https://www.gainesville.com/news/20180804/va-officers-facebook-post-causes-concern”
@Rosie,
You are correct on that. When I first started going to the VA that’s exactly what happened to me. Good Lord!
To the good docs and nurses of the VA out there…I love you people and thank the good Lord above for you. I get thanked for my serveses but when I went for my colonoscopy recently I thanked all the nurses and drs for theirs cause they deserve it. You folks should be getting better pay for what you do. It’s the higher ups who are causing all the problems at the VA.
@ Jeff,
If you are being seen at a big city, university connected VHA facility, then seeing the same STUDENT doctor more than once is rather remarkable! Even in primary, that student doctor is also training in taking patient history and you may never see the instructor you’ve been assigned to that oversees that clinic in order receive an accomplished Doctor’s diagnosis.
Also, many times a Dr./NP/PA is just filling a spot in primary for a while as they wait for their desired spot to open up for them.
I had a resident who was so impressive the first time I saw him; didn’t have to regurgitate 20 yr med history, he read my medical record before seeing me. Yay! No doctor these days does that. He said that he would finish residency in few months and when I found out he was going to the VA where I got specialty care, I told him “you will be my doctor, I’m selecting you”. I did and receive great care from him and he listens and include me in treatment plans.
@ Patricia,
I am pleased that you are among those that, in their experience, are content with the care recieved through a VHA facility. You have brought up a few interesting points to this thread that I should address. Keep in mind that I did read your earlier post stating you have and use outside insurance. You also said you get specialty care at VHA and did not mention whether that is where you get your primary care; that is an important point for this topic. Additionally, if you have a spousal benefit for VHA healthcare, then you ultimately have a far different perspective than the SC veterans that post their experiences here.
Intentional or not, VHA is extremely segregated in how it delivers care to those allowed to to utilize what it offers. That is an accurate statement, because there are eight groups (and possibly undisclosed subgroups), into which veterans are identified for the care given, or withheld. Yes, withheld. Tricare patients are treated in a different universe care-wise, even among the same providers of that care.
If you really read through the posts to Ben’s site over the years, it becomes very clear that the SC veterans getting care within VHA facilities are getting the short-shrift in many, many ways to circumvent any diagnosis for which proper care should have been given for years prior. There is no valid excuse to keeping a SC veteran to suffer for years with a very treatable condition that no one at a VHA facility will properly diagnose; Ben’s pages are full of a variety of those examples. VHA is constantly shoving cancer screenings at all of its veteran patients. Personally, I don’t know of one SC veteran, seen only at VHA facilities, without Tricare or outside insurance, that has been given their cancer diagnosis prior to stage-4; not one! NOT EVEN ONE! Please, think on that. Without outside insurance to bill, I guarantee VHA is not going to spend tens of thousands of dollars to save a SC veteran’s life; we just aren’t worth saving to them! The only possible exception would be if a university connected VHA facility has a team experimenting with a new drug or a new proceedure and they are needing human guniea pigs for federal approvals.
Also, it’s very important here, you said you were given proper treatment by a resident outside of the VHA. The residents and all practitioners at VHA facilities have a different set of proceedures to follow in treating SC veterans than those same patients that avoid VHA care or have other insurance to bill. As Taz pointed out above and in prior posts to Ben’s site, there are obvious constraints put upon VHA practitioners to, in my words, save money and screw the best care for the patient, or get black-balled.
Another point you made that raises my eyebrow, is your ability to select your physician at a VHA facility. There has to be unmentioned circumstances that intervened, because I am unaware of any SC veteran ever being granted a choice in providers at any VHA facility, just because they asked; in fact, the opposite is normal operating proceedure.
American healthcare outside of the VHA is by no means the the holy grail of perfection by any means either. It’s all a crapshoot with every entity doing whatever it wants to whomever it chooses, as is also attested to by some of Ben’s posters, and widely reported on news programming.
Benjamin, the difficulty in retaining physicians is multifactorial, as one would expect. I am a vet who is an emergency physician(EP). I worked for the VA for 4 years until the per diem pool closed and I was no longer needed. In that 4 years I never had one patient complaint. On the contrary, I would be thanked profusely; some vets would ask if I had a private practice(EP’s do not). I’ve been practicing 23 years and have a stellar record. Vets know…they know the difference between good and bad care. They tend to be very suspicious and cautious initially; however, once they are convinced of one’s sincerity, they trust. Contrary to much of the sentiment here, most of us who work for the VA do so because we really care about the vets–we are advocates. By being a patient advocate, we have to wrap our minds around the fact that we may lose our job. Can’t please the patients and the administration simultaneously. We get blamed for a lot of what is bad in the VA because we represent the face of medicine. What the vets do not see are the administrators and clipboard cops by whom we get badgered and receive no support. Try to speak up about the policies that don’t work, sub-standard conditions, mismanagement of veterans, etc. and make no mistake, it is just a matter of time before you are unemployed. And they will not provide you with a good reference. Therefore, docs keep their mouths shut and practice the status quo. Like most human beings, they have to work and make a living, so they keep their heads down and don’t make waves. If you recall the scandal regarding the famous “lists”, you will remember that issue was exposed by a long time physician of the VA. He followed the internal process to address the problem to no avail. Recognizing that pushing the issue would result in him losing his job and his pension, he became mum. The day after his retirement, he blew the whistle. I just want the vets and the public to understand, that there are many more like him. They just cannot do what he did and lose their livelihood. VA docs are employees, we do not run the show.
No physician ever became independently wealthy being employed by the VA. It isn’t always about money. Many leave for the reasons I mentioned above, which has nothing to do with money. But even if it were, so what? There is a lot of resentment by the public who think physicians make too much. I think that is wrong. The example of the cardiac surgeon leaving the VA and making twice the amount of money is accurate. One of the commenters above thinks that is ridiculous. It isn’t so ridiculous when one realizes that the cardiac surgeon spent 11-12 years POST COLLEGE to practice in that specialty. Add to that skyrocketing malpractice insurance, potentially owing $300,000 of medical school debt, ongoing fees(which are excessive) to maintain not only his medical license, but his board certifications in Surgery and Cardiac surgery, continuing medical education, undergraduate debt, college funds for his children, etc. It never ceases to amaze me that the public has no problem with athletes and entertainers making millions while a physician, making thousands but who can save you or your someone in your family’s life incurs such vitriol—as if he should be ashamed. We took a Hippocratic Oath, not an oath of poverty. That would be Mother Teresa. No one has the right to determine what is the appropriate income for another unless you have walked in their shoes.
It is important to note that physicians and nurse practitioners ARE NOT the same nor do we practice similarly. If we did, the degrees, training and licenses would be the same–they are not. Nurses are monitored by the nursing board and physicians by the medical board. Two completely different boards. Apples and oranges. However, the two fields complement each other. The VA decided to make NP’s independent because of the shortage. This despite their own metanalysis. That metanalysis, which was published in September 2014, could not conclude that patient care outcomes were similar between NP’s and physicians because the studies used in the review were poorly done. Bottom line, there was no proof that NP’s and physicians were equivalent in their practice or patient health care outcomes. VA allowed NP’s to practice independently anyway because…well, somebody has to take care of the vets. Even if it is not a physician. Something is better than nothing.
The example given by another commenter about about the similar pay has absolutely nothing to do with similar skills. It has everything to do with the devaluing of medical education and physicians in this country. Primary care physicians(ie: Internal Medicine, Family Medicine, Pediatrics) are the lowest paid medical specialties. Ironic since they have to know a tremendous amount about the human body, all of its systems and how those systems inter-relate and cause disease. Because the human body is complex it stands to reason that medicine will also be complex. It is not an exact science–everyone does not fit into a box. Therein lies the reason medical training is long and arduous; it’s supposed to be when a life depends on it. Nursing is algorithmic, medicine is deduction. Unfortunately the corporatization of medicine has effectively reduced the importance and meaning of medical education in an effort to promote those who are less qualified and have less training as being equitable to a physician. Because they are cheaper to hire. I ask you to use common sense. Since when has lesser of anything been the same or better? Since when has cheaper been better? If it doesn’t make sense, don’t believe the hype. You get what you pay for.
I too find it odd that the society that we live in would value a sports player above your profession
Taz. Many good things have been written. Allow my fifty cents worth that’s meaningless. Multifactorial is putting it medically and nicely enough. I call the entire American experiment FUBAR. A lot of it intentional and to protect the deeply seated and protected professional establishments and government. That said I have worn many hats and been played “advocate.” Cost me or prevented me from nice employment and positions. I know what being an advocate is and can recognize it easily. I haven’t seen much of it in action anywhere like with representation.
I have thanked and praised several at the VA in previous years and all I got back was blank stares if acknowledged at all.
For one I have seen admin types and new clinic heads walk around with those clip-boards and peaking in my exam room to see what was happening in some clinic. Lost a good MD because of it. Some new clinic head that looked like he just finished schooling saw an older female MD helping me out of a chair, one arm hug to steady me and ask if I was okay and well enough to drive home. That by his calling was ‘inappropriate physical contact.” So I got bounced to a new fresh out of school specialty clinic MD… young young female. With the personality and bed-side mannerism akin to a silent pet rock. Yeah I know that end of things too. Also seen the goofy battles and fits between “professionals” and various year med students and their narcissism or bloated ego or something that supposedly forbids a younger year student from asking a 7 or 8 year student questions about something. Or the soon to be graduating MD pissed off because someone hadn’t called them “Doctor” yet. I’ve seen a lot. I pay attention to my surroundings. This is in the VA, basement, hallways, stairwells, elevators, parking lots to restaurants… and smoke areas. However you are correct that medical staff do not run the show but have to obey orders or directives from the notorious and evil “top.” So what happened to medical boards (corrupted) and entire communities seemingly and health care people who all take part in ushering in VA and health care staff retaliation along to the point we can’t find care???? Holy shit it seems like one big connected network of cover-up, silent treatments and black balling. Who then has the power to change it all??? How many vets died due to some staff’s silence? I digress, I know all about the silent majority and covering ones own ass.
I also didn’t see those clip-board freaks or department head present or around when games were being played with us or there when the unions would collaborate to call in sick on the same days to create massive intentional shortages in multiple clinics. I DID see them poking around when decent enough MDs after some internal VA meeting turned into rattlesnakes being the total opposite of what they were previously for years.
Hippocratic Oath? I haven’t seen many professionals of any sort keep to their “oaths.” We could debate that even over the phony claims that “first do no harm” doesn’t exist or is part of that particular ‘oath.’ Plenty of harm has been done and is. Ruining lives with bankruptcy or withholding meds ruins lives. Kinda like those phony posters for unenforceable meaningless ‘Patient rights and responsibilities.” Too many things changed through the generations or ages. I have experienced locally or VA being one single law or HIPPA violation to the Disability Act of 1970 be enforced or anyone will to take on the VA or local medical black-balling community over any of it. When the VA, community, civilian care, medical boards, other MDs are in protection and covering up mode…. hang it up. Those oaths, ethics, decency, morals are thrown out the freaking window… for life. Some of those at the AMA, in DC, highly paid academic country club types should walk a mile in my shoes too.
OT Commercial:
Oh groovy. Trumpster and the U.S. just gave Israel 8.5 billion… with a B in defense funds. Ain’t that nice readers? Our shadow government needs mo money. The lying sacred cows and phony allies get while vets and tax serfs just get shit and corruption… censoring too. Oh those poor warmongers. Check me on correct amount but the Pentagon and others seem more worried about spending their black budgets on evil and foreigners rather on Americans or vets.
Back to more big money. How is it okay for medical care to drive millions into bankruptcy for care? Or care or treatments only the elite, Congress, the wealthy, and others can attain? It’s the big circle of the money game and no-one wants to fix that either. It’s okay for some to suffer and die while some get high grade care or put on organ lists being #1. High paying unions think all others can afford their rates while driving some costs sky high, make sense? Five days in a Eskenazi ICU is over one million dollars???? A write off if they can’t collect? The wrongs and non-sense is endless. But there is big bucks to be made by many just over medical bankruptcies, big bucks. I have met many that died or would rather die than be ruined by modern health care and costs that ruined their lives and their kids lives. Two sides of the coin. Die or pay or die or go back to the VA to be killed must be the only choices. Some choices in the land of free home of the brave. Cough cough. It’s all about power, control, money, force, and all the possibles.. for those at the “top.” Or carry a higher social status above us serfs, peasants, pawns, lab rats who get no pay in return for allowing others to “practice” their medicine on us or refuse it full circle. Or maybe to “protect us from ourselves.”
I am also not of the public mind-set, a big fan, or think that some scum bucket sports jock, racer, Hollywood freak, etc., should get the amount of pay and perks they do. Especially when very few of them care about our land and veterans. But that’s not being PC and not the way of our world. Distractions and games come first over all other things that should be higher priority. Not going to change in this Earth’s age.
You hit on the major point of we have to see somebody. But as someone posted how do we get care when we waste time with the revolving doors of PCPs or those who claim “don’t have the time to read our files?”
With each revolving door PCP regardless of what label they carry we have to keep wasting time repeating the same old shit and complaints that should be in our files and well and easily found on a pc. Or some NP or PA or stand-in of unknown labeling refuses to follow what a specialty clinic MD gave orders to do and meds to take?? Or as our files get messed with or deleted, lost, we have to play the same game over and over. if we happen to forget some issue or complaint while dealing with several specialty clinics, or forget about some test to come later on, on top of all the other BS, then some temp PCP finds it on their computer then we must be lying about something, not being totally upfront with them, or for not mentioning a upcoming test or clinic visit months away. There is no winning with any of it VA or not.
Or see a once NP or PA that lost their position to become shortly later some kind of pill pusher only position, or again some unknown label or techy person, and can’t discuss medical issues with us like in the past, and no reason given for that poor quality care or removal from such positions. But they can push head dope, play games, tell us to do as requested or be flagged as “non-compliant” or some such nonsense and play psychiatrist now, or back then rather? Playing intimidation staffer? Guess they are still playing the game.
Wait for the big grand change to come to fill America’s needs and the VA. Foreigners, the Visas, more false advertisements and papers from unknown lands. No speaka da English. That hate Americans but love the money and positions. The fudging of grades from GEDs up to get some poor oppressed peoples out of the big city, poverty, to jobs in hospitals as MDs or brain surgeons to fill some stupid agenda. Lower it all, make the smarter stupid, raise up the idiots/militants/activist so everybody can practice some kind of medicine and claim they made it on their own and ethically. I sure as hell don’t want lower IQ types/militants of any kind to cut on me or do dosage math on their own without some activist or enabler of the ignorant, the grade point fudgers, token glass ceiling breakers and unconcerned around me. The higher better qualified and actually/really educated not having their grade points and such fudged or fixed have done me harm. Don’t need any more bottom of the class or ‘just because society owes me’ types to do more damage.
Bottom line is this country is screwed up beyond repair and so is the VA and all health care I’ve discovered and discovered it well. Corruption abounds and so does all the fraud and attacks.
T,
I’m truly sorry your experiences have been so negative; I understand why you have the view you do. I don’t pretend to be a savior, I can only do what I can do in my corner of the world. I’ve paid a huge price by being a patient advocate. I cannot emphasize enough how difficult it is for a physician to speak up and out for patients in a medical facility, be it in the VA, military or civilian sector. You will be labeled a “disruptive” physician. Your privileges get compromised. You get sent to sham peer reviews who state that you are a problem physician, despite the fact that you may have no complaints other than the leadership who labeled you a disruptive physician. Once a doc has his privileges placed on probation, suspended or revoked, his name is sent to the National Practitioner Data Bank(NPDB). No doc wants their name in that entity, makes it hard to find a job. The Bank is also where the names of physicians who have committed gross negligence, crimes, etc. are sent. Every time I speak up, I have to make sure all my i’s are dotted and my p’s are crossed. My work has to be above board and above reproach. In 23 years, I have only had two medical directors who I found completely supportive. The rest have deserted me or thrown me under the bus. I’ve had financial difficulties. Takes 3-4 months average for a doc to begin a new job when terminated. I always have to make sure I have at least two jobs at all times. Being a patient advocate is not easy and I see why a lot of physicians cannot afford to take the risk. That’s a lot to ask of anyone. No one took an oath to be unemployed. But I want you to understand that some of us have the kind of ethics that we would rather lose a job than hurt or compromise a patient. I belong to a patient/physician advocacy organization that only formed last year. Our group is made up of over 8000 physicians of various specialties, we are growing every day as more and more of us become fed up with the status quo. Several of our members are active duty military and several of us are vets. This subset is in the process of strategizing a way to approach the VA and military to improve the care provided to our soldiers/vets. But we have to ensure that our colleagues in these institutions are protected when they speak up to make change. Right now, they are not. Physicians do not have unions. Everyone else does. We see the deficits. We see the harm being done. We see the apathy. And we aim to change it. Sometimes you just cannot depend on the government. You have to do it from a grass roots perspective and we are. But we need you to not give up in the meantime. You have to be your own advocate, no matter how frustrating or tiring it may be. We get tired too. We rest, then we continue to fight. For you. All I can ask you to do is hang in there. We’re coming.
Taz, thanks for your time and the reply, sorry for my late reply. I gotta do what my body allows me to do at times. If I try to catch up doing something else then takes away from my other to-do list.
I don’t mean to hit everyone or everything with a broad brush but they also have to try to read between the lines and try to understand what some other people deal with or deal with as individuals, different towns or different states. Locally all I see and get is the same ol same ole. Having a long track record of dealing with vast amounts of corruption. That is why I went public knowing I’d catch threats and flak, open to the dangers to show others how bad it can be for others in certain areas of the nation and how lame our government, the VA, all the connections, or over-lords to media are. Behind all the facade how bad Indiana and college towns here actually is. Also why I get thrilled to hear there are still people like you out there somewhere. I don’t get ‘thrilled,’ shocked or surprised easily.
It’s also good to hear groups are formed. Beware of traitors and rats. No such thing or group would last long around here. Too much corruption and in high places. Think I’ve shown that too. I can’t simply get med files from a local civvy clinic or the major hospital it’s attacking too??? And not one person in any agency, gubbermint, media, VSOs, etc., care but support it all? Tells the story obviously. Layers upon layers of it. At least from the VA we get some kind of files. Also why I try to pass along info like with Dr. Elaina George and her break from the corporate medical system. “Big Medicine” is her book. If I can’t get anything done for myself here maybe such info will help others… out there somewhere. Too many physicians don’t want change but cover-ups and corruption protects them or there groups like ‘United Associated Physicians,” etc. One person or a small group don’t have much of a chance with such kinds with a battery of attorneys, activist loyal staff who shouldn’t even be in the health care fields, and higher ups in league with them.
Before leaving the local CBOC in hopes of better care elsewhere I got to meet a newly trained MD that by our second meeting told me I couldn’t be treated as they wanted by the VA way or by their expectations, training or demands ‘from the top,’ the bureaucrats, or not allowing MDs to treat us as needed aside from any VA only big pharma listing etc. Too many restrictions and red tape. Being a stranger that MD was straight forward and upset. Bold move on that MDs part not knowing me well or knowing if I’d run off to rat the MD out. Told me we vets, I, would not like what is to be coming to us or some of us per the VA way, or coming down the pike. Told me it would be better for me to stop all the meds they had me on, wrote out my pain and cramp meds plus a couple others, said to leave the VA and find a good geriatric MD locally to take over my care and get what I needed instead of games and un-needed pills. Well, no geriatric MDs to be found locally, and that MD was correct about the changes to come at the VA. That MD left the VA and the last time seen. Then came telemed, ill treatments, cuts in items, changes to cheaper items that didn’t function like the old ones, more sneaky blood tests, etc. Switching to local PCPs that didn’t know how to even test for Gout but had to drive a couple hundred miles to the big city hospital for that. Then asked why that is. I didn’t know why or why their X-ray machine wasn’t working, so the trip. But that was my fault I guess too. About as bad as being told my appendix looked good in some testing. Damn, should look good or magical reappearing that once since it was removed when much younger! Oh what fun the back and forth can be at the VA.
I am hanging in there but there will never be a grassroots movement here about anything. Not allowed over any issue and is the reason why we are so censored and attacked with no-one wanting/daring to get involved. Only the cliques, unions, globalist, and others are allowed to be so open or have MoveOn, Antifa, socialist, activist type groups or meet-ups. Basically for the far left or college interest and not much else seen as unacceptable or against the grain of things here. If it’s not “positive’ for the “community” or “progressive” or sustainable according to the United Nation’s agendas and our shadow government/deep corrupt state cliques… it won’t happen here.
They all started this crap not me. I am not going to stop the protesting and bitching or trying to expose all the evils here. No more forgiving, forgetting, over-looking things, tolerating any of it, or whatever.
Wishing you, yours, your group best wishes, good fortune, blessings, in your endeavors. It’s very nasty and cruel out there, dealing with pure evil and greed.
T,
Have you looked into Direct Primary Care(DPC) for a physician? It is based on the old school model when physicians and patients had a relationship without a middleman. You could call your doc and see him/her in 2 days if you wished. You had direct contact; hence, the “Direct” in the title. These physicians do not take insurance, you pay them directly. Concierge medicine is geared more towards the wealthy. DPC is for everyone else. Typically, you pay a monthly fee(which is very affordable) and you see your doctor as often as you want. When you call him/her, that is who you get, not an assistant. A great many of my colleagues in the organization to which I belong have started their own DPC’s and by ALL accounts, patients and doctors are happy. Since they do not take insurance, there are no hoops to jump through. You can still use your access to the VA and Medicare for emergencies. Medicare will typically cover any lab test/radiologic studies needed. You just submit the bill/invoice. I stopped paying private insurance last September and only get my care at the VA. But I’m seeking a DPC physician as well. If you want to find one, search on DPCfrontier.com or simply Google “Direct Primary Care physician or clinic near me”. And yes, the doc actually reviews your medical records and spends time with you. If it takes an hour to see you as a new patient, then that is what it takes.
I know Dr. Elaina George, I was a guest on her podcast. She is basically running her own DPC as an Ear/Nose/Throat specialist. Many of our members know in Georgia know her as well. She is well-respected. And her patients are first.
As of yesterday, my organization, Physicians for Patient Protection(PPP) became an officially incorporated organization. Our primary goal is to prevent the expansion of unsupervised nurse practitioners and physician assistant’s. Also know as “independent” practice. We do not believe it is safe for patients to be fully managed by health professionals who do not possess the depth of education or training to treat patients, particularly when they are complex, such as the veterans. When I joined in August of last year, there were approximately 2500 members. There are now nearly 9000. This means that physicians from multiple specialties are singularly focused on protecting patients. Opposing organizations such as the American Association of Nurse Practitioners(AANP) will state we are doing this for money. Physicians make money whether or not mid-level practitioners are present. Those in my group take our oaths seriously. It is not a coincidence that several, including myself, have paid the price for speaking up on behalf of patient care and safety. And guess what, when I’m not working, I don’t make money. It would be easier to just keep my mouth shut and continue along with the status quo, but I can’t. My conscience will not allow me to do so.
The young MD who told you that you may not like what is “coming down the pike”. That may be true. But I will remind you that many in PPP, including myself, are veterans or active duty physicians. Many of us have practiced for years. We are very experienced with the bureaucratic mess inherent in the VA. We are seeking to make change and we are vocal. We are approaching legislators who are veteran advocates. I recently sent a letter to meet with my Congressman who is a staunch advocate of the veterans. We are doing what we can but it will take time. I cannot alter your experiences or perception. All I can say is what I said before, we are coming. And with that, a change is going to come.
Good luck to you.
Taz, yep, tried it all. Bought her book, signed, and used the info and links but nothing here locally.
Used the info AARP gave me about DPC months back but those old links/info are dead and from around 2013 I think.
Did the searches recently and months back but found nothing but a few possibles in the big city a hundred miles away. Two possibles locally turned out to be a couple of MDs that would take me five minutes to type their long strange names but they turned out to be regular PCPs and not taking patients with chronic pain issues, and another not taking new patients at all. Even though one advertised treating pain patients and elder care, not happening.
Been through the lousy phone books here with old info, false ads, and nothing.
Been told by many they are not taking new patients.
Been given referrals listings by hospitals here and nothing. Out dated lists, closed offices, needing those references, need the files from last seen MD like Union or UAP, to not taking pain patients even though I tell them I am not interested in getting pain meds from them.
I no longer, like with the VA, want nothing more (no more discussions or request,) to do with Union hospital or their UAP clinic here that have shown nothing but games and attitudes just like the VA and their staff did. City council members and the lefty cliques have family and spouses there that have fun being protected and playing identity politics and spreading my medical info around for kicks. Or not putting info in my files and then giving excuses, etc. All that is typical local mobster and Democrat party games here with their own additions to the VA retaliation and local physicians who like covered up for them over my broken jaw fiasco.
“The VA, IU health, etc.” control all health care in Indiana. “If you leave the VA or speak negative about them you will never find health care in Indiana again.” Per Steve (I think was his name_) during the “new pain clinic” orientation in the fall of 2015. The threats and games turned into facts not mere threats… all with a big smile. Nice long story I have about it all.
I have a nice long list of their phone numbers and recorded many messages and phone calls from them too to prove my points of insane harassment they’ve done for obvious reasons.
Been told by several they won’t see me without referrals or since leaving the VA I seen Union hosp and their UAP clinic they want their med files on me, which they refuse to give me or send to the MDs I was trying to see. And the MDs offices said they cannot or will not request the hospital or others to deliver up my files to them. It is “not their place or job to do.” Even though I have signed consent forms and made numerous phone calls to the hospital and clinic to send a copy to me and to specified MDs. They are nice to my face at times and then refuse to do anything but give me the VA treatment and enhance harassing phone calls. Or threats for some psychotic reason… retaliation. All the stuff medical boards to politicians are refusing to help with. See the VA and local networking game and retribution? That is life in a happy socialist styled town or state. Mob rule aka Democracy. Assimilate or die.
I’ve made enough calls in the past that I was warned about “doctor shopping” or drug seeking when drugs or pain meds weren’t even mentioned. I guess I am to inform new MDs of my problems finding health care and that I have already been in their state and local systems for background checks, drug seeking, doctor shopping, criminal record checks, background checks, pharmacy checks, etc. Failure to inform of such things can also be taken as criminal or trying to hide something. But still, they are all still required to run new patients through the games and checks. Especially us evil vets who are still on the domestic terrorist list and communities hate so much.
The only pain med MD I was referred to I and many others have to sign various contracts with him and to be sued if we didn’t follow his requests, whatever. That was the same clinic I sat over six hours in to see him and over two hours the next time until I got sick, things snapped out of place and I had to leave. Told the secretary I could not sit in those regular small chairs for long if at all and hours long waits were killing me. I also needed something to drink with me but water or drinks are not allowed in the waiting room. Gotta walk out a couple hundred feet for a drink in my vehicle. I asked her to call me for another app when I didn’d have to wait so long. The call never came. Long waits and games are accepted by the rest of his common patients who also bring picnic baskets and goodies to run to in the parking lot due to the long pathetic waits. Plus the lists of redundant test and specialist to be seen in his web that I have already seen and the tests recently done. Didn’t matter, had to their particular picks and previous info and wasted money didn’t matter.
Todd Young, Donelly, Kersey, MD congressman Bucheon and other politicians here are supposed to be veteran supporters but play games, big time liars too, do not really investigate anything or what I would call an ‘investigation.’ Pass the buck, just send our info and grievances back to some VA office and nothing more happens. “go back to the VA or VA rep saying we want you in for more recent evaluations and help you. yeah right. Politicians “are legislators not enforcers and can just pass complaints along to their respective agencies.”
I was also informed not to use more than one official office or more than one at the same time. Waste of official time and one office may interfere with the other, etc.
Now I am having to deal with another set of surgeries and don’t know if the cataract surgeries were another botched job or not. More of a money game, but my eyes are a mess minus the cataracts now too.
If I get bad enough I’ll just use a local walk in clinic for emergencies, non-hospital affiliated. Going without prescriptions or using old ones kept back for emergencies like with gout. Out of inhalers. LOL “Breath deep the gathering gloom.”
I did sign up for the newsletters on the most recent DCP sites I found. This area of mine is not too kind about those thinking outside of the box, Homeopaths, alternatives, etc. Just what they can control, restricts others from or profit from,. Eyes are done for now. Have a nice day all.
Truth! Excellent post, especially about pay or athletes and MDs. I guess people who got better care in private sector didn’t have blue shield/cross or Kaiser (killer Kaiser). I receive excellent care from VA, can’t say that about Kaiser. My plan is paid by my previous employer as a retirement benefit, all I pay is $15 copay, and I still prefer treatment at VA because I believe they are working to give best care they can with what they have. I hope and pray it’s not privatized.
Taz’s Post, I skimmed through the rest. Sorry
I receive my care from the VA also. I have no complaints. Decided I was sick of paying insurance after mine increased to $600/month with a high deductible. This was for me alone. Currently my co-pay is about $20 but I don’t care. Overall, what I pay is leaps and bounds below what I paid in the civilian sector and I have opthalmology, dentistry, social services, women’s health in addition to medical, all at my disposal. I worked for Kaiser. Let’s just say it was not a good match and leave it at that.
@Taz
Thank you for your insights and observations
I have found that my NP, acting as my PCP, has acted in the role as a gate keeper and care coordinator. She refers me to different specialists and is a good listener Perhaps there is a very useful place within the staffing for a career NP
My point was simply to clarify that physicians and nurse practitioners are not the same nor can a NP do what a primary care doctor does. This is propaganda that is being promoted but it is incorrect. There is indeed a place for them, they have existed for a long time. But that place is not to fill a “physician gap”; a nurse cannot replace a physician.
I’ve been going to the VA for about a decade now and have had all of my drs leave. I’ll see a dr a few times and then when I go back it’s a different dr. This has happened to me a crazy amount of times. It’s time for the higher ups to get their heads screwed on straight and do something to retain the good drs. When I do see a dr it’s like they have no idea of my past record. Makes me want to pull what’s left of my hair out! Damn how difficult is it to have my records on the computer that sits right in front of the dr?
The VA can save some money by getting rid of Patient Advocate, Bradley Hogue in Tucson, AZ. He is not qualified to do such an important position. His “help” is more needed in the kitchen. Just saying.
I was nearly killed at least 17 times during 21 years (VERY BAD AVERAGE!!!) by doctors who couldn’t even put a ‘band-aid’ on correctly let alone read a lab result correctly and make a sound medical decision based on those results to help me, the patient, live a better quality of life and moreso the depression associated with the knowledge that I am receiving the ABSOLUTE WORST HEALTHCARE IN THE WORLD from greedy people who do not give a damn how good I feel.
Willful incompetence seems to be the norm in the va system of crooks!!!
When will the madness stop!? Not a rhetorical question.
BTW, on another subject that should be written about, what about the neglect of patients in the last quarter of the fiscal year, July 1st through September 30th (of every year) that is very severe due to the fact that they withhold treatment to save money to increase the amounts of their bonuses on October 1st of every year. This year it is estimated to be close to $400,000.00 (last year was over $300,000.00) that will be divvied up amongst those who do not deserve it while thousands of Veterans go without proper care.
Well Ben, are willing to take a shot to expose it? It is so well hidden that the legislature doesn’t know about it and more importantly, doesn’t want to.
32 doctors per state. That tells me nothing. The states don’t have exactly the same number of vets. I need to know how many vets per doctor per state there are.
haven’t seen a doctor in yearrrrs! Let us go where the doctors have gone, to the real hospitals, not the prison medicine treatment veterans get from the va.
Can we make this news? The VA in Sepulveda in Los Angeles California out of no where got rid of all 42 mental health residents on June of this year, now they only have 3 mental health doctors at the facility which our appointments have mode to January of next year even for those going every 30 days for the past 5 years.
Many of us have requested the choice program just to find out that our doctors were not given enough time to sign the requests and basically voided our access to the choice program.
Now we are having to go as walk ins every thirty days just to refill our medication, do you know how tramautizing is having to tell every walk-in over and over why I’m there and a summary of my issues that I been working on for years??
We don’t know what to do….
@ Dan,
Untimely prescription delivery has been mentioned before, and I forgot to post that I chatted with someone that is getting all of his meds mailed. He calls in the next refills as soon as he gets the package(s). I can’t say that this will work for every type of prescription or prescribed aids/tools but, it may be worth a try for getting those very important needs met.
For controlled substances, like Morphine, you can’t call in your refill until you only have three days left. This of course, always falls on a Friday, so when they fuck up and don’t get it out on time, your going into withdrawals. Does the VA give a shit? as evidenced in multiple phone conversations with PCP, Nursing staff, pharmacy, NO, not one iota do they give a shit.
@ cj,
Thanks for that clarification! I figuerd there would be some things they’d do differently.
I’ve had scripts without prior notification; monthly counts was off (few times), and the directions didn’t add up to the amount that is should be prescribed, and a 95% reduction (gave me breakthrough med, but cancelled regular monthly script), and I’ve even had VA Medical Professionals threaten to cut a singular med off my formulary over arguing about an unrelated matter (although no complaints from me of side effects out of my control). So yes, VA plays with scripts.
Why can’t VA hire enough doctors?
Well, let’s see….
In the private sector there are no hospitals set up with offices to deal with retaliation from the hospital itself.
In the VA the so called whistleblower protections work about as well as a zip lock baggie during sex for protections.
Picture now that you have read multiple articles as a med student of doctors losing their careers over false charges and accusations by vindictive government worms. Now picture reading about employment where the only real cause for losing credentials is for incompetency instead of the reverse of pointing out incompetency as it is for doctors at VA.
Money? Maybe but VA is a dangerous career path to take for a competent young doctor who is but one report of incompetent procedures by his bosses to in turn get reported as being “suspended from duties” to the official medical establishment.
Add further to that the relentless marching along of reports of rampant corruption. Have you ever seen a front page newspaper headline boasting how many veterans had been saved by VA? I haven’t but I have seen multiple reports of VA neglecting, rejecting, and hurting veterans qualified for care.
The VA cannot complete a mission of care giving when the VA people could care less about anyone. VA is also an ego thing now that so very many horrors have come to light. What young doctor wants to admit that they learned their trade under their mentor the VA doctor lolz. It is like a dentist admitting that he learned his trade from Mike Tyson.
VA is bad for doctors. VA is bad for patients. VA is bad for America. VA is tainted.
Is there anyone at all that VA is good for?… Not counting the union and senior VA leadership of course?
What the problem is with the VA is that you can get nailed in the private sector for malpractice and come close to losing your license in one state, but you can move to a different state and go to work for the VA using the same license as all you have to do in some states is take the exam that may be more indepth then the state you came from and boom, you are now a licensed doctor in that state and can ignore your license that you had trouble with. And once you have a position at the VA, you can transfer anywhere in the US or where ever they have a VA hospital. So if we could keep records of people who have screwed up or have had complaints filed against them, that would be an immense help. I personally have been without a PCP for close to 2 years as the last one just up and left for a better position. And this has resulted in long waits for my medication (and sometimes I actually run out of the medication and its 5 to 10 days later that I receive it) or the last time I had an appointment with my VA Doctor (or Doctors position) was last year
I was booted from VA in a retaliatory move after I blew the whistle and was printed up in the newspaper. Washington D.C. forced them to assign me to a PCP over the objections of their senior staff after a two year battle to reestablish PCP and mental health care.
I went to my new VA PCP visit a month or so ago and asked for more non opiate pain killer and told him where I hurt. He felt around the area and said it was probably nothing and decided to prescribe a different kind of non opiate pian killer. He said, well I guess I’ll see you again next year!
As the pain progressed over the next few weeks it became impossible to ignore so instead of VA I went to the ER of our community hospital and told them the same thing. Three tests and eight hours later, yesterday, I was admitted to the oncology unit and am now assigned a cancer specialist and they have already set in motion treatment… the VA doc said nothing to worry about and see you next year!
Is this the doctor we should pay more to? Never ever trust a VA doctor for important stuff. EVER. Let them take your temp, lecture you on weight, and prescribe crutches from China but for goodness sake go to a real doctor when you get blown off by the staff at VA.
Will you be doing some sort of follow on CBD/THC therapy?
Without any doubt at all I will be continuing the ThC therapy. The pain is pretty steep with liver cancer and the civilian docs are putting me on a pain management program. But the THC augments pain control greatly and helps sleep. Plus I am among maybe the one person in North America right now that can isolate Delta 9 THC into absolute purity on my kitchen table. My website demonstrating patient refinement for the patient is called beakercracked dot com.
So because I can control the dosage and purity so precisely it does not matter what the starting plant or potency was. In this state as a pure isolate this medicine is VERY effective. I personally found CBD to be ineffective for the hardcore pain. THC as an isolated medicine can also induce unwanted anxiety but this is transient and once a patient knows their limit it is not an issue.
Luckily in Oregon this is an option for me. Plus it makes me feel like I am contributing to my own well being.
I actually wasn’t referring to the pain management aspect. I was referring to the anti tumor effects. I believe CBD has been shown to significantly impair a cancerous cell’s ability to multiply by robbing it of energy. From what I read, and this was about a year ago, it also helps kill cells by either making calcium or denying calcium to the cell. Something to look into.
I’m well aware of the anxiety aspect I’ve put myself up against the wall before and your right, it’s all about knowing your limit.
I’ll address the statement, “The VA has trouble hiring enough doctors in the first place, but also has trouble retaining the ones they have, which worsens the problem,” by highlighting what the VA has done to provide a workaround for the retention issue and exploring what systemic problems exist in regards to what type of physicians may choose to work within the Agency.
It’s well-known that the VA has difficulty maintaining its supply of physicians, as Ben points out, and in 2016 the Agency took steps to bypass the necessary step of increasing pay for physicians to remain to remain competitive with the private sector. Instead the VA opted to apply a Band-Aid to a sunken chest wound, so to speak. The hasty solution was to propose using advanced practice registered nurses (APRNs) in place of physicians (Document Citation: 81 FR 33155). This measure was subsequently approved and implemented the same year (“https://www.va.gov/opa/pressrel/pressrelease.cfm?id=2847”).
Ben adequately addressed the issue of pay disparity related to VA and private sector physicians, and with APRNs in place I wonder what sort of physicians would opt to forego increased pay and instead work with perhaps lesser educated, trained, and experienced medical professionals in the form of these nurses. One needn’t misinterpret my curiosity, as I have respect for the nursing profession as a whole. No disrespect intended. Still, I’d rather view this issue pragmatically than by allowing my subjective promotion for nurses to cloud reasonable assessment.
According to USAJobs, the salary range for an APRN in Las Vegas, NV is currently $78,699 to $133,475 per year (Announcement number: CBAN-10269711-18-MB) while the salary range for a primary care physician (PCP) at the same location is $103,395 to $224,000 per year (Announcement number: CBAQ-10166828-18-MD). That’s a potential savings range of $24,696 to $90,525 for an employee who is essentially allowed to perform the same function.
USAJobs further advertises that the salary range for an APRN in Fort Knox, KS is currently $77,571 to $112,448 per year (Announcement number: CBDF-10268341-18-KLS-BU) while the salary range for a PCP at the same location is $176,967 to $224,553 per year (Announcement number: CBDF-10118162-18-KLS-BU). Again, that’s a potential savings range of $99,396 to $112,105 for an APRN vice a PCP who is basically allowed to perform the same job function. Similar ranges can be observed throughout the country.
From a fiscal perspective it’s more logical to hire nurses instead of physicians. If I were a doctor who was offered less pay by a government organization than my private sector peers were receiving, and I’d be working with nurses who were increasingly able to acquire my job for less money, I don’t believe I’d be too enthusiastic about applying to work with the VA. Again, I wonder what sort of physicians would opt for less pay and voluntarily subject themselves to VA working conditions.
A cursory examination of VA hiring practices quickly addresses my internal question. According to one source, the VA is allowed to hire medical providers whose licenses have been revoked in one state as long as they maintain a valid license to practice in another state (Slack, D. 2017, Dec. 21; Illegal VA policy allows hiring since 2002 of medical workers with revoked licenses; USA Today). Even those physicians whose licenses weren’t revoked, though remained expired, were allowed to receive bonuses from the Agency, according to a separate source (Flatten, M., 2013, Aug. 23; VA giving big bonuses to absent, unlicensed, incompetent doctors; Washington Examiner).
It isn’t as though government officials are unaware of this illegal employment practice, as one Iowa Senator who is herself a combat veteran has openly stated, “it is unacceptable that the VA has failed to ensure that the doctors treating our veterans are certified to do so” (Leys, T., 2018, Mar. 2; Grassley, Ernst rip VA’s slow response to illegal doctor hiring case; Des Moines Register). And still the VA continues utilizing APRNs in place of PCPs and hiring physicians with problematic backgrounds. Regulatory oversight has had little effect on this matter.
From my perspective, a PCP with questionable credentials or a work history fraught with malpractice issues may reasonably and prudently consider the VA as a viable option for employment even when considering how less competitive pay is offered by the Agency. Of course, such an individual couldn’t possibly exemplify all or even the majority of physicians currently employed by the VA. I wouldn’t dare suggest such a thing. Nonetheless, a brief review of actions exhibited by the VA reveals that this sort of legally, ethically, and morally reprehensible behavior does in fact occur.
The VA has in the past dozens years hired medical figures for a wide realm of procedures. Problem is those supposed medical people would never be able to practice medicine in an accredited hospital or be cover by insurance. Of course it’s impossible to prove this since you can’t get any information on them on line. So they have started to rely on Nurse Practitioners and PA’s.
Maybe “Seymore” will come on today and reprint his sources on “…immigrants purchasing documents to work for VA.”
If I remember correctly, those who came here on a specific “visa”, don’t have to work in the private sector, I believe for 2 years, before being hired by VA.
Which should tell everyone the incompetence of the hiring process for VA!
As far as “wages” paid, how much and how many people need such outrageous wages to live comfortably?
I’m all for a person being paid a comfortable wage. Yet, $700,000? Come on now! That’s rediculous!
Even $150K/year is rediculous. Especially if the person only sees a few patients, say 5, a day! As we here have witnessed at many VHA’s nationwide!
It was either yesterday or this morning when “Fox News Anchors” stated: “There are 80K+ less federal (government) employees now than last year!” They also stated: “Many are jumping ship, because they aren’t able or are not experienced (educated) enough to fulfill their job requirements!”
Which is it?:
Is it due to “…jobs not being filled?” as some suggest?
Or, “Is it due to the inequality/inexperience/lack of education of the person not being able to fulfill their duties as required?” as others suggest?
President Trump did in fact sign into law, last year, allowing for the dismissal of federal employees not up to accomplishing their job! Basically, firing those who are incredibly incompetent!
“Seymore Klearly” has, many times verified – with sources, commented on how individuals have used the “broken ‘visa’ system” to gain access to high paying jobs within our government! Many, it would seem, “purchased degrees from universities – some which do not exist – to gain employment within our government!” (paraphrasing)!!!!
Lastly, could it also be, “credentialed individuals” see the corruption, waste, fraud and abuse within our government, especially the VA, and do not want that on their resume?
I believe it could be a combination of everything……….
Just makes the case stronger for A.I. in government.
Imagine if we could replace every last GS level employee with a small team of AI’s
Imagine if we could replace every last shitheel doctor with an AI that you can load up with every last scrap of medical information on the planet in a matter of minutes instead of decades of schooling.
38CFR would be a slight blip on this technology’s learning curve. Case files assembled in seconds Decisions rendered in perhaps minutes. Backlogs eliminated literally in hours. With correct decisions the first time every time there wouldn’t even be a need for an appellate process.
Imagine an AI in charge of inventory at a hospital. Zero theft. In charge of cleaning surgical/dental tools? Zero infections.
The list goes on and on and every time it is added to we as a country experience significant amounts of cost reduction and savings.
I hope your not just joking around WyldeChylde, because what you outlined, would be so much better than what is at present.
You come in holding your knee in pain, AI, renders x rays, an MRI, and even a computer guided, orhoscopy, compares evidence, and initiates a computer guided partial meniscus removal.
Wait time, as as you can get your ass to the AI table and ender you shit into the terminal or swipe your new VA-med card.
I can actually see this working.
And yes, no years upon years waiting for an appeal, since all of you history is available for an AI to make LOGICAL decisions.
Good post, WyldeChylde.
@CJ I was absolutely not bullshitting. Most of the technology we need is already invented. We just need to put it together in the right way. We’ve been doing robo surgery since the late 80’s early 90’s? We just need to refine the ways an AI could effect and affect real world results in veteran patients.
Doctor shortage? What doctor shortage. An AI could theoretically scale itself up or down depending on patient load. And each patient would be receiving the same competent and timely care. Lab work done at a fraction of the cost with the lab running 24/7 as often as needed. No rude, snotty, fatbacks. No contemptuous and dismissive assholes. Just a nice calm friendly voice “How can I assist you today veteran?”
Oh and my personal favorite? An AI probably wouldn’t forget to call you back 😉
Howdy, Crazy Elf,
I agree with you too. Many factors are involved in the situation. How have you been? Do you remember me just a tad?
Best, Angela
Angela,
Hey, welcome back, friend! Of course I remember you!
How ya been?
With a worldwide shortage in the healthcare workforce of about 4 million (according to WHO) this should not be terribly surprising
I can also see how this plays in the quality of doctors that the VA does retain. This has resulted in scandals in the past due to the number of malpractice issues the VA has to deal with, as well as a lot more that have not been acted on (my case was pure malpractice, but they hid the facts and circled their wagons and I just didn’t file a FTCA case on it because I could not get advice from a lawyer).
The M.D. responsible for my lame leg was shipped to Louisiana for a year, then back into Florida. Dr. Z. heard me complain about my back pain, and she indicated in my medical file that the problem was from when I was in the Army 30 years ago. She ignored that I was 55, and instead of sending me off for an xray, I was sent to therapy where the wrong exercise resulted in a permanent 60/10% disability to my legs. Never had thought that would happen because I trusted that doctor and it resulted in some serious problems. Dr. Z is still working for the VA.
That is the real nightmare. The last 2 years another MD has supervised a resident I was assigned to, and this MD failed to properly supervise my health care and omitted monitoring my liver, my DMII and refused to provide me treatment on several occasions when my resident was not available. The resident was clueless.
In the 1970s there were plenty of VA physicians, up until Reaganism. The curtailment of entitlements. Those apply very directly to veterans. Health care, compensation and other costly benefits. There was a scholarship program for health care professionals through the VA until the early 1980s. But the Bankers wanted to draw on physicians salaries for life. So the scholarship program is on the books but like Choice it is very under funded.
“Its your money,” an old Reagan quote. You get what you pay for or don’t pay for. Scholarships got access to the teaching hospitals best plus well trained physicians in repayment of their scholarships. Your money is in your pocket and it buys us 37th place, 18 places below the last place in the industrialized country health care providing. And where are we with Infrastructure? I suspect even Vietnam is ahead of us on that. Yeh, keep your tax money in your pocket and claim our decendents should pony up for us. Its the Reaganism way since “Its your money” won an election and put the GOP bankers in power.
Sorry Lem, but your statement of “In the 1970s there were plenty of VA physicians, up until Reaganism.” isnt based on fact but most likely your opinion. According to VA records clear back to the 60’s, the VA has ALWAYS had a problem of getting doctors as what the Government can pay is far less then what the private sector can or is willing to pay. In Ohio and Michigan and Indiana, the VA’s have a contract with the local medical colleges so the physicians can come and do their residency at a VA hospital. And the claim that we are far below in industrialized health care is bogus as well. According to the World Health Organization from the UN, the US rates at 14th in the top 20. SO you can stop with the “GOP bad” crap. If you want socialized medicine, then move to Canada (where your tax rate will be well over 58% of your income) or move to Norway or England where your tax rate will be closer to 75% of your income to pay for it.
Mr. Dan,
I 100% agree with you. You are absolutely right. Best, Angela
I agree 100%.
Well not really. The way the get around it is contract doctors, are they in the numbers? Contract doctors get the top end pay for their area, food and lodging expenses along with benefits. Some areas pay $500 a day food and lodging and that is the high end. Supposed to be temp, my last PCP was there 10 years, told permanent and skipped and went to TX to collect the same. The VA shot itself in the foot, already short they first offered money. And everyone got a raise, then a 40hr workweek and so did everyone else. Never mind anything you can’t have 40hr weeks in a hospital. Just the amount of time to change shifts is enough sometimes. You can’t run as Urgent Care clinic. It’s a joke and besides the money most doctors are crap and people don’t want to work with them and that’s the main reason. They are ready to work 60-70 hours easily, how many hours are you quoting for 700k? This is the real nightmare. In Denver the got lucky and were able to build next to a main hospital, the only thing lucky. So when need a doctor, one should be available to look at files and pics and ruN over for 15 minutes and was 75ft from the building. So utilizing their doctors how needs to go, especially with downsizing as vets get old. Need to do everywhere