Yesterday, we asked you to share your experiences dealing with the beleaguered Department of Veterans Affairs—the good and the bad. The response was overwhelming. Today, we focus on two accounts that defend the VA, while laying much of the blame for its problems on Congress.
Our first contributor is a former surgeon for a "high volume VA hospital":
As with all VA hospitals, the hospital that I was affiliated with was under pressure to expedite evaluations for veterans with urologic issues, and had strict criteria regarding the time frame within new consultations had to be evaluated (on the order of weeks)...
We had pride in how we were able to meet the guidelines set out for our department, both at the institutional and federal level. No shortcuts were employed. No "secret lists" were generated. We simply worked with local and regional urologists and primary care providers to appropriately triage patients in need of urologic care within "VISN 11." Targets were met and the majority of patients received the care they needed.
Broadly, I feel strongly that individual VA hospitals have made strong efforts to optimize the quality of care delivered to veterans in need of both urologic and general/primary medical care. Nevertheless, when resources are restricted at at national level, there are going to be breakdowns at "weak spots' in the system. Whether this includes centers without strong academic ties (like Phoenix), or regions with dominant private medical groups which tap the majority of non-vulnerable (read: non-homeless, Medicare eligible) patients, I feel like the recent events in Phoenix don't reflect a systemic problem with the Veteran's Health Administration, but instead a regional administration that reacted poorly to a situation of high patient demand in the setting of restricted resources...
I think, by and large, the care received by veterans is on par with (or in some cases, exceeds) the care delivered to vulnerable and underinsured patients seen in private settings. This has been supported by a number of studies out of RAND, comparing (at a population level) VA care to private hospital care.
However, I believe the trouble spots often are related to legacy providers that are older, more removed from academic centers, and less likely to adopt guideline-based and high quality care. I believe that this can be improved by allocating more resources to primary care centers to increase the ability to see more patients. Also, I think more research funds and loan repayment programs could be instituted to attract newer, younger, higher quality providers (both primary care and specialists) to areas previously underserved (or bogged down with stubborn, older providers that haven't updated their practice style to state-of-the-art medicine).
A lot of these thoughts are pure hypotheses and more work has to be performed to truly understand how best to improve the care for veterans in the United States. I am sorry I can't expound further, but I have to run to the OR!
Our second source is a manager at the Veterans Health Administration (VHA) and a combat veteran of two wars:
I've been reading the pieces about the VA on Gawker and I agree with everyone from POTUS on down that this business of cooking the books is reprehensible and inexcusable. It's probably also systemic and I think the IG investigation will probably bear that out. Don't take this email as a defense of shady practices, but maybe the VA healthcare system in general.
I think the information in your piece from earlier today was probably unfortunately pretty accurate.
... as Members of Congress and the Administration fashion their torches and sharpen their pitchforks to go after Secretary Shinseki, I think it's important to remember that many of these issues are access driven, meaning we've been at war for around 21 years counting the cumulative total of years between the wars in Iraq and Afghanistan and a healthcare system that between this administration and that idiot Bush and his crew, didn't adequately plan for the consequences of never ending warfare and haven't done nearly enough to get caught up. Facilities are literally bursting at the seams to manage their workload.
My program and the other capital programs within VHA have been consistently underfunded for years now... a $6B backlog and we get a couple hundred million in the budget, which might fully fund a project or two. The subject medical center in Phoenix has been begging to decompress that facility for years and actually have a large lease (~175k sqft) in the FY15 (and FY14 and possibly FY13) budget request, which has been stuck for at least two years because of a lease scoring issue with the Congressional Budget Office. Congress, OMB and the White House are either unwilling or unable to help. We in the Department have fought tooth and nail. It's the epitome of bureaucratic bullshit.
I may not always agree with the size of our promise to veterans, but I will always honor that promise.
Unfortunately, an entity the size of VA with the kinds of workload demands placed upon us has a hard time being nimble and much of our ability to affect change is decided by the cruel Federal budget cycle... I don't know the director at Phoenix, nor do I know what the motivation for the alleged cooking the books was, but this isn't just VA's problem. It's a completely foreseeable consequence of war and an existing population of veterans who have reached an age and station in life when VA healthcare may be their only option. Korea and Vietnam veterans, for example.
I just hope people can keep this in mind before they hand down an indictment of what is fundamentally, a good system of care. Unless we find a way to improve that access to care piece in a hell of a hurry, the situation will continue to degrade.
I don't always like my job, but the mission is important.
Again, if you have personal dealings with the VA, consider sharing them in the comments below or emailing adam.weinstein at gawker dot com.
[Photo credit: Win McNamee/Getty Images]