VA Healthcare: A High-Quality, Cost-Effective, Resource for 21st Century Medical Education for All. (Part 1 of 2)

We propose that converting some Department of Veterans Affairs Hospitals into VA Hospital & Medical Schools would benefit both the VA and the country's healthcare at large.

The affiliation of VA's with medical schools came as World War II ended. There were 98 VA hospitals with almost no doctors facing a return of thousands of injured fighters. Nearby university hospitals were experiencing just the opposite, that is, they had too many doctors and too few patients. In January 1946, Congress approved affiliations and returning veterans were well treated in VA hospitals by university residents and part-time academics. Thereafter, new VA facilities were constructed within the shadow of a medical school. Medical students received hands-on training in the VA facility. University academics received VA funding for research and had research access to VA patients.

Persistent media attacks on VA care and whispers that some part-time physicians were paid for time not always served, resulted in a 1992 review by the Institute of Medicine. Affiliation agreements were scrutinized. The committee asked was it “an even exchange” and were some schools “taking advantage” of the VA.

They concluded that disaffiliation would be a disaster as some VA physicians would resign; research halt,and residency training would be undone. They concluded that the affiliation helped provide good VA care.

Since 1992 VA medical competency has enjoyed national recognition. The VA spawned the National Surgical Quality Improvement Program which has exposed the VA's superb record in surgical care. The VA pioneered the Electronic Medical Record (EMR) which has benefitted every VA patient. The VA's commitment to fine Primary Care results in every patient having a personal physician who fully coordinates that patient's every health care issue. The VA has opened over 300 Community–Based Out-Patient clinics in which primary care physicians are available closer to patients' homes.

But there have also, been challenges. VA care has moved from serving only injured soldiers to serving all veterans. When aging veterans sought economical VA coverage, Congress responded and opened the VA to all vets including those with no service connected disability and regardless of income. Congress, also, authorized the VA to bill patients. An amount equivalent to a co-payment, is charged each patient of means for each non-service drug and doctor visit. This has given the VA entrepreneurial experience.