Recent events in Arizona (and subsequently other locations) have opened the Veteran's Health Administration to considerable scrutiny and criticism. Some of this is well deserved. Reports that veterans died while awaiting an appointment are both shocking and appalling. A thorough investigation must occur and those responsible for wrongdoing must be punished accordingly. However, it is both inappropriate and unfair to condemn the entirety of the system and its employees based on these truly unfortunate incidences. That is not the VA I know and take pride in working for.
I was fortunate enough to graduate from an excellent medical school, complete residency in a highly regarded program, and serve as a chief medical resident at one of the top hospitals in the country prior to taking my current job. Perhaps because of that good fortune, both family and friends sometimes ask me, "why do you work at a VA?" in an almost accusatory tone -- as if working for the VA was marker of failure or incompetence. People sometimes assume I took this job for the loan repayment (I get none), because I served in the military myself (I did not), or because I couldn't find an alternative job (not the case). They are surprised to hear that I chose to work at a VA because I believe in the mission of the VA and have a deep, abiding faith that we can and should fulfill that mission. A mission best articulated in the words of Abraham Lincoln, "To care for him who shall have borne the battle..." In accordance with that charge, I believe that supporting our troops means more than putting a bumper sticker on your car or a blanket statement at the end of a broadcast. I believe that implicit in the pact between citizenry and soldier is the promise of not only health care, but high quality health care. And I believe if we fail to live up to that standard, we are breaking a central tenet of our society.
I am not alone in this belief. There are more than 14,000 full-time physicians in the VA system, many of whom have passed up higher paying or more prestigious jobs to work with veterans. Many have academic appointments at top medical schools and bring a wide range of expertise and a wealth of experience. These physicians, with the help of nurses and mid-level providers, delivered clinical services to more than six million veterans last year. Many of these patients might not have had any access to health care if these benefits weren't available.
The problem is an issue of access, not quality of care. In general, the care our veterans receive is excellent. Exceptional providers and a system wide emphasis on quality and safety have led to outstanding results compared with private sector hospitals. Multiple studies have concluded that for many measures of quality, care within the VA system is at least as good or in some cases better than care received elsewhere. For example, in 2012 (the most recent year data are available) the VA performed better than commercial hospitals in indicators of clinical quality including rates of colon cancer screening, blood pressure control, diabetes monitoring and adult vaccinations.
No system is without its flaws, and the VA is no exception. Access to both the health care system and the disability system are major issues for our veterans, which makes the reports of "secret lists" all the more alarming. Our mental health is woefully understaffed for the current need and our primary care divisions are overstretched. Like any large institution, the bureaucracy can be frustratingly complex to navigate and the pace of change can feel glacial. However, instead of these failings being reason to denigrate the entire system and its employees, perhaps we as a society and medical providers as a profession should see these as challenges that must be met to give our veterans the care they deserve. There are solutions to these problems and finding those solutions is our duty to the men and women who have borne our nation's battles.
However, I don't believe "privatizing the VA" is the solution. Efforts to ease backlog by facilitating access elsewhere when needed are a good step, but quality control and coordination of care will suffer the more disjointed the system gets. Integration of a health system seems to be a key component of quality care in many instances, especially for older and chronically ill patients. This has been demonstrated not only at the VA but in private integrated health systems like Kaiser Permanente and the Mayo Clinic. The emphasis should be improvement of the current system, not radical redesign of veterans' health care.
I will continue to work for the VA, continue to believe in the mission of the VA, and continue to recruit my colleagues and trainees to the VA. I am proud of the organization I work for and proud of the work we do. Our nation's veterans deserve better than what occurred in Arizona and we must work harder as a system to have our actions reflect our mission and to demonstrate to our patients that we are truly grateful for their service to this country.