Is understaffing caused by inability to hire physicians?
The Memphis VA Hospital has been flagged as part of the ongoing Veterans Administration investigation involving long wait time for care. In order to partially ease that situation, patients have now been given the green light to use VA funds to see local physicians, rather than wait their turn at the VA.
In addition, Department of Veterans Affairs’ (VA) Medical Center and Health Care System Directors have begun conducting monthly in-person reviews of scheduling practices in every clinic within their jurisdiction to ensure all policies are being followed to deliver timely care to veterans.
Understaffing has received the major share of the blame for the long wait time for care. If that is indeed the major cause of the problem, it raises the question, is there a major difficulty in hiring physicians?
“American Federation of Government Employees (AFGE) has said all along that understaffing and inadequate funding of front-line services have been main causes of long wait times for veterans seeking care at VA facilities,” said AFGE National President J. David Cox Sr. “Even though Congress has made efforts to provide the agency with the budget it needs to carry out its mission, the agency consistently fails to allocate appropriate resources to direct patient care and support functions, fostering an environment for 'wait list gaming.' At the same time, the VA continues to add more positions to HR, system redesign, labor relations, and numerous other management positions that involve zero patient care.”
Cordell Walker, executive director of Alpha Omega Veterans Services, Inc. in Memphis sees the long wait problem emanating from another source.
“It isn’t so much mismanagement resulting in understaffing, as it is a sharply escalating volume of veterans in need of medical services,” Walker said. “Due to the fact that we have recently participated in two wars, Afghanistan and Iraq, that combat involvement has resulted in an increased number of veterans suffering from traumatic brain injury and other war-related disorders and disabilities. The sheer number of wars and conflicts that have occurred, dating back to Viet Nam, has escalated the number of veterans needing services through the VA health facilities. Simply put, we’ve been involved in numerous conflicts so there are more veterans in need of services.”
Still, why would doctors choose to practice through the VA system, rather than go into private practice? According to recruitment information posted on the U. S. Department of Veterans Affairs website, there are a myriad of strong reasons to entice doctors to practice medicine at a VA health facility.
As government employees, VA physicians are eligible for federal benefits.
“They don’t have to carry personal liability insurance, a considerable cost savings. To that end, physicians get to keep more of what they actually earn,” said Mike Cates, executive director of the Memphis Medical Society. “They are covered under a federal umbrella that takes the place of personal malpractice insurance.”
According to the Veterans Affairs website, “As Federal employees, our health care professionals are protected by the Federal Government in instances of alleged malpractice or negligence resulting from the performance of their duties in, or for the Veterans Health Administration of the Department of Veterans Affairs. The United States Government accepts responsibility and liability for its employees' negligent or wrongful acts or omissions during the exercise of their official duties. This applies when employees' actions are in accordance with the policies of the institution in which they are practicing.”
The VA website highlights the phrase “People not Paperwork,” meaning that since VA physicians are part of the federal government system, they have their administrative burdens lightened. VA physicians don’t have to worry about employee scheduling or payroll. The VA system touts that it “allows physicians to spend more time on medicine, and less time on business tasks. It also provides predictable scheduling for nurses. And for physicians, it means reduced paperwork, the elimination of billing hassles, and lifting the burden of liability coverage,” according to its recruitment materials.
Physicians who work for VA hospitals do not have to bear the overhead expense of equipment costs. Through government funding, doctors have access to the latest technology, which often results in improved patient outcome. It also supports innovative research projects.
As for their own professional development, the VA system has a comprehensive education support system in place.
“Continuous learning is essential to medical professionals' ability to provide top-notch patient care. We understand that and encourage VA employees to pursue higher education by offering one of the most comprehensive education support programs in the nation,” per the VA website.
Many of the doctors at the VA in Memphis chose to work there, instead of going into private practice, because they wanted to teach and to do research. They say the VA hospital, which grants them the status of being University of Tennessee faculty, helps them fulfill their mission of patient care and teaching new physicians.
The VA's Office of Academic Affiliations website provides a comprehensive look at the educational incentive programs the VA affords its employees and trainees.
Personal support is offered through a focus on achieving a work/life balance, beginning with the assurance that physicians’ work weeks don’t advance past 60-hours. There’s also the offer of generous vacation time, as well as personal accommodations (i.e., The Family and Medical Leave Act and the Family Friendly Leave Act).
When it comes to actual pay, the VA claims to offer employees salaries that are competitive with the private sector. For instance, for most health care occupations, the starting salaries and pay scales are “recommended by a professional standards board and are based on education, training, and experience.” Additional pay incentives include the possibility of a recruitment bonus that can equal up to 25 percent of the rate of basic pay. The same amount is possible as a relocation bonus, and as a retention bonus for remaining with the government. And these are just a few of the forms of government-offered incentive pay and awards.
Overall, the benefits packages offered through the federal government are better than most in the private sector. Vision and dental are standard offerings, along with the option of using Flexible Spending Accounts which allow employees to use tax-free dollars to pay for medical, dental and vision care expenses that are not reimbursed by their health insurance plan. Term life insurance, family and additional coverage options are also available, with the cost shared by the Federal Government. The Thrift Savings Plan offers the government’s version of the private sector’s 401(k) plan to help employees build their retirement funds. And VA employees are part of the Federal Employees Retirement System (FERS). Under FERS, they are eligible for monthly retirement benefits after just 5 years of federal service. If they leave federal employment, this retirement system is portable.
So the system seems to be in place to provide doctors with the tools and the time to focus on their practice of medicine. The compensation packages seem to be commensurate with or better than those offered in the private sector. And a cap on the number of hours in a workweek seems to be a gateway into living a balanced work life.