Thursday, June 19, 2014
Recently, my primary care provider left her medical group practice in Amherst to take a job elsewhere. I received a letter notifying me of her departure and informing me I could call and schedule my annual exam with another provider in the practice.
To my surprise, the soonest availability was in seven months. Discouraged by this, I decided to look to other recommended providers in Amherst for a more timely appointment. Two of the three recommended providers I called weren’t accepting new patients because their panels were full. The third provider was able to see me within a month of my call.
I’ve been thinking about my own experience with primary care here in the Valley as, along with other veterans hospital employees here in Northampton and across the country, I’ve weathered the media storm focused on “wait times” for veterans for both primary and specialty care visits. Recent news reports suggest that limited access to primary and specialty care is a phenomenon unique to the Department of Veterans Affairs.
Unfortunately, that’s not true. Especially in rural areas like western Massachusetts, shortages of primary and specialty care physicians is a problem that has been identified by the American Medical Association and the Department of Health and Human Services, and this problem is expected to grow as the population ages and other demographic shifts occur.
It’s challenging to draw providers to rural areas of the country where salaries are typically lower, especially when these clinicians have sizable student loans to pay off.
To fully understand the nature of some of the wait time problems identified recently in the VA, it is first important to understand the VA system itself. The first medical facility for veterans was authorized in 1811, and Abraham Lincoln’s immortal words “To care for him who shall have borne the battle and his widow and his orphan” became the VA motto in 1959.
At present, the VA healthcare system is comprised of approximately 1,700 hospitals and clinics across the country that serve over 8.8 million enrollees who receive more than 83 million outpatient visits each year. Though not all veterans quality for VA care, combat veterans who served in Operation Iraqi Freedom, Operation Enduring Freedom (Afghanistan), or Operation New Dawn (the peacekeeping mission in Iraq) are entitled to five years of free healthcare for conditions related to military deployment.
Many of these veterans return from deployment with substantial combat and trauma-related medical and mental health problems. It is VA providers who have the most sophisticated training and knowledge to address these problems.
Because of its commitment to newly returned veterans, the VA has seen a substantial influx of veterans seeking VA care. This large number of veterans, coupled with shortages of primary and specialty care providers here in western Massachusetts, has contributed to “wait times” that average a little over 70 days for a new primary care appointment.
These prolonged wait times are being actively addressed nationwide by the Accelerating Access to Care Initiative, which aims to evaluate provider panel sizes, extend clinic hours into evenings and weekends to ensure veterans can receive the care they need and to utilize non-VA, community-based care in instances where the VA is unable to increase its capacity in a way to meet veterans’ needs.
Though the media reports regarding VA care have been dire, there are successes not heralded by the media that are important for providing a balanced examination of the state of VA care.
First, the VA consistently outperforms the private sector in terms of quality of care and patient safety. Study after study demonstrates that veterans have higher rates of preventative screening and treatment (such as colonoscopy, mammography and diabetes) as compared to the private sector population.
Second, through its dedicated research and clinical education programs aimed at improving veterans’ health and health care, the VA has incorporated this knowledge into evidence-based, patient-centered healthcare delivery approaches designed to optimize care for veterans.
Third, over the past two decades, the VA has been working hard to ensure all veterans, including women veterans and LGBT veterans, feel welcome and receive comprehensive care for all of their needs.
Finally, the VA system as a whole employs nearly 400,000 people across the country, and nearly a quarter of these employees are veterans. VA employees are among the most dedicated group of people that I’ve worked with in my career, and they are absolutely committed to caring for the needs of those men and women that have served our country.
Every VA employee I work with, whether they be mental health or primary care providers, physical therapists, voluntary service directors or social workers, are compassionate and dedicated workers who often put in long hours to ensure veterans are getting the care they need.
So, please, as we at the VA work hard to remedy problems associated with wait times, know that VA employees are as dedicated to their mission as they have ever been. And next time you see a friend or neighbor on the street who is a VA employee, thank them for their dedication to veterans.
As with any health care system in the world, we aren’t perfect, but we are working hard to improve our processes and systems in order to continue to provide high-quality care to our nation’s veterans.
Kristin M. Mattocks, Ph.D., is associate chief of staff/research and education at the VA Central Western Massachusetts Healthcare System in Leeds.