Editor’s Note: Below is the first of three posts on providing care to members of the military, veterans, and their families. Read additional perspectives on this issue. Be sure to also read the commentaries by Gleeson and Hemmer and by Lee et al, which are online now.
When I was a resident, part of my training occurred at the Veterans Affairs hospital (VA). Compared to the University, the environment was more relaxed and the rules were different. If we wanted to get a procedure done quickly, we would wheel the patient to the location where the test was being done and sweet talk the clerk and nurse into moving our patient ahead on their list. Usually we had time for leisurely discussions about esoteric diseases, and the patients were willing to let a team of students and residents listen to their heart murmur or feel for a liver edge. There seemed to be an unwritten compact that the patients would get the benefit of smart, hard-working physicians with up-to-date knowledge and the trainees would get the opportunity to repeat histories and physicals on the patients. Because of the affiliation with the medical school, VA physician specialists and researchers developed collaborative teams with the University physicians. When the University’s chair of medicine went on sabbatical, the VA chief covered for him. The relationship felt like an extended family, with the occasional odd quirks but still a trusting and committed family.
At some point, this relationship began to weaken. Although the affiliation remained in name, the trust between the institutions was not the same. When I returned years later as associate dean for graduate medical education, I found problems and misunderstandings between University and VA faculty. Neither group recognized the tremendous benefits that the other could provide for training, scholarship, and clinical care. I suspect it may have had something to do with the increasing pressures on University faculty for clinical revenues and on VA faculty to increase clinical productivity.
The current crisis at the VA appears focused on veterans’ access to care problems. Many have become frustrated with these problems and have suggested moving veterans into a different care system. However, such a change would disrupt many of the unique programs available at the VA. In their recent commentary, Lee et al. (1) describe the unique issues that veterans face and the programs and services the VA has developed to address them, particularly in rehabilitation and mental health. They also describe the VA’s commitment to medical education at all levels, noting that over one hundred thousand health sciences students and residents participate in educational rotations at the VA and about 80% of medical schools have affiliations with the VA. In a related commentary, Gleeson and Hemmer (2) describe the Military Health System, which is separate from the VA and provides insurance and medical care to active duty and retired military as well as medical education. They describe the unique military culture and the importance of understanding the medical problems that often affect military personnel and their families.
Taken together, these commentaries provide up-to-date information about current opportunities to improve the health of our armed forces personnel and veterans. Our Joining Forces article collection contains 53 other articles that provide additional information concerning military health and medical education. As we debate how to improve health care delivery to veterans and active duty military, these resources can provide useful information concerning some aspects of the VA and the Military Health System that have worked well over time.
The partnership between academic health centers and VA hospitals has been a cornerstone of our medical education system as well as an opportunity to provide exemplary medical care to those who have sacrificed so much to keep our country safe. Now we need to recommit ourselves to this partnership, rebuild the relationships that have been neglected, and further strengthen those that are succeeding. I am sure we will not go back to the halcyon days when I was a resident. Too much has changed in health care for that to be possible or even desirable. However, there are new opportunities to develop models of population health, team based care, and data-driven individualized care that could improve outcomes for veterans and educate our next generation of physicians, nurses, and other care providers. I hope the current crisis provides the stimulus for academic health centers and the VA to forge new bonds that will be better than what existed in the past. Our students, residents, and veterans deserve no less.
- Lee J, Sanders KM, Cox M. Honoring those who have served: How can health professionals provide optimal care for members of the military, veterans and their families. Acad Med. 2014.
- Gleeson TD, Hemmer PD. Providing care to military personnel and their families: How we can all contribute. Acad Med. 2014.