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Tuesday, April 11, 2017



A Win-Win for Doctors and Vets / #Save GME
https://www.youtube.com/watch?v=VZvNDuP1xlY

Most of the solutions I have described to eliminate the Residency Shortage will take time to enact.  They involve legislative changes at both the National and State levels (I have already talked about how long and hard those changes can be).  I have also described what has been passed in several States.  What most concerns me are the unmatched doctor grads TODAY.  What can we do to “preserve” them before they are forced to leave Medicine permanently?

Perhaps you recall a “mini uproar” that came out in the Washington Post in May 2016.  The article titled, “VA:  Let nurses Treat Vets”, related how “The Department of Veterans Affairs would dramatically expand the authority of nurses to treat patients…”(1)  This plan was intended to reduce long waits for medical appointments and “to ensure the VA has the authority to address staffing shortages in the future”, according to VA Undersecretary for Health Dr. David Shulkin.

 I wrote to Dr. Shulkin at that time to propose a “win-win” for both doctors and vets.  I suggested hiring the unmatched doctor grads through the VA to see patients under the supervision of the current VA medical staff (much as with the supervision provided in a residency program).  The unmatched doctors would be given meaningful work as well as further medical experience and training.  The Vets would receive timely care with reduced appointment wait times due to the increased staffing.  The doctors would apply again for residency as the number of residency slots increased.  The supply of doctors would increase to alleviate doctor staffing shortages for the VA in the future as well.

Ironically, these doctors would be “distributed” all across the US, as are the Veteran Hospitals.  This would be a quick fix to two currently existing problems, the Residency Shortage and the long appointment wait times for Vets.

I received a response from Dr. Shulkin stating that the VA does NOT have its own residency programs (although residency programs actually DO staff VA hospitals).  I responded again to Dr. Shulkin that I was aware of that fact, but was instead suggesting a temporary use of these unmatched doctors until the deficit was eliminated.  Dr. Shulkin replied, “Oh, now I understand”, but nothing more was said.  I suppose this is where the politics come in to play.  I am assuming the “greater plan” was to reduce healthcare costs for Vets by allowing nurses to provide more cost effective care (I discussed the pros/cons of nurse vs. doctor provided care in a prior blog). 

So this is one proposal I am suggesting to “preserve” the unmatched doctors in a timely fashion before it is too late, and their educations would have been for naught.  The VA could more easily create a system much like Missouri did (Assistant Physician license), because the VA system is Federally operated.  It would require only “one” new license which would apply nationwide.  The usual hurdles of individual state licensure for these “unlicensed” doctors would not be an issue.  It would save the costly and tedious process of changing each state’s licensure laws to accommodate this National “emergency”.  These doctors could work to provide quality, yet supervised care to our veterans, while under the supervision of current VA doctors.

(1)
https://www.washingtonpost.com/news/powerpost/wp/2016/05/27/to-cut-wait-times-va-wants-nurses-to-act-like-doctors-doctors-say-veterans-will-be-harmed/?utm_term=.52493662cce7

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