Denver, CO,
09
January
2017

New VA Secretary Must Seek Help From Private Sector

Summary

Jacob Hyde is faculty director of the Sturm Specialty in Military Psychology and a clinical assistant professor. He started teaching at DU in 2016. Hyde is a veteran of the Iraq War and serves on the University of Denver's Institutional Review Board and is the faculty advisor to the University of Denver's Student Veteran Association.

President-elect Donald Trump and his transition team have yet to announce their choice for secretary of the Veterans Affairs Department who will take over our country’s largest, most bureaucratic, and failing health care system.

At this point, the choice of secretary may seem meaningless to some veterans who have watched countless Veterans Affairs secretaries take the helm and guide the ship in circles. The wind has been taken out of the sails of VA by scandals, congressional critique, budget overruns, and numerous patient complaints. While VA sits dead in the water, it needs more than just money and hot air from another politician to fill the sails. The new secretary should look at innovative approaches to veteran care by leveraging strategic partnerships with universities, academic medical centers, and community agencies who employ doctors with extensive VA training experience.

Almost 125,000 physicians, psychologists, clinical pharmacists, and other health professions trainees receive a large majority of their training within VA each year. During that clinical education, trainees provide a sizable portion of the VA’s clinical services and receive excellent training in evidence-based medicine and behavioral health.

Four of my six years of clinical psychology training were anchored within VA. The VA was where I received some of the best education a burgeoning young doctor could ask for. The VA was where I met my mentors who have spent years treating veterans, conducting research, and overseeing departments full of doctors and trainees.

In my last year of training at VA, I shared an office with seven other post-doctoral trainees, all of whom have the clinical skill and ability to treat Veterans within any clinical setting utilizing the latest in evidence-based approaches. Of the eight fellows in our class, only one is now employed by VA. For myriad reasons – lack of available positions, sub-par compensation, and burnout to name a few- these young, talented, and motivated doctors have left the VA system and moved into academic medicine, community agencies, and private practice.

Some of the top contenders for secretary have withdrawn from consideration, leaving the president-elect and his transition team to continue the search or seriously consider keeping current Secretary Robert McDonald. Whomever the choice, the secretary would be well-suited to consider options that expand public-private partnerships, but with some intensive selection criteria. The secretary should choose to leverage partnerships with universities, academic medical centers, and practices who are filled with VA-trained clinicians and researchers who also maintain the requisite competence in treating this population.

If the secretary wanted to start reform within the walls of VA, they could fund and expand the VA’s innovative and successful Academic Patient Aligned Care Teams where copious amounts of interns, residents, and fellows from medicine, psychology, pharmacy and nursing work collaboratively under intensive supervision, all while holistically addressing the needs of veteran patients within primary care clinics.

Outside of VA, many of our large academic medical centers employ young doctors fresh out of residency and fellowship training within VA and reap the benefits of their years of evidence-based and inter-professional healthcare education provided by the immense training infrastructure within VA. These jobs, along with private practice, provide two appealing and potentially lucrative career options for young doctors from all professions who have racked up massive student loan balances after years of education, training, and very little sleep. Additionally, there are university-based clinics full of VA-trained clinicians who teach in the classroom and exam room about the unique health disparities endemic to this population but struggle to fill their training clinics with veteran patients because initiatives like the Veterans Choice program are cumbersome, confusing and frustrating for clinicians and patients alike.

The secretary should direct VA to partner with academic medical centers, university-based clinics and private practices who employ doctors that received VA training during their education and to prioritize these partnerships over other community agencies who may employ providers who do not have the requisite exposure, training and cultural competence in treating this population. Taking this approach could alleviate some of the strain within VA, allow for veterans to receive evidence-based and culturally competent healthcare, leverage the strengths of many talented healthcare professionals who have trained with VA, all while ultimately providing Veterans with the care they deserve.

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