Physician Staffing for the VA Volume I (1991) / Chapter Skim
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9 - AFFILIATIONS WITH MEDICAL SCHOOLS
9 - AFFILIATIONS WITH MEDICAL SCHOOLS
Pages 343-362
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From page 343... ...
Thus, the affiliation agreements have facilitated the incorporation of teaching and research functions as formal components of the mission of the VA health care system. To reflect the integral part that affiliations play in the physician staffing for most VAMCs, the original planning study, which generated the scope of work for this study, gave important attention to medical school affiliations.
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From page 344... ...
staffing requirements for patient care to take account of the loss of staff time for teaching students and the gain in patient care services provided by residents. The second would examine the broader implications for the VA health care system of its medical school affiliation agreements.
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From page 345... ...
- Because the affiliated institutions are mostly tertiary care facilities, do affiliations serve the primary care, rehabilitation, and chronic care (including psychiatric) needs of the population served by the VA?
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From page 346... ...
Well known to many deans and university professors in medical schools across the country, Dr. Magnuson drafted a plan to have medical school deems supply the staff for the VA's hospitals, and determined that he could have the first two such affiliation agreements operational within six weeks.
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From page 347... ...
group indicate only undergraduate medical student training rather than the presence of residents; a number of others list several staff physicians who have faculty appointments at the affiliated medical school, but apparently train neither students nor residents within the VA hospital itself. At the other end of the continuum are the large urban tertiary care VAMCs, which typically train 100 to 150 residents in many different specialties, as well as large numbers of medical students in clerkships, and trainees in many other health professions.
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From page 348... ...
In order to estimate the magnitude of physician effort that these arrangements represent to the VA system, the affiliations panel conducted a series of four site visits in November 1989 and a mail survey of 24 VAMCs in February 1990 to help clarify the contribution of C&A and WOC physicians. Four large, highly affiliated facilities were visited.
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From page 349... ...
Most of the research is separately budgeted, either through VA research funds or from external sources. Although physician time spent in research is often not accounted for in the VAMC's personnel budget, it is explicitly estimated in the facility's Cost Distribution Report.
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From page 350... ...
The relatively low FTEE for C&As and WOCs, as reported earlier in this chapter, probably does not reflect the important role non-VA physicians play in providing coverage at the affiliated VAMCs. The use of residents also provides substantial patient care services at lower rates than equivalent full-time physician services purchased on the open market or provided through VA physician staff.
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From page 351... ...
And, any proposed change would have to bear the burden of proof that the alternative approach would do the job as well. Access to Highly Qualified Physicians Across the Whole Spectrum of Health Services, Including Recruitment and Retention of VA Physicians The complex arrangements for providing physician services under the affiliation agreements involve faculty appointments, teaching and research
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From page 352... ...
It was not part of this committee's charge to look in detail into the recruitment and retention of VA physicians. However, the committee firmly believes that if the VA attempted to staff the currently affiliated VAMCs by some way other than through the affiliations, the recruitment and retention of equally qualified physician staff would be much more difficult.
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From page 353... ...
Again, the committee notes that, because many VAMCs are tied so closely to tertiary care medical environments, special attention may need to continue to be given to overcoming particular problems with the pattern of care typical of the teaching affiliation environment.
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From page 354... ...
Consequently, any deemphasis of affiliations that signals-correctly or not that the VA has narrowed the scope of its mission could raise questions about the net benefit to American society of its substantial tax investment in the VA health care system. Policy on Lack of Affiliation in Some Institutions The affiliations panel reports a growing feeling on the part of the unaffiliated hospitals that they are being treated as "second class citizens.
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From page 355... ...
The benefits include: An improved ability to attract and retain well-qualified physicians and other health professionals; A wide spectrum of services provided by a pool of highly qualified physicians, both those on the VA staff and those whose services are made available to the VA through other relationships with the medical schools; Access to state-of-the-art tertiary care; Participation in the education of physicians, which is a mandated part of the VA mission and which cannot realistically take place currently in the absence of affiliations; Participation in medical and health services research, resulting in contributions to the advancement of medical knowledge and improved health services that benefit the general population as well as veterans.
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From page 356... ...
These indicators will be critical, not only for the full development of the physician requirements methodology, but also for a more definitive evaluation of the effect of affiliations on the quality of care. The development of structure and process measures such as information on board eligibility and board certification, analysis of the matrix of quality measures and scores utilized by JCAHO, and further refinement of the availability of specific clinical services within all VA facilities may all be useful interim steps.
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From page 357... ...
Such arrangements would be consistent with the intent to extend the purposes of affiliations beyond providing access to acute services and state-of-the-art tertiary care. The committee believes that this extension represents an exciting opportunity for the VA that could help meet some of the staffing needs that are likely to be identified through the application of the proposed physician requirements methodology.
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From page 358... ...
medical schools and the Veterans Administration. Alabama Journal of Medical Sciences 24:83-88.
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From page 359... ...
AFFILIATIONS WlTTI MEDICAL SCHOOI-S 359 TABLE 9.1 Mean Percentage of Physician FTEE Allocated to Direct Patient Care, by Specialty and RAM Group, for FY 1989 RAM Group Physician Specialty 1 2 3 4 5 6 Medicine 71.7 92.1 55.1 80.7 61.7 90.3 Surgery 72.4 92.3 61.4 81.9 67.4 71.5 Psychiatry 74.4 91.2 70.6 85.0 71.1 91.0 Neurology 65.0 2 69.0 82.8 69.0 79.7 Rehabilitation Medicine 96.0 92.3 81.7 92.9 81.1 93.1 Anesthesiology 93.3 97.8 78.8 91.2 77.5 79.2 Laboratory Medicine 86.9 94.8 71.8 87.6 83.5 90.8 Diagnostic Radiology 88.7 91.6 82.1 90.7 83.0 95.0 Nuclear Medicine 78.2 83.6 76.5 93.2 77.0 87.1 Radiation Oncology 2 2 88.4 2 79.5 2 tData derived from VA Cost Distribution Report. 2No direct patient care FTEE reported in this hospital group.
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From page 360... ...
~ P ~ys~c~" Specialty 1 2 3 4 5 6 Medicine 12.8 2.0 20.1 8.4 17.3 2.8 Surgery 19.1 2.9 23.1 8.4 21.4 7.4 Psychiatry 11.4 0.9 15.6 6.4 14.9 3.8 Neurology 15.7 2 13.1 6.6 14.8 8.8 Rehabilitation Medicine 1.0 0.8 11.4 1.5 10.3 0.8 Anesthesiology 6.0 1.2 14.9 6.0 16.7 8.1 Laboratory Medicine 5.2 0.8 11.4 1.6 5.3 1.4 Diagnostic Radiology Nuclear Medicine Radiation Oncology 4.9 7.9 4.4 1.7 2 2 8.4 9.7 5.5 10.4 9.4 3.5 11.4 9.7 3.8 2 7.5 2 tFTEE for education is defined as the sum of FTEE allocated in the Cost Distribution Report to the three Education & Training" categories of Instruction, Administration, and Continuing Education.
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From page 361... ...
AFFILIATIONS WITH AfEDICHL SCHOOLS 361 TABLE 9.3 Mean Percentage of Physician FTEE Allocated to Research, by Specialty and RAM Group, for FY 1989i RAM Group Physician Specialty 1 2 3 4 5 6 Medicine 10.7 0.0 21.1 2.7 16.8 1.1 Surgery 3.3 0.0 12.9 2.7 8.7 1.1 Psychiatry 4.8 0.7 10.1 1.7 10.2 1.6 Neurology 13.3 2 15.7 4.9 13.8 8.1 Rehabilitation Medicine 0.2 0.0 4.1 0.3 3.1 0.0 Anesthesiology 0.1 0.0 5.0 0.8 5.1 1.6 Laboratory Medicine 2.3 0.0 8.8 4.2 5.8 0.4 Diagnostic Radiology 0.6 0.0 4.8 0.7 4.5 0.0 Nuclear Medicine 8.3 0.7 10.3 1.0 7.6 1.3 Radiation Oncology 2 2 2.6 2 4.2 2 tData derived from Cost Distribution Report. 2No direct patient care FTEE reported in this hospital group.
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From page 362... ...
Defined in this study to include all programs and services not classified as high tech. SOURCE: Clinical inventory conducted in 1990 by the VA Commission on the Future Structure of Veterans Health Care (see "References" above)
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