Physician Staffing for the VA Volume II, Supplementary Papers (1992) / Chapter Skim
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Section II: Affiliations Panel ReportAffiliations Panel Report
Section II: Affiliations Panel ReportAffiliations Panel Report
Pages 393-418
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From page 395... ...
Teich INTRODUCTION As a part of the broader charge by the VA to the Institute of Medicine for the study of physician requirements, the study committee was charged with examining the impact on physician manpower requirements of Changes in the number, type, and intensity of VA-medical school affiliations.. The work plan for the study states: ~There are two sorts of analyses essential to the development of a methodology for determining physician staffing requirements associated with the VA education/train~ng mission.
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From page 396... ...
What is clear, in the Panel's judgment, is that the affiliation arrangements are integral to the effective functioning of He VA health care system at the current time, and that He overall effect of these amogements on the recruitment and retention of highly qualified physicians and on the provision of many Apes of medical care has been beneficial. BACKGROUND AND HISI ORY OF VA-MEDICAL SCHOOL AFFILIATIONS The principles and concepts regarding affiliation agreements between the VAMCs and U.S.
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From page 397... ...
Well known to many of the deans and university professors in medical schools across the country, Dr. Magnuson drafted a plan to have medical school deans 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 398... ...
group indicate only undergraduate medical student training, rather Man 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, many of which train 100 or 150 residents in many different specialties, as well as large contingents of medical students on clerkships, and trainees in many other health professions.
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From page 399... ...
Underlying these questions Me other, more subtle issues regarding the ways in which affiliations affect physician staffing paladins. It appears, for example, that He more highly affiliated a VA hospital is, the more likely it is to employ large numbers of pad-time rather In full-time 'staff physicians.
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From page 400... ...
of the VA by expecting VA hospitals to provide teaching and supervision as well as substantial research space, which is difficult to find in the schools themselves. Further, some VA personnel express the fear that medical schools are usurping control of affiliated VA hospitals through the existence of Dean's committees, and the influence which these committees may exert over hiring of VA staff physicians and over the dayto~ay functioning of the hospitals.
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From page 401... ...
Affiliations Panel staff explored current literature on a number of these measures, as well as the availability of such data within the VA system. The panel determined that it would be of great benefit to the VA to be able to conduct analyses related to medical care outcomes, although data collected currently by the VA may not be adequate to do so.
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From page 402... ...
The significance of the contribution of these C&A and WOC physicians should not, however, be underestimated; most often, they represent highly skilled subspecialists to which the VAMC has access only through this amngen~nt. Their presence in the VAMC is of vital importance to VA staff physicians with respect to staff morale, as well as access to State of-the-art medical expertise and technology.
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From page 403... ...
one. The chief of surgery at one VAMC Stint that between 40 and 50 percent of the surgical procedures at his facility are supervised or performed by WOCs; it was estimated at another VAMC that 40 percent of the patient care time in medicine and its subspecialties is being contributed by WOCs.
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From page 404... ...
At the request of the data and methodology panel, affiliations panel staff subsequently conducted a written survey of 24 facilities in order to substantiate the preliminary findings regarding C&As and WOCs. (The survey questionnaire is shown in the Appendix to this section.)
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From page 405... ...
service, or facility type were not available for analysis; further, it was felt that the implications of these alternative types of staffing a~angem~ts could be Outstood only Trough in-pemon discussions with VA staff at various facilities. Affiliations panel membe" felt that this information regarding the distribution of full-time versus part-dine physicians, and the question of whether the time they contribute is accurately represented by the neighed in the existing VA data systems, would contribute to our understanding of how VA staff physicians function.
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From page 406... ...
Allocation of physician time within affiliated VAMCs. Another issue of concern to the Affiliations Panel was the question of the allocation of physician time among patient care, msearch, and teaching activities in affiliated facilitie~the so called Joint product.
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From page 407... ...
Although detailed information on residency positions is available through the VA data systems, comparable data on numbers of medical students who do clerkships in VA hospitals is not maintained in any systematic way. Since medical student clerkships do represent a substantial amount of teaching and supervision time for VA staff physicians, the affiliations panel attempted to gather information during its site visits on the number of students doing clerkships, and the amount of staff effort required by the supervision and teaching of medical students.
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From page 408... ...
~8 ~ ~ ~ ~-~ As_ ~'_~, pa_ ~ ~ -_ ~ -~ ~ ~ I
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From page 409... ...
would be the best way to approach the issue; the question was explored during the interviews during the final eight VAMC site visits. Clearly, there is widespread concern among VA staff that any changes which curtail or eliminate affiliation relationships would result in serious negative consequences for affiliated VAMCs, as well as for the nation's medical schools.
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From page 410... ...
It was frequently stated that VAMCs would not be able to deliver the same level and range of acute tertiary care services which they now provide if Hey did not have medical school affiliations. Over time, facilities would probably be limited to care for chronic patients.
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From page 411... ...
As the veteran population ages and resources become more scarce, which of these missions should take precedence? Historically, affiliations have been concen~1 in institutions which provide specialized, tertiary care; the VA,s own projections, however, indicate Hat He need for short-term, acute tertiary care As will decrease over the next few decades, while needs for long-term and chronic care will increase.
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From page 412... ...
CONCLUSIONS AND RECOMMENDATIONS Conclusions For purposes of this study, the network of affiliation relationships between VA hospitals and medical schools has been considered from two perspectives: first, Heir relationship to physician requirements within VA facilities; and second, their overall impact on He VA health care system.
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From page 413... ...
Data and impressions gathered during numerous site visits by the affiliations panel indicate that the benefits of affiliation are generally perceived as: Improved ability to attract and retain well-qualified physicians; · ability to provide state-of-the-art tertiary care; · increased access to a wide spectrum of services and a pool of highly qualified physicians, as well as to other, ~hidden. resources of the medical schools;
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From page 414... ...
Re comm en d at lo D s 1. The Panel recognizes the significant value of the affiliation agreements to the VA health care system, and strongly recommends Hat these
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From page 415... ...
3. The panel recommends that, while maintaining and promoting He tertiary care model of affiliations in VAMCs where it is appropriate, the VA should also work to develop new and innovative models of affiliation, targeted specifically to long-term care, ambulatory care, and rehabilitation.
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From page 416... ...
416 ~-~o ~e _ _i~ of ~ M~ In.
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From page 417... ...
attending physicians on your service or section: Number of WOC visits to VAMC/month (for patient care conferences, teaching rounds, clinics, etc.~: Average number of hours per WOC visit: Estimated number of WOC FTEE on your service per month (derived from questions 1 and 2 above3: 4. Estimated number of patients seen per month at VAMC by WOCs: a.
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From page 418... ...
DAVID H LAW, Deputy Associate Deputy Chief Medical Director for Hospital Based Services, Department of Veterans Affairs, Washington, D.C.
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