I'm late to the game here. I recently started working as a doc at the VA after a 23 yr career owing my own practice. THE VA IS THE ABSOLUTE DUMBEST PLACE YOU WILL EVER WORK! I find the providers are good. But the 'big brother' admin are the dumbest of the dumb.
Now, I'll explain. Their CPRS (computerized patient record system......that the rest of us on planet earth call EMRs) is a 1997 ridiculous outdated MS DOS charting system. The VA/gov't recently spent......no wasted....$80 BILLION to try to come up with a new system as they know it's horrible and causes most doctors to end up quitting. It failed. So, 80% of my time is clicking a mouse, typing and copy-n-pasting non-stop. I've actually counted them. 420+ (minimum) mouse clicks for the average patient. 6,200 clicks per day. 31,000 clicks per week. After using EMR for 23 years my fingers actually have bruises on the pads from the 8 straight hours of non-stops clicking.
In between the non-stop clicking and typing, I peek at patients. But make no mistake, patients are secondary at the VA. Or actually tertiary. Doing stupid training is first ('How to Answer the Phone', 'How to Deal with Irate Patients', 'Showing Respect to Your Fellow Human'. Totally insulting to the intelligence-- stupid training that I have to find time to do in between my pts or during my 30-minute lunch. So that's priority # 1. An idiot admin actually told me to give her my cell number and she's arrange that I could do my 40 hours of training at home -on my own time. I laughed and laughed and laughed. No freaking way I'm doing the VAs work on my own time. This is the reason I sold my private practice.....to get rid of the admin hassles. But it's 100 times worse here. I even still have to code the insurance and write up the constant PAs (prior authorization) for the pts to get their meds. I might as well be in private practice and make more money doing the same work. And that's exactly what I'm going to do.
Priority #2
Documenting the chart. Non-stop, ridiculous amount of documenting. Then they have "Chart Reviewer" that constantly harasses you to document it this way or that way. I ran into a former pt of mine in the hallway. She told me that SHE was the head of these idiot Chart Reviewers. I happen to know, over the 23 yrs of see her and her family, that she is one of the dumbest people on earth. The kind of patient you cringe when you see on your schedule. I know these 'reviewers' are telling me incorrect things. I've documented for 23 yrs, wrote a book on insurance coding and survived 2 Medicare audits with flying colors. I KNOW how to document and code! But I/we have ******* high school grads telling me I need to do this or than on my charts. Put this or write it this way. They have zero experience in medical care. Just hired off the street and, instantly become your BOSS! This charting in an inefficient and outdated system and the constant harassment is what causes MOST doctors to quit. The charts are basically a Word document so you are writing a small book on each patient (even with templates).
I have to open 9 different programs on my computer each morning just to start the day. Sometimes they work. Sometimes they don't. The place is paperless so you have 25-35 random people messaging you on the computer non-stop all day, needing this or that or whatever. The printers are all locked in rooms. Why they lock up $100 printers is beyond me. So anytime the needy, whiny pt needs something printed, it a hassle.
Priority # 3 is Patient Care. It's an afterthought. I have 10 minutes to see the patient and it take 30+ minutes to document the encounter.
There are very few people in charge at the VA. We have no boss. No one in charge of the clinic where I work. 70% of employees are admin people and they all seem to have only ONE job each. Absolutely no cross-training. So, to get anything done, you are jumping from employee to employee to employee. They will all 'pass the buck' to the next person.
I could go on and on (but my typing fingers are too sore). I'm quitting the VA after 2 months. My goal in life now is to stop any doctor from wasting their time going there. It takes anywhere from 6 months to a full year just applying. Again, a ridiculous process which should have told me how bad it would be. Only when providers refuse to work there will it change. So, by me staying there, I would be contributing to the problem.
I worked at the VA part-time in 2003. I thought that maybe it would have improved in 20 years.........but it hasn't.
The only doctors that survive there are those that are meek and mild and are raised by the VA (having done their training there and just never leaving). Those that are insecure in their skills and need 'big brother' to run their lives (not surprisingly, all docs in my clinic are female these days). Frankly, I think the docs that survive have developed 'Stockholm's Syndrome' where they fell in love with their abuser/capture (the VA). I feel sad for them.
And I can't end this without saying something. The patients at the VA are NOT HEROs. They are welfare recipients using the VA instead of Medicaid. If you work there, you will be working in a welfare clinic 100%. I feel I can say this as a Marine Corp combat veteran myself. These pts are the most entitled people on earth, that for some reason, think/have been told that a few years in the Army should endow on them a free lifetime of medical care and thousands of dollars of meds and appliances per year. We even send them free supplies of artificial tears automatically in the mail.
There is no need for the horribly inefficiently run gov't VA system. It's always been flawed and always will be. If the gov't wants to pay for veteran care, they should just pay outside providers. It would be far less expensive in the long run.
