Is There A Doctor Shortage?

[Lawgiver]

Genius, lazy, world is ending = This thread summary. Waiting for the 100% serious thread inviting all med students to come drink cool aid in a cave in South America.

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[DarknightX]

To me, this is akin to a religious belief. It's like quoting the Qur'an to decide treatment for a patient. I just can't wrap my mind around this mentality.

NASA, the highway system, etc. are all massive boons to our economy and well being. Hell, most of the medical treatments in this country are based upon government-funded research (NIH, NSF, etc.) and a massive portion both of your training (residencies) and of the patients care you provide (Medicare) will be paid for with government money. Government research designed the very medium by which we are communicating (DARPA), one that has now given rise to hundreds of billions of dollars in economic activity. The fact is that many, many private industries wouldn't exist (or would be feeble) were it not for government-run projects.

Obviously, the government shouldn't do everything, but it history has shown that it can provide foundational support for many industries and systems.

EDIT: In fact, your very avatar provides an example of a highly successful, large scale government operation--maybe the biggest of them all!

Any argument defending government and healthcare can easily be reputed using 2 words.

The VA.

 

[PL198]

Genius, lazy, world is ending = This thread summary. Waiting for the 100% serious thread inviting all med students to come drink cool aid in a cave in South America.

nah south america is where we blow up our mines when people piss us off

people that understand this reference, I love you

 

[Corpsman]

I would call NASA, the interstate system and medicare all huge screw ups... I'm never going to buy into the government doing anything successfully till they manage to actually budget and plan something sufficiently. Until that happens, 0 faith. So easy to do successfully, just need competent people. Too bad gov't jobs generally drive those people away and get the inferior ones.

The human genome project, funded and run by the NIH was completed under budget and ahead of schedule. It has proven somewhat useful to the field of medicine. There is your example.

 

[Lawgiver]

Im starting to think PL198 is a 21 year old Rush Limbaugh impersonator.

thx derm.

 

[DermViser]

Im starting to think PL198 is a 23 year old Rush Limbaugh impersonator.

21 year old.

 

[PL198]

The human genome project, funded and run by the NIH was completed under budget and ahead of schedule. It has proven somewhat useful to the field of medicine. There is your example.

great, so we're 1/millions of projects the government funds. you're right, just saying there's a whole lot of pork

 

[DermViser]

great, so we're 1/millions of projects the government funds. you're right, just saying there's a whole lot of pork

Most of the work was done by scientists and physicians, not govt. workers.

 

[blackkrim]

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[DermViser]

Scientists and physicians employed by the government or using government funding. C'mon, man...

I don't think of famous research scientists and physicians at the NIH on par with govt. employees like the TSA, the passport office, etc.

 

[PL198]

enron happened because of a lack of free enterprise, not because of free enterprise...

 

[DermViser]

This is like saying: "Any argument in favor of free enterprise can be reputed using one word: Enron."

It simply has no basis in reason. The VA screwed up--badly--but many veterans would be entirely or largely without healthcare in its absence. Moreover, the failure of one government program or department shouldn't inherently damage the reputations of other programs any more than the fraud committed by one private business should castigate some other private enterprise. Nobody attacks capitalism simply because some businesses behave badly...

Yeah, except the VA, IS THE example of a completely single payer system in America. Veterans can't go outside the system, without paying out of pocket. Up until the VA scandal, liberal policy wonks, bloggers, politicians were hailing the VA as THE STANDARD that medical care in America should strive to be. Funny how all of a sudden, those people are so quiet now. Huh. I wonder why.

And this wasn't an isolated foul-up either. We now know that this was a SYSTEMIC failure in the VA caught on many levels and which NOTHING was done about it and in which deficiencies were papered over and data was unethically manipulated.

 

[blackkrim]

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[DermViser]

There's another example of single payer, though, and a much better one: Medicare. Beyond that, there's the other developed countries worldwide with single payer systems that by-and-large see high satisfaction and excellent provision of care. When I temporarily lived in one of them, I experienced it firsthand and that's a lot of what changed my mind about healthcare in America.

You are correct, though, that these sorts of programs should be carefully overseen and be very open access. I don't know exactly how such a system should work (maybe another country has one already?) but independent, public oversight and access to budgeting/outcome data may prove useful in preventing systemic problems like we saw at the VA. Congress (and the President) really dropped the ball.

Medicare is an insurance plan that is accepted by private hospitals as well. Not just public hospitals. If you're in the VA you have to go to a VA hospital. PERIOD. You can't go outside the system w/o paying out of pocket, which most can't.

Medicare ALSO has a lot of bureaucracy, waste, and a backlog as well. I realize it's easy for you to think a "Medicare for all" is the solution to all our problems, but it's not. It has very real and serious problems which has been discussed ad nauseum on the news and by policy wonks.

The VA purposefully manipulated outcome data for the purposes of looking like they were meeting mandates and for salary bonuses. There are emails corroborating that this was pure deception. Unfortunately for them, veterans died bc of that deception. How would you feel if it was your father who died of bladder cancer as told in the CNN story due to this chicanery? Or are these people who died bc of VA malfeasance just lost collateral to you?

 

[blackkrim]

Medicare is an insurance plan that is accepted by private hospitals as well. Not just public hospitals. If you're in the VA you have to go to a VA hospital. PERIOD. You can't go outside the system w/o paying out of pocket, which most can't.

Medicare ALSO has a lot of bureaucracy, waste, and a backlog as well. I realize it's easy for you to think a "Medicare for all" is the solution to all our problems, but it's not. It has very real and serious problems which has been discussed ad nauseum on the news and by policy wonks.

The VA purposefully manipulated outcome data for the purposes of looking like they were meeting mandates and for salary bonuses. There are emails corroborating that this was pure deception. Unfortunately for them, veterans died bc of that deception. How would you feel if it was your father who died of bladder cancer as told in the CNN story due to this chicanery? Or are these people who died bc of VA malfeasance just lost collateral to you?

So the VA is like the NHS in Britain, which isn't the system I'm advocating for here. Some have been repackaging "single payer healthcare" as "Medicare for All," which may make it sound less scary. Many such models would still allow for private hospitals, physicians' groups, etc., they would just be the de facto insurance provider for every American (not just the elderly).

Some officials in the VA did what they did because of the perverse and poorly aligned incentives built into the system (as you said, salary bonuses and asinine mandates). Those need to be fixed, the people responsible obviously need to be held accountable, and oversight needs to be improved. To that end, I'm not necessarily opposed to the idea of making the VA operate more like Medicare. Ideally, it wouldn't be necessary anyways because single payer would cover everyone, veteran or not.

What is your proposal? Do we just eliminate all such programs (since government is incompetent!) and make all veterans purchase their own insurance with their own money?

To your last paragraph: Obviously, I'd be upset if my own family fell victim to this. I was criticized earlier for creating a scenario based partially on emotion (the hypothetical about the homeless man), but now you're playing the same game. So to retort: How would you feel if your father couldn't afford insurance (or was denied it due to a preexisting condition) and therefore couldn't pay for the life-saving operation he needed? How about if his operation were delayed due to private insurance chicanery?

 

[DarknightX]

[QUOTE


This is like saying: "Any argument in favor of free enterprise can be reputed using one word: Enron."

It simply has no basis in reason. The VA screwed up--badly--but many veterans would be entirely or largely without healthcare in its absence. Moreover, the failure of one government program or department shouldn't inherently damage the reputations of other programs any more than the fraud committed by one private business should castigate some other private enterprise. Nobody attacks capitalism simply because some businesses behave badly...[/QUOTE]

You think it's just one incident that gives the VA a bad name???

Come on man.

Clearly you've never set foot or worked in any type of healthcare. Anyone whose ever worked at the VA knows it's a joke.

Go see some patients and then maybe you can come to reality instead of happy premed land.

 

[DermViser]

You think it's just one incident that gives the VA a bad name???

Come on man.

Clearly you've never set foot or worked in any type of healthcare. Anyone whose ever worked at the VA knows it's a joke.

Go see some patients and then maybe you can come to reality instead of happy premed land.

Any third year medical student who has rotated in a VA knows how bad the care is there. The politicians who say how the VA has such "great" outcomes are lying and we now know that the VA cooks the books in its best interest. This isn't the only time they've had problems. It is a systemic, cultural problem that no amount of throwing money at it will solve. I swear it's truly where hope goes to die.

 

[DermViser]

So the VA is like the NHS in Britain, which isn't the system I'm advocating for here. Some have been repackaging "single payer healthcare" as "Medicare for All," which may make it sound less scary. Many such models would still allow for private hospitals, physicians' groups, etc., they would just be the de facto insurance provider for every American (not just the elderly).

Some officials in the VA did what they did because of the perverse and poorly aligned incentives built into the system (as you said, salary bonuses and asinine mandates). Those need to be fixed, the people responsible obviously need to be held accountable, and oversight needs to be improved. To that end, I'm not necessarily opposed to the idea of making the VA operate more like Medicare. Ideally, it wouldn't be necessary anyways because single payer would cover everyone, veteran or not.

What is your proposal? Do we just eliminate all such programs (since government is incompetent!) and make all veterans purchase their own insurance with their own money?

To your last paragraph: Obviously, I'd be upset if my own family fell victim to this. I was criticized earlier for creating a scenario based partially on emotion (the hypothetical about the homeless man), but now you're playing the same game. So to retort: How would you feel if your father couldn't afford insurance (or was denied it due to a preexisting condition) and therefore couldn't pay for the life-saving operation he needed? How about if his operation were delayed due to private insurance chicanery?

Really? You think the VA did what they did bc the "incentives" weren't right? All that's needed is more oversight or more money? Really? Wow, you are so naive.
I would take the worst private hospital over the VA any day, no question.

 

[blackkrim]

Really? You think the VA did what they did bc the "incentives" weren't right? All that's needed is more oversight or more money? Really? Wow, you are so naive.
I would take the worst private hospital over the VA any day, no question.

Great of you to ignore everything else I wrote. The VA is besides the point, because it has nothing to do with single payer healthcare as a larger issue.

And yes, I think that poorly aligned incentives along with bad management led to the cheating and corner-cutting involved at the VA. That's not naivety, that's basic human psychology: we respond to incentives within systems. If you want to fix a system--whether it's a private business or a government agency--you correct the incentives and apply good, transparent management principles. Do you think that everyone who works for the VA is a malicious soul looking to kill veterans?

Again, I pose this challenge to you: if the VA is so miserable, what should we do to fix it? Shall we simply eliminate it and make veterans pay for healthcare from their own pockets?

 

[DermViser]

Great of you to ignore everything else I wrote. The VA is besides the point, because it has nothing to do with single payer healthcare as a larger issue.

And yes, I think that poorly aligned incentives along with bad management led to the cheating and corner-cutting involved at the VA. That's not naivety, that's basic human psychology: we respond to incentives within systems. If you want to fix a system--whether it's a private business or a government agency--you correct the incentives and apply good, transparent management principles. Do you think that everyone who works for the VA is a malicious soul looking to kill veterans?

Again, I pose this challenge to you: if the VA is so miserable, what should we do to fix it? Shall we simply eliminate it and make veterans pay for healthcare from their own pockets?

It's bc most of your post was bloviation. If you think the VA (the prototype example of single payer healthcare in this country) has nothing to do with "single payer healthcare as a larger issue" then there is absolutely no point in discussing this with you further. The VA killed people due to their vast incompetence and deliberate covering up the truth of their wait times and outcomes. At least in a private business, there will be a lot more forces in place for "good, transparent management principles."

The govt. has no "good, transparent management principles" bc there are no forces in place to do so. It takes forever (if at all) to fire an incompetent govt. employee. The only reason we even knew about the VA scandal is bc a retired physician from that VA whistleblew on what was happening.

I like how you say, "if the VA is so miserable" as if it's an actual question now. Have you EVER actually rotated at the VA as a medical student? Oh, wait, no bc you're premed. There was a bill in Congress (don't know if it passed) for veterans on long waitlists to bypass the VA system and go straight to private hospitals so they can be seen. Another option is for the govt. to pay for private health insurance for veterans so they can go to private hospitals.

 

[blackkrim]

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[DermViser]

It's because you don't actually have a response to most of the things I've written. As I've said, the VA is a very distinct type of single payer healthcare (single payer + single provider) that I haven't actually been arguing in favor of. You've repeatedly ignored or misconstrued what I've written throughout this thread. I've only kept responding here because I've been watching you do this in many other threads and I'm a sucker for the red meat you've thrown out repeatedly.

Funny, that ("no forces in place to do so") sounds an awful lot like poorly aligned incentives...

No, but it doesn't matter that I haven't because this isn't a matter of medical knowledge, which you obviously have more of than I do. You're making a very specious argument from authority here and your constant reference to my lack of medical credentials just exposes how poorly your arguments are supported.

The crazy thing is that what you are proposing is (surprise!) single payer healthcare for veterans! The big, bad government pays private hospitals, etc. for services provided. You may not actually be disagreeing with me at all!

Wow, so much wrong, it's not even worth responding to. The VA is not a "distinct" type of single payer. It IS single payer. As a veteran, you can't go "outside the system". In a country that adopts single payer, you can't go outside the system.

No, "no forces in place to do so", means there is no accountability. It's not something you can write into a law. In a private business, the company loses money? Heads roll, people get fired. In any govt. controlled entity, no one ever gets fired and incompetence compounds itself. The VA inspector general was not allowed to fire anyone for incompetence. That would be UNHEARD OF in any private business.

This has nothing to do with "medical knowledge". You have never been in a VA, you have never rotated in a VA, and you have never shadowed in a VA. Bc if you did, you would see exactly the level of incompetence and bureaucracy that exists at the place from top to bottom.

Govt. buying and paying the premiums for private health insurance (meaning health insurance from private companies) for veterans is not equivalent to govt. single-payer healthcare (in which govt. is the third party payer) for veterans. If you can't see that, then there is no helping you.

 

[KinasePro]

These damn zeke emmanuel threads get me every time.

 

[blackkrim]

Wow, so much wrong, it's not even worth responding to. The VA is not a "distinct" type of single payer. It IS single payer. As a veteran, you can't go "outside the system". In a country that adopts single payer, you can't go outside the system.

That isn't true. Canada and Australia are great examples of systems in which the government acts as the payer and private hospitals act as providers. Both are very successful and have high levels of care and satisfaction. Anecdotally, when I lived in one of these countries, I had nothing but fantastic experiences.

What you're thinking of is single payer/single provider systems like the NHS in Britain. Nonetheless, I believe that they have private providers you can pay for out-of-pocket, and even with this single provider system (which I'm less inclined toward) they experience high satisfaction.

No, "no forces in place to do so", means there is no accountability. It's not something you can write into a law. In a private business, the company loses money? Heads roll, people get fired. In any govt. controlled entity, no one ever gets fired and incompetence compounds itself. The VA inspector general was not allowed to fire anyone for incompetence. That would be UNHEARD OF in any private business.

I'll agree with you that there are problems with accountability in some government programs. I think where we differ is that I don't think these are insurmountable, and (having extensive experience in private industry) I don't think that private businesses are entirely divorced from these same problems. Hell, a lot of my job is advising companies on this very issue...

This has nothing to do with "medical knowledge". You have never been in a VA, you have never rotated in a VA, and you have never shadowed in a VA. Bc if you did, you would see exactly the level of incompetence and bureaucracy that exists at the place from top to bottom.

The plural of anecdote isn't data. I only care about data. Firsthand experience is emotionally illustrative, but that's it. The funny thing is that despite the whole scandal, patient satisfaction with the VA is reasonably high.

Govt. buying and paying the premiums for private health insurance (meaning health insurance from private companies) for veterans is not equivalent to govt. single-payer healthcare (in which govt. is the third party payer) for veterans. If you can't see that, then there is no helping you.

Sure it is. The cost is ultimately falling upon the government, which means that the government is the ultimate payer of all (or most) veteran healthcare expenses.

 

[KinasePro]

That isn't true. Canada and Australia are great examples of systems in which the government acts as the payer and private hospitals act as providers. Both are very successful and have high levels of care and satisfaction. Anecdotally, when I lived in one of these countries, I had nothing but fantastic experiences.

Anecdote usage noted.

You're distinction is a non-sequitur. The VA analogy works for the canadian and austrailian systems, too. Don't like the Memphis Va? Then go to the Mountain Home or Nashville VAs. There's your second and third providers funded by the same payor.

The plural of anecdote isn't data. I only care about data. Firsthand experience is emotionally illustrative, but that's it. The funny thing is that despite the whole scandal, patient satisfaction with the VA is reasonably high.

Criticism of anecdote usage noted....

Anyway, what does that patient satisfaction data tell us? Probably that our mechanism for measuring patient satisfaction in VA patients is crappy. It's sexy to demand data and ignore anectdote, all the wonks and academics love to do it. But that assumes that your data is high quality, and ignores that anecdote reflects experience and is less convoluted. As someone who's actually practiced some medicine, I'd trust a seasoned clinician over a sexy NEJM article any day of the week. The plural of anecdote IS valuable in situations that are staggeringly complex.

Besides, have you ever read the JAMA article on patient satisfaction? Higher the patient satisfaction, higher the mortality risk.

 

[DermViser]

That isn't true. Canada and Australia are great examples of systems in which the government acts as the payer and private hospitals act as providers. Both are very successful and have high levels of care and satisfaction. Anecdotally, when I lived in one of these countries, I had nothing but fantastic experiences. What you're thinking of is single payer/single provider systems like the NHS in Britain. Nonetheless, I believe that they have private providers you can pay for out-of-pocket, and even with this single provider system (which I'm less inclined toward) they experience high satisfaction.

Canada has a well known set of problems with its healthcare system that have come to fruition, which Canada fully acknowledges, esp. when it comes to waitlists and waiting times for common procedures. The NHS has even more horror stories. It's easy to be satisfied with something when you don't actually need to use it frequently.

I'll agree with you that there are problems with accountability in some government programs. I think where we differ is that I don't think these are insurmountable, and (having extensive experience in private industry) I don't think that private businesses are entirely divorced from these same problems. Hell, a lot of my job is advising companies on this very issue...

You are free to believe they are surmountable. The VA has existed for decades with the same problems in place and not due to a lack of legislation to fix the issue. It's well known in this country that whatever the govt. touches turns to ****.

The plural of anecdote isn't data. I only care about data. Firsthand experience is emotionally illustrative, but that's it. The funny thing is that despite the whole scandal, patient satisfaction with the VA is reasonably high.

There's a very good reason why patient satisfaction at the VA is "high" among veterans esp. since it's their only avenue to get healthcare: http://www.kevinmd.com/blog/2014/06/va-works-veterans-less-demanding-patients.html - the author is actually an attending at the VA. If they were your average American citizen, they wouldn't be high at all. People would be livid. Yes, plural of anecdote is not data. And any data from the VA is now tainted bc it is now a well known fact that they will put out fake numbers and blatantly lie to cover things up.

 

[DermViser]

Sure it is. The cost is ultimately falling upon the government, which means that the government is the ultimate payer of all (or most) veteran healthcare expenses.

The premiums would be paid by the federal govt. in full. The actual reimbursement is given by the private health insurance company (Cigna, Humana, BCBS, etc.). The govt. paying premiums (and not doing the reimbursing of services) doesn't make it a single payer system.

 

[DermViser]

These damn zeke emmanuel threads get me every time.

Awesome gif.
Brings out the "Single Payer is the answer to all our problems" sycophants out of the woodwork as well. Usually by premeds.

 

[blackkrim]

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[blackkrim]

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[KinasePro]

I don't follow how my statement is a non sequitur. Universal healthcare takes a wide variety of forms. I support one of them, but not necessarily all the others. The VA is an example of single payer/single provider care that I'm not sold on, the Canadian and Australian systems are closer to what I support and quite different from VA style care.

You're saying that the VA is single payor single provider, which isn't true. It's not true, because if you don't like the Memphis VA then you can go to the Mountain Home or Nashville VAs. There are your second and third providers funded by the same payor.

VA is the payor, VA hospitals are the providers. Vets are free to receive care from multiple VA hospitals, and therefore this is analogous to single payor/multiple providers.

This is why everyone lauds the VA's medical record (which I agree, is actually decent). Vets can float to VA hospitals all over the US (which they frequently do), and you can access their medical record at any VA hospital.

 

[DermViser]

No system is perfect, but Canadians are generally very happy with their healthcare and their outcomes are excellent by any statistical measure. As I've said above, wait times are only shorter in the USA because we exclude millions of people from access to medical care.

Yeah, until you actually need a procedure. In pain, and need a knee replacement surgery? Sorry, that's elective, you'll have to wait 3-6 months. Certain provinces in Canada the doctors will stop doing certain procedures bc they've reached their cap for the year. Watch the Benjamin Rush debates on Youtube with Sally Pipes. Wait times are actually shorter here bc there is private insurance that pays higher than Medicare/Medicaid. If everyone had the same type of insurance, there would be no incentive to take on more patients in a day.

That's a dogma, not an argument.

It's also true. The VA has been well-known for decades as a huge sloth-like bureaucracy. No matter what legislation has passed, nothing has changed. Any resident that has worked at a VA knows about labs being lost, hoops to jump thru to get the most basic **** done, and how VA nurses are like.

Right: many veterans wouldn't receive any healthcare at all without the VA. The same goes for the elderly in the absence of Medicare. The crazy thing is that private insurers want nothing to do with these demographics and wouldn't insure them in the absence of government-funded programs...

And that's my point. When you're part of a govt. system, you have no other alternative avenue, which affects the most vulnerable. There are many alternatives to a govt. funded program (Health savings accounts, etc.) of which nearly 9 times out of 10, the beneficiaries put in much less than what they are getting out of it in benefits.

 

[DermViser]

The fact is that Americans pay the highest percentage of GDP for healthcare of any nation on Earth, and we don't (statistically) achieve any better outcomes for such exorbitant expenditure. Even a dumb premed can see that's a problem!

Have you seriously no idea what other confounding factors there are as to WHY healthcare outcomes are not better in the U.S.? Do you think our health occurs entirely w/in the vaccuum of a hospital? What about once we leave the hospital and our eating habits, exercise habits, smoking habits, lifestyle factors? Have you looked at our cancer survival rates in the U.S. from time of diagnosis? I realize you repeat the same refrain like a parrot that we pay a higher percent of GDP for worse outcomes. But the real story, is a lot more nuanced, and requires actually looking at why that is. Or did you watch Michael Moore's movie Sicko too many times, and have it to memory?

 

[KinasePro]

It's also true. The VA has been well-known for decades as a huge sloth-like bureaucracy. No matter what legislation has passed, nothing has changed. Any resident that has worked at a VA knows about labs being lost, hoops to jump thru to get the most basic **** done, and how VA nurses are like.

What are the 3 differences between a VA nurse and a bullet?
-A bullet reliably draws blood.
-A bullet usually only kills one person at a time.
-A bullet can be fired.

(couldn't resist the opportunity to tell this joke...)

 

[DermViser]

What are the 3 differences between a VA nurse and a bullet?
-A bullet reliably draws blood.
-A bullet usually only kills one person at a time.
-A bullet can be fired.

(couldn't resist the opportunity to tell this joke...)

That's why I mentioned them. If there is anyone as useless in the VA, it's a VA nurse (with the attitude to match).

 

[blackkrim]

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[DermViser]

What are the 3 differences between a VA nurse and a bullet?
-A bullet reliably draws blood.
-A bullet usually only kills one person at a time.
-A bullet can be fired.

(couldn't resist the opportunity to tell this joke...)

Speaking of: http://allnurses.com/nursing-career-advice/has-anyone-ever-593759.html

 

[KinasePro]

All of those are under the aegis of the VA, which makes them part of the same system. By your logic, is an NHS hospital in Birmingham competing with an NHS hospital in London as though they were independent companies?

How do you define provider?

 

[DermViser]

I really don't think the VA debacle is as one sided politically as it would seem from reading this thread. I agree it's ugly, but there's plenty of blame to throw around.

I didn't say it's a political party's fault. It's a bloated, govt. bureaucracy that papers over its deficiencies.

 

[compstomper]

I didn't say it's a political party's fault. It's a bloated, govt. bureaucracy that papers over its deficiencies.

I wouldn't be surprised if the government decides that the solution here is to hire even more bureaucrats and non-medical staff to oversee physicians and other medical professionals. The government's gotta dig its way out of the hole somehow.

 

[PL198]

I wouldn't be surprised if the government decides that the solution here is to hire even more bureaucrats and non-medical staff to oversee physicians and other medical professionals. The government's gotta dig its way out of the hole somehow.

Yes. Government's solution to all problems: Digging a hole in your yard, leading to dirt being piled up in another part of your yard. How to get rid of that dirt? Dig another hole of course!

 

[DermViser]

I wouldn't be surprised if the government decides that the solution here is to hire even more bureaucrats and non-medical staff to oversee physicians and other medical professionals. The government's gotta dig its way out of the hole somehow.

And the VA already has trouble recruiting physicians.

 

[RJGOP]

And the VA already has trouble recruiting physicians.

Well, it's just a bunch of FMGs anyway. But yeah, I wonder why? (Facetious)