VA Hospitals

[ddwl]

Hi,

As a non-American, I am just wondering why Department of Veteran's Affairs hospitals are an underserved population?

Is it due to low pay? Undesirable lifestyle, patient population or geographical location? Howcome they have difficulty staffing their hospitals?

Thanks.

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[Mumpu]

VA is underserved? Really?

It's the single best healthcare system in the nation - the only one with a national EMR (Kaiser is only local networks), and one that provides a decent amount of specialst services for its patients, including psychiatric services. Much of it is cheap or free too. It also does the best job of enforcing age-appropriate screening and other health maintenance recommendations.

Not always the nicest working environment and there is a lot of bureaucracy, but as a healthcare provider you could do far worse.

 

[(nicedream)]

I did a rotation at a VA and found the care provided there to be top gear - far better than that I've seen at other hospitals. The computerized system is really awesome and is a big part of what enables that higher standard of care. The physicians were also very interested in teaching and continuing education. Interestingly, all but one of the hospitalists were FMGs. The jobs are not in great demand because the pay is low compared to what you would make in the private sector. The good parts, other than what I already mentioned, is that the lifestyle is pretty good (8-4 at the one I was at) and great benefits.

 

[toofache32]

The VA here in Dallas is far from top-notch. We don't write orders....we write suggestions. Blood only gets drawn about 50% of the time and the nurses systematically ignore the patients' call buttons and requests for pain meds. There have been several times where I write a simple order like "place a foley" and 24 hours later it's still not done. I guess that's what happens in an environment where you can't get fired since you're a government employee.

There was an article in the newspaper a couple of years ago about a vet who kept pushing his call button but nobody would answer. After a few hours, he picked up the phone and dialed 911. An ambulance actually showed up to the hospital and that's how it made it into the news.

 

[Winged Scapula]

I have to agree with the post above - I've worked at VA hospitals since 1988 (doing medical research while in graduate school, then in medical school and residency) and as member of a military family, have been treated in them.

The vast majority of my experience echoes that of toofache - orders are not followed through on and no explanation is given, dressings meant to be changed TID are not changed at all until the physician does it the next morning, patient call bells are ignored, patients fall out of bed with an alarming regularity (I realize that they are an older population who perhaps is prone to do so, but no one seems to take any precautions), the computerized ordering system might make for less errors but if the orders aren't carried out it might as well be written on salt tablets and the tendency exists to cut and paste physical exam notes from previous days and not examine the patient (I also saw this with alarming regularity done by medicine residents following my surgical patients - the note would be word for word exact day after day, despite changes in the patient's condition).

I was constantly suprised that the vets put up with it - but I guess when you don't pay for something, you don't expect a lot.

 

[usnavdoc]

I have to agree with the post above - I've worked at VA hospitals since 1988 (doing medical research while in graduate school, then in medical school and residency) and as member of a military family, have been treated in them.

The vast majority of my experience echoes that of toofache - orders are not followed through on and no explanation is given, dressings meant to be changed TID are not changed at all until the physician does it the next morning, patient call bells are ignored, patients fall out of bed with an alarming regularity (I realize that they are an older population who perhaps is prone to do so, but no one seems to take any precautions), the computerized ordering system might make for less errors but if the orders aren't carried out it might as well be written on salt tablets and the tendency exists to cut and paste physical exam notes from previous days and not examine the patient (I also saw this with alarming regularity done by medicine residents following my surgical patients - the note would be word for word exact day after day, despite changes in the patient's condition).

I was constantly suprised that the vets put up with it - but I guess when you don't pay for something, you don't expect a lot.

VAs are hit or miss. Ive worked at several across the Southeast and I have to say that the larger ones associated with University medical programs usually have great doctors but its the ancillary services including nursing where you run into problems. You have to remember that they are govt employees and it is very hard to fire them. The interns and med students usually have to make up the difference in care.

As far as the facilities go though many(at least the ones Ive worked at) are very modern compared to surrounding hospitals.

Now some of the smaller hospitals and clinics across the US tend to have FMGs as there source of doctors.

 

[chesterfield]

Hi,

As a non-American, I am just wondering why Department of Veteran's Affairs hospitals are an underserved population?

Is it due to low pay? Undesirable lifestyle, patient population or geographical location? Howcome they have difficulty staffing their hospitals?

Thanks.

I would love to work at the VA, the only problem is the ridiculous salaries they pay, I do not want to get paid ½ of what I can make else where. One of my friends works at the VA great benefits, no malpractice problems, (you have governmental Immunity) after you make it two years you get tenure and it is next to impossible to fire you, hence the stories about the nurses who do not do anything, and ignore physician orders. My favorite story is of the Doc at the VA who sleeps at the center nurses station for the majority of his shift. Behavior like that at any other job would get you fired at the VA they make you Department Chairman.


The government has promised more healthcare than they are willing to pay for so they are trying to cut their expenses any way the can. Hence they pay salary that would only be attractive to visa workers. There is a lawsuit the VA won in Virginia where the VA argues that they should be able to pay 80% of the ridiculously low DOL OES salary.

I did this research for an Job posting for a Visa worker Anesthesiologist where the prevailing wages are 250K to 300K per year for new graduates but this shows you how ridiculous the DOL OES wages which the VA wages are based on are by comparison. You will see this difference in most every specialty however the differential between real wages and OES for lower paid specialties are less pronounced.

The salary was most likely set buy our government with your tax dollars. The DOL (department of labor) has an online OES Immigration Wage Data Which shows that for Anesthesiologist the mean wage is 141K working in a hospital, or 147K working in an office setting, i.e. pain management. The government only requires that employer pay their worker 80% to 90% of the prevailing wages. Lucky this aspiring worker is not in Massachusetts since the mean salary for anesthesiologist is 121K in that state.

OES Immigration Wage Data ;
The Occupational Employment Statistics (OES) program conducts a semi-annual mail survey designed to produce estimates of employment and wages for specific occupations. The OES program collects data on wage and salary workers in nonfarm establishments in order to produce employment and wage estimates for about 800 occupations.Employment estimate and mean wage estimates for Anesthesiologist at;

DOL OES survey for Anesthesiologists

Anesthesiologist Employment OES Salary summary

Offices of physicians
$86.89/hr $180,730/year

General medical and surgical hospitals
$68.13/hr $141,700/year

Outpatient care centers
$84.77/hr $176,310/year

Colleges and universities
$47.48/hr $98,760/year

Offices of other health practitioners
$71.14/hr $147,970/year

 

[Whodathunkit]

Had patient the other day who wanted to get a test(EMG/NCS) to see if his peripheral neuropathy had gotten worse, because he's 90% service connected...and wants to get the other 10%.

He's has DM-poorly controlled(HgB A1c=8.3), obese, TG=560, HDL=low, Choles=high, and he smokes 3/4 pk/day.

Wasn't interested when I talking to him about lifestyle modification. Just was trying to figure out how to get "his" other 10%, by having the test say "it was worse".

*sigh*