I spent a fair amount of time at the VA in Richmond (McGuire), so I can tell you a little about my experiences. It is difficult to generalize, so don't take my perspective as gospel.
For starters, the folks at McGuire told me that VA's fall into one of two categories: good and bad. McGuire was, of course, a good one. There were a few others in the region (who shall go unnamed) that you might consider sending grandpa to if you're eyeing his inheritance. At least, that was the word around the campfire.
Many people call it the "VA Spa", as things just run a little slower there. Think of a plantation circa 1830 on a hot summer day. Consults don't happen, orders don't get filled, and so on. You can faintly smell the government bureacracy in the hallways, but don't get me wrong. A helluva lot of excellent providers work their butts off to take care of the vets. And yet, just try getting a CT scan on the weekend, for example. It usually involves calling the radiology tech and begging profusely.
One thing you might notice about the VA is that the patients tend to die a lot. I had one patient die in a month of university medicine wards, while at the VA we were having several a week drop out of the living program. Some lung cancers, a horrible idiopathic pancreatits, etc. One guy called the hospital with severe diarrhea and said his friend was driving him the 2+ hours to McGuire. When the ER folks went out to get him he was stone dead in the passenger seat. Such is life there.
One interesting thing about the VA is the patient population, as they tend to be grizzled old guys with a lot of problems. There are a lot of scars, both psychological and hepatic. Most of them are very pleasant and accepting, and I've had some great times dealing with them. If you were to roll a keg down the hallway there would be a veritable comet of old guys behind you, staggering, limping, rolling and crawling along.
The computer system at McGuire is awesome. It's extremely intuitive; I literally taught myself most of the necessary aspects of it in about 20 minutes. I wish MCV had adopted it (it's open source code, I'm told), but instead they blew 50 million bucks installing Cerner Millennium, which is a pile of almost unusable electronic garbage.
As for the nurses, I hesitate to say anything. Just consider that many of them have been VA employees for a long, long time, and they are deeply entrenched. Enough said.
