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Reforming Delivery
VA Secretary Resigns, But Scandal Remains

It’s official: Secretary of Veteran’s Affairs Eric K. Shinseki has resigned over the recent scandal involving a cover-up of long waits for care at a Phoenix hospital. How do things get so bad? The NYT reports that doctor shortages were a significant part of the problem. The demand for health care far outstripped the supply: 

Most experts agree that soaring demand for veterans’ care has outpaced the availability of doctors in many locations, and that high turnover is a major problem. In the past three years, primary-care appointments have leapt 50 percent while the department’s staff of primary care doctors has grown by only 9 percent, according to department statistics.

Those primary care doctors are supposed to be responsible for about 1,200 patients each, but many now treat upward of 2,000, said J. David Cox Sr., national president of the American Federation of Government Employees, which represents nurses and other support staff. He said the department spent too much hiring midlevel administrators and not enough on doctors and nurses, a complaint shared by some lawmakers and veterans groups.

In this respect, the VA is a microcosm of the whole U.S. medical system. The generalized doctor shortage across the country is extensively documented, and it’s more important than ever that we take big steps to open up the system to more providers. Legislators could start by allowing nurse practitioners to do more unsupervised primary care. Another step would be for the medical community to admit more people to medical schools and residencies. As Matt Yglesias has pointed out, for example, even after females entered the profession in large numbers, the total number of spots available remained the same despite vastly increased demand.

The Association of American Medical Colleges has now come around to this view of things, and is urging schools to expand enrollment and legislators to lift the federally mandated caps on residency programs. The guild-like behavior of the medical establishment has restricted the number of providers, which in turn keeps salaries high. Until we take these steps the structural problems that plagued the VA will keep popping up—and will soon burden our whole health care system.

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  • Pete

    Expand enrollment in medical school is a long over due and much needed reform, a reform which historically has been fought tooth-and-nail by the AMA.

  • Corlyss

    I am shocked that Obama actually pulled the trigger. Shinseki must have insisted. And really, who wouldn’t want to be liberated from this f’d up administration? Even Carney is fleeing.

  • Arkeygeezer

    The first priority is to provide care for the Veterans. This could be accomplished rapidly by granting Medicare benefits to all Veterans. In this way the VA hospitals would have to compete with regular hospitals for patients. Our Vets would receive better and prompter care.

    • Andrew Allison

      Great idea!

  • Arkeygeezer

    oh, I forgot to add. All Vets should also receive citizenship.

  • Bruce

    Of course they spent too much money on mid-level administrators. That’s how you expand the bureaucracy and increase power. The objective of every bureaucracy is to grow and expand. If a few patients get treated along the way, that’s fine, but it’s not the real goal.

  • Boritz

    “The VA scandal points to a systemic problem in U.S. health care: there are not enough care providers to meet patients’ demand.”

    Banks used to have tellers dedicated to the lobby and tellers dedicated to the drive-through. If the drive-through was very busy and the lobby wasn’t the lobby tellers twiddled their thumbs while the drive-through stacked up.

    Now banks are designed so a pool of tellers handles both queues. It’s called load balancing.
    Restricting veterans to VA hospitals while other near-by hospitals could help them is a big part of the problem. ACA brings this problem to the rest of us with restricted, not expanded networks.

    • Andrew Allison

      Good point. How about appointment/treatment wait-time thresholds which, if exceeded, result in referral to an outside hospital?

  • Donald Campbell

    Doctor shortage? I know, why don’t we create an ACA with new burdensome reporting requirements that turn our Doctors into Data Entry Clerks. What could go wrong?

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