Too Many Patients, Too Few Doctors

(2 pm. – promoted by ek hornbeck)

The recent scandal about the possibility of patient deaths, long waiting lists for appointments and falsified data in the Veterans Administration run hospitals across the country has it roots in a very obvious fact: too many patients and too few doctors.

At the heart of the falsified data in Phoenix, and possibly many other veterans hospitals, is an acute shortage of doctors, particularly primary care ones, to handle a patient population swelled both by aging veterans from the Vietnam War and younger ones who served in Iraq and Afghanistan, Congressional officials, veterans affairs doctors and medical industry experts say. The department says it is trying to fill 400 vacancies to add to its roster of primary care doctors, which last year numbered 5,100. [..]

But the inspector general’s report also pointed to another factor that may explain why hospital officials in Phoenix and elsewhere might have falsified wait-time data: pressures to excel in the annual performance reviews used to determine raises, bonuses, promotions and other benefits. Instituted widely 20 years ago to increase accountability for weak employees as well as to provide rewards for strong ones, those reviews and their attendant benefits may have become perverse incentives for manipulating wait-time data, some lawmakers and experts say. [..]

The precise role incentives and performance reviews might have played in falsifying waiting-list data remains unclear. In Phoenix, the inspector general’s office said, investigators plan to interview scheduling supervisors and administrators to “identify management’s involvement in manipulating wait times.”

But documents suggest that using the data in annual performance reviews may be commonplace. One review for a Pennsylvania veterans medical center director showed that a significant portion of the director’s job rating was tied to “timely and appropriate access,” which would include waiting times for doctor appointments. One of those goals would be met only if nearly all patients were seen within 14 days of their desired appointment date – a requirement not found in the private hospital industry.

While greed may well be part of the problem, it all stems directly back to the influx of new patients and the lack of primary care physicians to manage their cases. According to the article, primary-care appointments have increased 50 percent over the last three years while the department’s staff of primary care doctors has increased by only 9 percent. There are only so many hours in the day.

The other issue for doctors in the VA system is the pay disparity with the private sector.

V.A. primary care doctors and internists generally earn from about $98,000 to $195,000, compared with private sector primary care physicians whose total median compensation was $221,000 in 2012, according to the Medical Group Management Association, a trade group.

Privatization is not the solution. The private sector is no better equipped to handle to large influx of patients, especially patients with special needs that stem from the wars. It is also wildly unpopular with veterans and veterans groups. The Republicans in congress have other ideas because they perceive the VA as socialized medicine which they hate.

The Republican Party Has a VA Problem, Too: Privatization Isn’t Popular

By Brian Beutler, The New Republic

In light of the GOP’s decision to fold the Veterans Affairs scandal into a broader ideological crusade, I noted on Wednesday that in seeking redress, liberals shouldn’t lose sight of the fact that the GOP’s answer to every administrative blunder is to dissolve whatever program or agency screwed up. The unspoken corollary is that, by using the VA scandal as a narrative building tool, they’ll face pressure to put up a “small government” alternative to the VA that would be a better deal for actual veterans. And that carries risk, because the Republican alternative is unpopular. And yet…

 

The chairman of the House Veterans Affairs Committee is calling on the Obama administration to permit veterans waiting for care at VA hospitals to seek treatment outside that system, if they want.

   Rep. Jeff Miller, a Florida Republican, called on President Barack Obama to issue an executive order that would allow those veterans to act on their own and charge the government for outside care.

As Brian pointed out, when Mitt Romney suggested that veterans be given vouchers, he was vehemently criticized by veterans. Romney, being the political coward, did an immediate reversal, proposing instead spending more money as demand increased. How liberal of him.

MSMNB’s Rachel Maddow did an extensive report on the VA crisis, highlighting the problems within the military medical care system and the new details outlined in the V.A. inspector general’s interim report. She also had interviews with Paul Rieckhoff, founder and executive director of the Iraq and Afghanistan Veterans Association and Senator Bernie Sanders, Chairman of the Veterans’ Affairs Committee.

I don’t believe that firing Secretary of Veterans’ Affairs Eric Shinseki is the solution. The solution is hire more doctors and that would require making the position more competitive with the private sector.