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Monday Feb 18, 2019

Better Health Care for Veterans Requires Better Payment

A recent study highlighted the challenges associated with health care for veterans and the complicating fact that many primary care physicians outside the Department of Veterans Affairs (VA) have "great uncertainty" about how best to address these patients' unique needs.

[physician and military physician]

This touched close to home for me as a U.S. Army Reserve physician who has been called to active duty. I have been helping soldiers with their medical issues -- both mental and physical -- on their return home from deployments. I also care for active-duty soldiers, retirees and their families in my civilian practice, and I already knew what this study found: These men and women have unique health challenges.

The study suggested that primary care physicians should ask patients whether they served in the military so they can better understand these patients' issues. That's a good first step in addressing veterans' health care needs, but the issue is much more complicated.

My military experience allows me to help these veterans navigate a system that can be extremely complex. Many of them have been sent to primary care physicians outside the VA system because of the limited number of VA health care professionals in their areas. Many of these men and women simply cannot find a VA facility close to home. And, like the VA system, the private-sector primary care system that these veterans turn to has its own workforce shortage, especially in rural areas.

Finding a solution has been difficult. The Veterans Access, Choice and Accountability Act of 2014(www.va.gov) allowed the VA to expand its graduate medical education offerings by as many as 1,500 residency slots(www.va.gov) over five years with a focus on primary care, mental health and physician shortage areas. Although this is encouraging, there are still issues with payment for primary care, budget constraints and medical student indebtedness that continue to compromise this initiative and other important pipeline programs.

Adding to this payment challenge, the Military Health System(www.health.mil) has to compete with the private sector to attract and retain physicians, and many military physicians transition to civilian practice because of marked disparities in salaries.(www.kevinmd.com)  

A 2018 report on Veterans Health Administration facilities by the VA's Office of Inspector General(www.va.gov) found primary care shortages in 66 of 141 locations surveyed. Psychiatry was the only clinical position with a greater shortage. Two of the biggest challenges cited were noncompetitive salary and high staff turnover.

Another pay-related obstacle to veteran care is that reserve physicians -- me included -- struggle when we're mobilized because of decreases in compensation even as we face the stress of leaving a practice behind for 90 days or more. Although this only occurs every few years, for most of us, it can be a hardship. The result has been fewer physicians caring for our military men and women.

About 65 million Americans live in primary care shortage areas,(www.commonwealthfund.org) and the strain on the primary care workforce that results from increased demand is expected to continue to increase. So not only do we need to ask that vital question about whether a patient is a veteran, we need to again address workforce issues so we can provide quality health care to these men and women who serve, and who have served, our country. Family physicians have a great opportunity to provide care, but we need to ensure that we have an adequate workforce with fair compensation.

Ada Stewart, M.D., is a member of the AAFP Board of Directors.

Posted at 08:50AM Feb 18, 2019 by Ada Stewart, M.D.

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