VA hospitals beset with problems [Letter]

The Sun has been covering the Department of Veterans Affairs fiasco for weeks ("VA's acting chief tours Baltimore medical center," June 17).

One idea to deal with the backlog of veterans who have been waiting for care at VA hospitals is to send them to private practitioners and pay the practitioners for their services. This would be nothing new: Veterans have always been able to access private practitioners, both specialists and internists, for their care.

Unfortunately the VA system has not paid the private practitioners for services rendered. Whenever I treated veterans in my endocrinology practice and billed the VA, I was systematically ignored and no one addressed my complaints so I could be compensated.

If veterans have private insurance the billing is infinitely easier. But those who rely on the VA system have to pay out of pocket for private care. And I don't see many private practitioners jumping on the bandwagon to treat veterans while relying on Congress to set aside money to keep veterans waiting an inordinate time to see doctors.

There are multiple reasons why the VA system has failed veterans. In some VA hospitals there has been a culture of impunity and a not unfounded belief that no one will catch the scofflaws with their pants down. Gross understaffing is the norm and an ongoing problem. The VA system has too many chiefs and too few Indians to carry the burden of complicated medical care for veterans returning from places like Iraq and Afghanistan.

The VA has dedicated and fine doctors, but the doctors are overwhelmed. As you reported, the Baltimore VA now wants to have Saturday clinics and says it is hiring new physicians to expand hours and access. But these clinics can be mind-numbing for doctors when patients are scheduled every 15 minutes, and the computer documentation regime is tyrannical.

The clinics are also detrimental to the health of physicians who sit for eight or nine hours at a time seeing patients one after another with no breaks, while their superiors, the administrators, are off enjoying self-congratulatory bonuses far from the madding crowd.

Physician burnout, cynicism and exasperation are common among VA doctors and other VA employees. While the general belief is that VA doctors have fixed salaries and benefits and enjoy good hours, that belief is belied by the facts that they have to deal with highly limited formularies for drugs, lack of on-site specialists in many clinics, demanding, non compliant and even threatening veterans who feel entitled to terrific care and gratuitous administrators who want more work for less pay from their employees.

Usha Nellore, Bel Air

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