VA Hospital Fiasco a Harbinger on Nation's Physician Shortage

The big problem at the VA is that it's competing for doctors with every hospital in the country, physician practices, insurance companies, urgent care centers, retail clinics, and community health centers.

This ongoing scandal surrounding long waiting times for physician appointments at Department of Veterans Affairs hospitals has generated an array of justifiable responses including grief, anger and embarrassment.

It should not, however, generate surprise. The long waiting lines at the 150 VA hospitals across the nation are largely because of staff shortages. The New York Times reports that the VA is trying to recruit 400 primary care physicians.

American Federation of Government Employees National President J. David Cox Sr. was spot on when he said: "There is no solving the wait list issue without first solving the staffing issue."

This problem won't be solved in a few weeks or with reassuring sound bites, quick fixes, the resignation of VA Chief Eric Shinseki, made-for-TV Congressional inquiries, campaign grandstanding, or even money.

This shortage will last as long as it takes to figure out a way to treat people without a reliance on primary care physicians, or until we can train sufficient numbers of new primary care physicians to replace the growing ranks of their retiring older colleagues. We're talking years, perhaps a decade or longer.

We've been hearing about the "looming physician shortage" for decades. It looms no longer. It has dropped upon us and it's not going away soon.

Marginalized people in this country have been dying for years from failure to access healthcare. The VA debacle shows that even people ostensibly with health coverage will not have an easy time accessing physicians, and that some of them will die because of it.

A big problem for the VA is that every hospital in the country wants to hire primary care physicians. So do physician practices, insurance companies, walk-in clinics, companies providing workplace clinics, community health centers, and any number of concierge and niche providers.

"Primary care physicians are our No. 1 most requested searches for eight straight years. It's the most competitive market," says Travis Singleton, vice president of Merritt Hawkins, the Irving, TX-based physician recruiters. "The largest health systems on the planet tell you that primary care is the name of the game for the next two years."

"We are already in a market that is overstressed, but where the VA is particularly in trouble is that they are competing against a proliferating number of facilities and delivery options like we've never seen."

A Litany of Hurdles for the VA

"Obviously there is the PR issue, and they are dealing with a bureaucracy that was created in the 1980s that is confusing and inefficient and makes it more difficult to get things done," Singleton says.

Salaries for family practice physicians at VA hospitals range from about $95,000 to $195,000 depending upon factors such as experience. In the private sector the average salary for a family physician is $199,000 with outliers as high as $293,000, according to Merritt Hawkins' annual survey of physician compensation.

"The compensation is not going to compete with the private market. In some respects that is a known. Physicians know they're not going to make as much as at XYZ health system. The issues is that now that gap is greater than we've ever seen, so it is a little harder to ignore."

As for the immediate task of recruiting 400 primary care physicians, Singleton says "that is such a massive undertaking I am not even sure how to put it into words."

"The only groups that would even be able to accomplish that in this market would be someone that just flat out bought a 200-physician group. Otherwise you are recruiting one by one. You have to take a step back and ask, 'is what we need even realistic with the resources and options we have at our disposal?' The answer is undoubtedly is no. That's not just the VA. I don't know a health system that could do that."

Instead, Singleton says, the VA might be better served with internal adjustments to mitigate the shortages, and by working with outside partners to bolster the clinical staff.

"You are going to have to look at a temporary and a permanent labor force and use them in the most efficient ways possible," he says. "I don't know if the system right now in the VA is set up to allow you do that."

"If there is any good result out of this tectonic shift they are going through it is that the VA is going to reevaluate systems and processes that they have had in place for years that aren't efficient. They needed to before and unfortunately it took something this drastic to move the Titanic."

The VA as Harbinger

The VA scandal is likely a harbinger of what our broader healthcare system can expect in the coming years. The American Medical Association reported in 2012 that 43% of the nation's one million or so doctors are age 55 or older. That figure was 35% in 2006. The demographics are relentless and they don't lie. This is not a favorable trend.

"What's happening at the VA is horrible, but my fear is where else is this happening where we can't track it?" Singleton asks. "Who else out there is not able to see a physician and God forbid it becomes a fatality that we will never know about because, say, a county hospital's ER was understaffed. It is a little unlucky for the VA that it's in this highly visible world."

There are other challenges surfacing with the shifting healthcare landscape.

"The physicians we have are working less, or becoming more specialized and going into areas where we don't need them," Singleton says. "And it's not just the patient wait times. Now you have to look at Medicare and Medicaid acceptance. You look at these new health plans with deductibles that are sky high."

If the VA can be fixed, Singleton says, "there should be no problem fixing the private markets. But I expect this is going to get worse before it gets better."