Does VA delays .....means more jobs ...for PAs coming ...

[drjay88]

I know VA is the largest employer for PAs and if they get ....in trouble .....means more jobs are coming for PAs ...

[ventana]

I would love to think so, but having been tried to be hired by the VA in the local community based outpatient clinic I have no experience with having any type of logical decisions made.

 

On a national level I could see PA being part of the solution however they have a wage freeze in place at many of the local places which means top of scale is 90,000. This is simply unacceptable, and they cannot get positions filled. If we are truly practicing under the new guidelines of the VA, physician collaboration, we really need to be closer in paid to the docs. Talking to any PA working in a community based outpatient clinic we do the exact same jobs.

[GetMeOuttaThisMess]

V, did you ever get far enough along to where a grade/scale was discussed?  I'm awaiting my slotting today (now this afternoon, so I was told yesterday) and I was able to find the grade/scale salary table online for my local area for 2014 (it has a 20% bump from base due to area it states).  Thanks to the web I was also able to find employee plans/costs for health, dental, and vision.  They even have the retirement plan options posted as well.  Based on all this, and a spreadsheet that I keep updated, all I need to do is plug in a salary value (bi-weekly, semi-monthly, or monthly) to see what my take home will be, having already included the benefits cost and my election for retirement contributions.  Top scale for my position is posted at $98,900 in the job description yet none of the pay grades/scales match this number.  Guess I'll find out later...

 

At this stage of my career it is more about personal time, continuing to max retirement, and doing something for a patient population that allows me to finally "give back".  The PTO and holiday schedule is nice as well.

[drjay88]

ventana,  I agree with you partly ..but being in Military and now reserve,  I am certain that they ran  out of option now ..only to hire more providers. and sooner or later we will see ...hiring more providers (PAs)....

[ventana]

Top of scale was 98,000, I never got an offer. Top of scaleFor a nurse practitioner is 114,000!

 

http://www.nytimes.com/2014/05/30/us/doctor-shortages-cited-in-va-hospital-waits.html?ref=health&_r=1

 

Doctor Shortage Is Cited in Delays at V.A.

Hospitals

By RICHARD A. OPPEL Jr. and ABBY GOODNOUGH MAY 29, 2014

Dr. Phyllis Hollenbeck, a primary care physician, took a job at the

Veterans Affairs medical center in Jackson, Miss., in 2008 expecting

fulfilling work and a lighter patient load than she had had in private

practice.

What she found was quite different: 13-hour workdays fueled by large

patient loads that kept growing as colleagues quit and were not replaced.

Appalled by what she saw, Dr. Hollenbeck filed a whistle-blower

complaint and changed jobs. A subsequent investigation by the

Department of Veterans Affairs concluded last fall that indeed the Jackson

hospital did not have enough primary care doctors, resulting in nurse

practitioners’ handling far too many complex cases and in numerous

complaints from veterans about delayed care. “It was unethical to put us

in that position,” Dr. Hollenbeck said of the overstressed primary care unit

in Jackson. “Your heart gets broken.”

Her complaint is resonating across the 150-hospital Veterans Affairs

medical system after the department’s inspector general released findings

on Wednesday that the Phoenix medical center falsified data about long

waiting times for veterans seeking doctor appointments.

In Washington, the number of lawmakers in Congress calling for the

resignation of Eric Shinseki, the Veterans Affairs secretary, grew by late

Thursday to nearly 100 — including almost a dozen Democrats — asPresident Obama prepared to receive an internal audit on Friday from Mr.

Shinseki assessing the breadth of misconduct at veterans hospitals. White

House aides declined to say whether Mr. Obama would ask Mr. Shinseki to

step down.

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, according to congressional officials, Veterans Affairs doctors

and medical industry experts.

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.

“The doctors are good but they are overworked, and they feel

inadequate in the face of the inordinate demands made on them,” said

Senator Richard Blumenthal, Democrat of Connecticut and a member of

the Senate Veterans Affairs Committee. “The exploding workload is

suffocating them.” 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 reward strong ones, those reviews and their

attendant benefits may have become perverse incentives for manipulating

wait-time data, some lawmakers and experts say.

Representative Jeff Miller, a Florida Republican who is chairman of

the House Veterans Affairs Committee, said whistle-blowers at several

veterans hospitals had told his staff members that they would be

threatened if they failed to alter data to make patient-access numbers look

good for their supervisors, one reason he has called for a criminal

investigation into the Veterans Affairs hospital system.

“Fear was instilled in lower-level employees by their superiors, and

those superiors did not want long wait times,” Mr. Miller said in aninterview. “Bonuses are tied directly to the waiting times of the veterans,

and anybody that showed long wait times was less likely to receive a

favorable review.”

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 at a Pennsylvania veterans

medical center 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.

Schemes to disguise wait times generally followed a handful of

approaches, whistle-blowers and officials in Congress say. In Phoenix,

where administrators were overwhelmed by new patients, many veterans

were not logged into the official electronic waiting list, making it easier to

cloak delays in providing care.

Another strategy, according to documents and interviews, was for

Veterans Affairs employees to record the first date a doctor was available

as the desired date requested by the veteran, even if they wanted an earlier

date.

“Yes, it is gaming the system a bit,” one employee at the Veterans

Affairs medical center in Cheyenne, Wyo., explained in an email to

colleagues. “But you have to know the rules of the game you are playing,

and when we exceed the 14-day measure, the front office gets very upset.”

In Jackson, Dr. Hollenbeck reported that hospital administrators

created “ghost clinics” in which veterans were assigned to nonexistent

primary care clinics to make it appear that they were receiving timely care.And in Albuquerque, an employee at the veterans center said some

doctors were shocked when they received a memo a few months ago

stating that 20 percent of physician “performance pay” would be doled out

only to doctors who found a way to limit patient follow-up visits to an

average of two a year — a tactic to reduce waiting times by persuading

veterans to make fewer appointments.

“Clinic staff were instructed to enter false information into veterans’

charts because it would improve the data about clinic availability,” states a

whistle-blower complaint filed by the employee, who did not want to be

identified. “The reason anyone would care to do this is that clinic

availability is a performance measure, and there are incentives for

management to meet performance measures.”

Experts point out that performance reviews and incentives were a

crucial element in transforming the Veterans Affairs medical system,

considered a medical backwater after the Vietnam War, into a national

health care system that, for all its problems, is generally well regarded.

Debra A. Draper, the director of the Health Care Government

Accountability Office, said that performance-contract incentives were only

one possible explanation for inaccurate wait-list data, and that other

factors included lack of oversight and training.

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 andveterans groups.

The department said this week that it was reviewing the size of patient

panels at its hundreds of outpatient clinics and assessing whether more

could provide night and weekend hours. The department also said it would

increase the number of patients it referred to private medical care, to

reduce waiting times.

Critics and supporters of the department agree that many facilities do

not have enough physicians. But they disagree about whether that is

because the department has poured too much of its hefty federal budget

increases into hiring midlevel managers instead of clinicians, or whether

the system simply does not have enough funding — or a large enough pool

of doctors to hire from — to keep up.

Supporters of the department also note that hospitals everywhere are

struggling to find primary care doctors. But some experts say the

department has additional hurdles, including lower pay scales. Primary

care doctors and internists at veterans centers 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.

Many veteran medical center directors tend to make $160,000 to

$190,000; according to 2012 data, those directors given performance

awards typically received $8,000 to $15,000 more.

Dr. Atul Grover, chief public policy officer at the Association of

American Medical Colleges, said the department’s doctor shortage came

down to a simple fact: “It’s just harder to attract physicians to care for

more challenging patients while paying them less.”

There are long delays for specialty care, too, veterans say. Kent

Carson, a former Marine with epilepsy, said he had tried to make an

appointment with his neurologist at the veterans hospital in Nashville after

having five seizures in four days in 2012. But Mr. Carson, 29, said he was

told he would have to wait more than two months — or go to the

emergency room. He has since switched to private insurance through hisjob as an accountant in Lenexa, Kan. The Nashville hospital did not

respond to a request for comment.

“I have seizures, but it’s not life-threatening,” Mr. Carson said. “But I

really do worry about vets who have more serious problems.”

A version of this article appears in print on May 30, 2014, on page A1 of the New York edition with

the headline: Doctor Shortage Is Cited in Delays at V.A. Hospita

[blueridge]

Regarding the NYT article, Doctor Shortage Is Cited in Delays at V.A. Hospitals, I read through the comments here and there as they were posted glancing/looking especially for comments noting PAs and NPs.  Though I didn't make a comment this go-round, I was ready if there was any substantial ragging on PAs.  The general consensus of the comments on PAs (there were not that many) supports an increase in hiring of PAs (and one noted paying more for all providers) in effort to reduce wait times and provide care to more VA patients.  There wasn't one harsh comment about PAs (that I noticed, but one stupid comment) and the commenting readership seems to acknowledge the need to hire more PAs though several eluded to the leaving the more complex stuff to docs, etc.  I perceive a possible window of opportunity to push for master's level and seasoned and residency trained PAs (or some benchmark) to practice in an independent manner within the VA.  A swipe of a pen…???  Even something like this - http://www.minneapolis.va.gov/education/AffHealthHome/AffhealthPAC.asp - and then upon successful completion, release them as independent practitioners (naturally occurring collaboration/second opinion as necessary), even if only within the VA.  Of course, the title of physician associate would help perception.  

 

Thought the comment section is closed, letters to the editor are being accepted.   

[gleannfia]

I work with an NP at the VA who is at 110K.  He is prior military, so not sure if that is the difference.

[gleannfia]

I find this situation varies by VISN, or region.  Here in Minneapolis, we have little to no wait for new patients.  According to my director, we are on of the top VA VISNs in the country.

[gleannfia]

I just find it sad that the bean counters in the VA system are sullying our reputation.  Management is, and always has been, the problem.  Not the quality of providers or care.

[gleannfia]

Yes, there is absolutely no difference  between what I do and my physician colleagues do on a daily basis, unless they are administrative.  We work the same hours and see the same complexity/patient load.

[Boatswain2PA]

I find this situation varies by VISN, or region.  Here in Minneapolis, we have little to no wait for new patients.  According to my director, we are on of the top VA VISNs in the country.

Of course, your Director may be saying that because, since his 5 figure bonus probably depends on being one of "the top VA VISNs in the country" with little to no wait time for new patients, he has your administrative staff play games with the system.

[SoCalPA]

Am i naive in thinking that those in charge don't know how to make the system work or do they simply not care.  I mean it's not rocket science to me that more clinicians means less of a wait for patients.  If you increase pay you will get more clinicians.  I'm not saying pay what physicians pay but at least be competitive. 

 

Would it be a waste of time for PAFT to write some letters noting the inequities in pay between NPs and PAs in the VA system.  The fact that some jobs are only advertised for NPs when they really can be done quite well by PAs. Maybe this is an opportunity while people are focused on the systemic problems.  

[Will352ns]

Of course, your Director may be saying that because, since his 5 figure bonus probably depends on being one of "the top VA VISNs in the country" with little to no wait time for new patients, he has your administrative staff play games with the system.

?? Bonuses in the GS system?  Not sure that's accurate.

[weezianna]

In most VAs the NPs are on a different pay scale and make more money than the PAs.  They have great representaton within the organization.  PA positions are generally a Grade 12, and a few sites still have 13s.  In waiting for a VA job, the salary is the last thing to be determined in the many steps towards actual employment; the compensation board has to meet to determine that.  In exigent situations, i.e.  a clinic shortage, etc., higher than usual salaries can be obtained if the appropriate recommendation is made.

[Contrarian]

^^^Yep...^^^

I started at grade 13, Step 10.