Another partial solution to the problem of serving patients in rural areas is a technology in which the VA has been a leader: telemedicine, wherein patients are introduced to easy-to-operate equipment to check blood pressure and perform other basic monitoring tasks at home, the results of which are then transmitted to a doctor who could be anywhere in the country. In some cases, doctors also can consult with patients by phone or computer video while checking those vitals in real time.
“Our pay scales are comparable until you get into some highly specialized disciplines, such as cardiology, so we look at ways to share resources, such as interim staffing providers and shared resources. We just can’t get to what they can make in the private sector, so we have to be creative in other ways.”
“It helps in areas where we’re having difficulty recruiting, so someone in a bigger population center can provide telehealth to a rural area,” Perry explained. “That compensates where we are not able to put people in remote physical locations.”
Another issue that may be a problem in the future is getting young people to take the difficult path of medical school – and the more difficult one of specialization. While medical school enrollments have been on the rise, funding shortages have been reducing the number of available residencies for more than 20 years.
That compounds another growing problem – nearly half of all physicians practicing today are 55 or older. Given that it takes a decade or more to complete undergraduate pre-med, then medical school, then an internship and a residency, even if only half of those doctors retire at age 65, there would not be enough new doctors in the pipeline to replace them. As a result, a study released this summer by the Association of American Medical Colleges predicts that by 2030, the United States will face a shortage of between 42,600 and 121,300 physicians.
“The Mission Act, in particular, was set out to help us come up with different ways to increase the number of people enrolled in medical school. However, from our perspective, there’s nothing I’m aware of that is helping drive medical students into specialty areas, and we’re not in a position to steer that conversation. But there does need to be some thought put into that, perhaps through our affiliate program, but that is a broader question than just the VA; it’s impacting health care nationwide,” Perry said.
“Another thing we’re leaning on is the increased utilization of our affiliates and leveraging their staff at some of our larger facilities as another stop-gap measure. We’re also looking at our J1 [non-citizen medical providers] population. There are two segments: foreign-born doctors who are citizens, and those in our J1 program, who are considered for employment after all other efforts to recruit have not been successful.”
Since 2014, the VHA’s Office of Inspector General has issued an annual report – “Determination of Veterans Health Administration’s Occupational Staffing Shortages” – in an effort to determine the status of staff shortages across the VHA’s various medical centers. While the FY 18 report followed a different set of rules than the four previous studies, the top five critical-need clinical occupations – especially the top two – have remained relatively consistent: medical officer, nurse, psychologist, physician assistant, and medical technologist.
Despite overall shortages, especially in rural areas, the VHA also has the nation’s highest growth rate for physicians and other clinical staff. Their reported vacancies in all sectors total about 10 percent, which Perry said is good compared to the private sector, where vacancy rates can run as high as 30 percent.