Why is getting an appointment at the VA such a ****ty experience?

[NontradCA]

I'm not sure if this is appropriate for this forum, but it seems like once you get in, you're taken care of rather well by the providers but getting to that point is just a **** show. I know they are backlogged for disability claims, vocational rehab and things like that, but what about just plain primary care? Being a veteran that has moved a few times after getting out I noticed it's a nightmare to get into the system when doing a hospital to hospital. I know several people with mental issues who don't bother with the red tape and just walking around self medicating with boos and heroine.

Also, could anyone shed some insight on the emergency and urgent care facilities of VA systems? They seem to cherry pick patients with the type of coverage/insurance they have and I've encountered vets who are SOL.

So my question is, who are the people that are changing these issues and if the VA has such a huge budget, why is all this BS going on?

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[HighPriest]

Generally speaking, military medical facilities are seprate institutions from the VA system, which is run by the Veterans Administration rather than a branch of the military. There may be someone here who can comment, but this is to some extent asking oranges a a lot of questions about apples. (Although military hospitals have a lot of the same fruit-oriented problems).

 

[HighPriest]

What I can tell you is that, as a resident, we tried like hell to get the VA (not 2 miles away) to send us their cancer patients so that they could be treated close to home and all in one hospital. Instead, the VA made their patient's drive 1 hour each way - to a different VA hospital- for their treatment,which in many cases involved radiation therapy every day for 6 weeks. All because someone wanted to avoid toe-stepping or paperwork. It was a tragedy, but it demonstrates the point: military medicine is a different pocket from the VA.

 

[NontradCA]

What I can tell you is that, as a resident, we tried like hell to get the VA (not 2 miles away) to send us their cancer patients so that they could be treated close to home and all in one hospital. Instead, the VA made their patient's drive 1 hour each way - to a different VA hospital- for their treatment,which in many cases involved radiation therapy every day for 6 weeks. All because someone wanted to avoid toe-stepping or paperwork. It was a tragedy, but it demonstrates the point: military medicine is a different pocket from the VA.

I get this. But why? It's fairly obvious that people require better healthcare after their military service than during it. I mean this to say that the population differences in terms of health are vastly different.

 

[i want out]

Consider the motivation of the system.

Does anyone at the VA get paid more for seeing more patients?

If you have spent any time active duty, you should know that questions about what should happen frequently have very different answers from what DOES happen.

You state, that "it's fairly obvious that people require better healthcare after their military service"

The reality, is that they require MORE healthcare after their service.
because the VA is generally a last resort system for most, they will always try to make sure they aren't your first choice, since they can't do that by increasing the price, they add hurdles to keep their patient flow managed.

The physician won't generally be the one placing the hurdles which is why your observation regarding care after being in the system is what it is.

I am out.

 

[NontradCA]

Consider the motivation of the system.

Does anyone at the VA get paid more for seeing more patients?

If you have spent any time active duty, you should know that questions about what should happen frequently have very different answers from what DOES happen.

You state, that "it's fairly obvious that people require better healthcare after their military service"

The reality, is that they require MORE healthcare after their service.
because the VA is generally a last resort system for most, they will always try to make sure they aren't your first choice, since they can't do that by increasing the price, they add hurdles to keep their patient flow managed.

The physician won't generally be the one placing the hurdles which is why your observation regarding care after being in the system is what it is.

I am out.

Well looking ahead (I start med school in July), what can I do to alleviate this outside of politics? I'm looking at fields such as PMR and Neuro, maybe family medicine so I can get involved with my brothers who feel like they're lost in this system. Any little difference I can make matters to me and I want to get back to "the guys". I can't do active duty because of service connected disability.

 

[HighPriest]

I get this. But why? It's fairly obvious that people require better healthcare after their military service than during it. I mean this to say that the population differences in terms of health are vastly different.

The answer to why comes in two forms:

Simple, short answer: who knows?

Longer version: Politics, inefficiency, and an idea that might have been good at one time that has since been dragged through the bureaucracy for so long that it would take more work to fix it than anyone is capable or perhaps willing to do. Plus, now there are people out there profiting from it, and they'll fight like hell to abort change.

 

[HighPriest]

If you want to help veterans, work at the VA. Other than that, change is going to require political motivation at some of the highest levels. The VA system is a national institution, and with that kind of mass comes a large amount of inertia.

I'm 100% with you on this issue, I think the fed could do much, much better in terms of what they do for our veterans. My original point was simply that military medicine is not VA medicine.

 

[pgg]

what can I do to alleviate this outside of politics?

Nothing, the problem starts and ends with politics and politicians. The system does what it was designed, funded, and directed to do ... the people in the system do what they are hired and paid to do ... with substantial regional variability dependent on some other factors.

Congress has directed the military health system and the VA to work together more closely. It's the right thing for the patients and the taxpayer, but it feels like lip service. At the local level, variable efforts are made and I'm personally seeing some actual progress on projects between my military hospital and our local VA. We have a great arrangement by which our mental health patients can be directly transferred to them (we have no inpatient psych capability but they do). Also, there are these things called "Joint Incentive Funds" which are pots of money to be used specifically and only for creating better cooperation and resource sharing between military hospitals and the VA.

But the basic problem is huge, and structural. We've still got AHLTA here and VistA there. Some problems are simply ... political. There's no sane reason, rationale, hope, dream, idea, or excuse that AHLTA is still in existence when the government (taxpayer) has already bought and paid for a better EMR. Only politicians can fix the inertia, greed, and bad decisions made by politicians.

If you want to change the world, be a politician. If you want to get rich, be an entrpreneur. If you want to impact and improve individual lives one at a time via health care, be a doctor.

 

[HighPriest]

Yeah, they offered a program funded by joint incentive by which we would perform the initial evaluation and work up for cancer patients, and then send them for treatment at the VA 1 hour away. But they were allowed to come back to us for their 5 years of follow up. Seemed like a great gig.......

 

[idq1i]

If the VA and MHS were to merge, a lot of high ranking dead weight could be purged. That dead weight controls most of the strings...therefore no merger is possible, at least for a while. Plus, it just makes too much sense for the government to implement.

 

[met19]

If you want to change the world, be a politician. If you want to get rich, be an entrpreneur. If you want to impact and improve individual lives one at a time via health care, be a doctor.

a great line...and i'm in total agreement

 

[Gastrapathy]

Get rid of the 80% with bull**** disabilities, plenty of resources for the rest


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[pgg]

Get rid of the 80% with bullcrap disabilities, plenty of resources for the rest

How dare you speak so of our LBP-suffering sleep apneic veterans! They got fat on active duty, it's service related!

 

[NontradCA]

Nothing, the problem starts and ends with politics and politicians. The system does what it was designed, funded, and directed to do ... the people in the system do what they are hired and paid to do ... with substantial regional variability dependent on some other factors.

Congress has directed the military health system and the VA to work together more closely. It's the right thing for the patients and the taxpayer, but it feels like lip service. At the local level, variable efforts are made and I'm personally seeing some actual progress on projects between my military hospital and our local VA. We have a great arrangement by which our mental health patients can be directly transferred to them (we have no inpatient psych capability but they do). Also, there are these things called "Joint Incentive Funds" which are pots of money to be used specifically and only for creating better cooperation and resource sharing between military hospitals and the VA.

But the basic problem is huge, and structural. We've still got AHLTA here and VistA there. Some problems are simply ... political. There's no sane reason, rationale, hope, dream, idea, or excuse that AHLTA is still in existence when the government (taxpayer) has already bought and paid for a better EMR. Only politicians can fix the inertia, greed, and bad decisions made by politicians.

If you want to change the world, be a politician. If you want to get rich, be an entrpreneur. If you want to impact and improve individual lives one at a time via health care, be a doctor.

Thanks. I was saying this in an earlier thread but throwing money at something doesn't really seem to fix problems. I figured I can't do much. That's a great last paragraph, and as buzz killing as it is, I find it true for the world.

 

[NontradCA]

How dare you speak so of our LBP-suffering sleep apneic veterans! They got fat on active duty, it's service related!

When I was on AD I met countless service members on route to being med sepped for back/disc issues that they had prior to joining. From an efficiency standpoint these people were a void for resources and then they're getting disability for life!

 

[idq1i]

I have found the wtu/meb crowd to be overall the nastiest, most malignantly entitled bunch in the service. Their attitudes and excessive demands carry right over into the VA system, resulting in so many of the VA-sided problems.

That's not to say that injured SMs shouldn't get all their needs addressed. It's just that so many of these people's problems are related to obesity, psych issues (aside from PTSD), scoliosis, FAI, flat feet, smoking, drinking and other congenital and self-inflicted causes and conditions

 

[Ziehl-Neelsen]

Not really germane to the OP's initial question but in the "spirit" of this thread since we're talking about disability ratings...

Sometimes I kind of wish I had a uterus so that I could have it taken out and get a 30% disability rating.

Carry on.

 

[HighPriest]

MEB/WTB. Yet another mismanaged, shameful system that the fed has cooked up. Just like the VA - created with the best intentions, and then summarily corrupted.

I have very dichotomous interactions with WTB soldiers. There are the guys who definitely should be there (hit with an IED, major reconstruction, TBI and functional defecits), and then there are the fat, lazy slugs. Many of those tubs-o-lard were put in the MEB specifically because they were a problem for their command - too lazy, too fat, too stupid, too untrainable. If you start looking for a reason to attach a soldier to the WTB, you'll find one. So it's a great place to stick PVT Porkins when you, as a line officer, are tired of dealing with him.

Since we often have to deal with these guys anyway, having them in clinic isn't the issue. It's having them prioritized. It's the aforementioned sense of entitlement. It's knowing that they're eating up resources that should be directed towards the guy with the IED damage.

Anger!

 

[NontradCA]

MEB/WTB. Yet another mismanaged, shameful system that the fed has cooked up. Just like the VA - created with the best intentions, and then summarily corrupted.

I have very dichotomous interactions with WTB soldiers. There are the guys who definitely should be there (hit with an IED, major reconstruction, TBI and functional defecits), and then there are the fat, lazy slugs. Many of those tubs-o-lard were put in the MEB specifically because they were a problem for their command - too lazy, too fat, too stupid, too untrainable. If you start looking for a reason to attach a soldier to the WTB, you'll find one. So it's a great place to stick PVT Porkins when you, as a line officer, are tired of dealing with him.

Since we often have to deal with these guys anyway, having them in clinic isn't the issue. It's having them prioritized. It's the aforementioned sense of entitlement. It's knowing that they're eating up resources that should be directed towards the guy with the IED damage.

Anger!

Doesn't the Army have a separate WW program that separates and prioritized the two differently?

 

[HighPriest]

I personally have a program that seperates and prioritizes the two differently and I call it my subconscious. Other than that, they all show up as WTB patient referred by case manager.