One-fourth of new M.D.'s in the U.S. perform residency training at Department of Veterans Affairs Medical Centers (VAMC). The residents, particularly in specialties, are important to the care of chronically ill veterans, the VA's most basic stakeholders. In the early 1990s, VAMC medical residency slots were one-third primary care, two-thirds specialties. Until 1994, these proportions were stable, while the absolute number of residency slots grew. Then, amid projections of a looming surplus of specialists for the general population, the U.S. Department of Health and Human Services began to press for a shift in favor of primary care residencies. From 1994-5 through 1998-9, VAMC's as a group responded by increasing their primary care slots linearly by close to 200 per year. For the first two years, though, VAMC's balanced their conflicting demands by maintaining their numbers of specialty slots. Only in 1996-7, after the VHA Residency Realignment Review Committee (Petersdorf) Report mandated that the societal mission to provide an appropriate mix of new doctors take precedence, did the VAMC's reduce specialty slots. They did so in earnest, at a rate of about 220 per year. By 1999, 44% of DVAMC residency slots were allocated to primary care. VA networks varied in their implementation of the shift to primary care training, in ways that can be related to the mission conflict. Supported by VA Health Services Research and Development Funds, awarded to author 2.
Learning Objectives: Listeners will be able to discuss how VA hospitals responded to conflicting demands on their medical residency programs during the 1990s
Keywords: Veterans' Health, Medical Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Department of Veterans Affairs Medical Centers
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.