Beyond the leadership vacuum: Challenges facing Veterans Affairs

The U.S. Department of Veterans Affairs is seeking its eighth leader (when considering both acting secretaries and official secretaries) in the last 10 years, showcasing instability as the norm. The ongoing debate about how to fill the leadership vacuum has reinvigorated the debate about the gap between veterans’ vital health care needs and the system’s ability to provide.

The lack of qualified senior leadership is not the most pressing challenge facing the agency in the near- and long-term future, however. The most critical issue is the ongoing struggle to strike a balance between calls for private sector care and calls to invest and innovate across the VA enterprise.

{mosads}Adequate and timely health care has long been an issue at the VA, and the increase in post-9/11 veterans who are seeking care has exacerbated the challenges of the VA’s ability to meet customer needs. After a years-long cover-up involving patient wait times, the conversation about privatizing the VA has taken on a new furor. Finding the balance between care services that are veteran-specific and programs that allow service members to seek care in the private sector, will become one of the most contentious challenges facing the system in coming years.

The debate is a complex one; however; a recent RAND study indicated that the civilian care setting is not necessarily prepared to serve the needs of veterans.

The choice facing veterans isn’t as simple as telling veterans to go seek care in the civilian health system. Not all providers are capable of the integrated, specialty mental and physical health care many veterans require, and they lack the contextual understanding that patients find with a VA physician.

Dem senator: Trump VA pick pledged to oppose efforts to privatize veterans health care https://t.co/oFOymfrvNe pic.twitter.com/YHJ24T2n0Z

— The Hill (@thehill) April 17, 2018

When Kate, co-author of this column, visited her civilian gynecologist late last year, for example, her appointment was easy to book and accessible logistically. The friendly physician mentioned starting mammograms in another 5-7 years, per guidelines. Kate’s visit to her VA primary care physician a few weeks later was different. This provider looked at Kate and convinced her to get screened right away. She knew Kate had spent time around toxic burn pits while deployed. The VA doctor mentioned anecdotally that she’d seen many women veterans who had returned from deployment with breast cancer.

“It is likely nothing to worry about, but I am writing you the referral and I want you to go get a mammogram,” she said. This referral led to biopsies, scans, and eventually a Stage IV cancer diagnosis, a terminal prognosis. With no family history and no symptoms at age 38, Kate never would have known she had exposure risks to consider and a need for earlier screening. It took a VA physician, familiar with health trends amongst this unique population, to intervene.

The VA is meant to serve complex, service-connected health care needs for veterans and at times, it does that job better than the civilian health market can.

Today’s veterans are more diverse than other generations (e.g., women, 9 percent of the veteran population, are expected to double in proportion by 2045). Nine million veterans rely on the VA for health care and the agency offers a culturally-competent site for them. The VA is indeed a massive agency with  100,000 medical specialists, more than 125,000 support personnel at more than 1,000 facilities, including 163 hospitals. And yet, the system is too small to meet the current needs of veterans seeking care. In fact, there are still around 33,600 job openings at the VA.

“Political divisions have created a distrust between veterans and elected officials” https://t.co/fNLvJveLUj pic.twitter.com/6iHLKXK3lv

— The Hill (@thehill) April 29, 2018

Wait times remain. Some veteran medical records exist in hard copy only and a $16 billion contract to make VA electronic health records compatible with the Defense Department’s system remains in limbo. Many clinics don’t have professionals who are trained to provide unique mental health treatment or gender-specific medical care that is unique to servicemen and women. The men and women who serve and defend our country, less than 1 percent of the U.S. population, deserve more.

Quality care for veterans calls for visionary leadership committed to upgrading and modernizing a struggling system as well as an investment in attracting and retaining top administrative and medical personnel. It’s time for innovation and organizational transformation, but that must begin with a visionary leader who can fight to protect the rights and dignity of all those who have answered the call of duty.

Dr. Kate Hendricks Thomas is a public health professor and the author of “Bulletproofing the Psyche: Preventing Mental Health Problems in Our Military and Veterans”, and a Marine veteran.

Paula Broadwell is the director of the Think Broader Foundation, a co-host of On Point Women Warrior Writing Workshops, and an Army veteran.