Perspectives on career opportunities within the Veterans Administration (VA) for geriatricians
Ted Hahn M.D.
Director, GRECC at the VA Greater Los Angeles Healthcare System
Los Angeles, CA
The VA health care system currently offers a broad range of opportunities for academic career development in geriatrics. The VA has been a national leader in geriatrics training and career development over the past 3 decades, in large part due to the fact that the VA population is considerably older on average than the general population. Currently nearly 40% of the veteran population is aged 65 or over vs. 13% of the general population. Geriatrics and long term care have increasingly become the major priority of the VA health care system, and this focus on aging is accompanied by increasing resources and career opportunities in geriatrics.
In addition, the VA patient population has doubled in the past 6 years to 4.8 million patients nationally, due to continually improving cost/benefit factors, care quality, and patient satisfaction. These changes are in large part attributable to enhanced use of modern information technology and a system-wide commitment to continual process improvement. As a result, the VA system leads the nation in a large number of quality of care, cost-effectiveness, and patient satisfaction and outcomes areas (1-3). For example, the VA is the national benchmark for 18/18 preventive care indices and improvement continues on all fronts. This advance is also being fueled by continuing the VA's commitment to excellence in basic, clinical and health services research, and the rapid application of research findings to patient care issues.
Quality of patient care is a primary focus in the VA system. Care quality is enhanced by a range of cutting edge technologies that power the VA care system, most notably an extremely effective, totally computerized patient record system that allows instant access to all notes, reports, laboratory data, radiologic images etc. on all patients. This system markedly improves the patient care process and also provides an invaluable tool for clinical and health services research studies.
To better care for its increasing older patient population, the VA is rapidly expanding its home and community based long term care (LTC) programs to provide improved LTC that is delivered in the patient's preferred care setting - his or her home and local community. This shift in primary site of LTC delivery is further enhancing patient preference for the VA care system, and offers a myriad of exciting new research and career development opportunities.
One particularly exciting new development in the VA system is the current nationwide implementation of home care coordination programs facilitated via telehealth technology, including 2-way video systems with patient measurement peripherals (e.g. ECG leads, stethoscopes, blood pressure, digital scales, glucometers), text messaging machines, and various other patient-friendly 2-way communications devices. This approach provides fully coordinated, constantly supervised care in the home setting for patients with chronic disorders, especially the frail elderly. Results so far show markedly reduced care costs due to decreased hospitalizations and nursing home admissions, improved patient outcomes, and greatly increased patient and family satisfaction. This revolution in care delivery will dramatically alter the way that LTC is provided in VA system, and subsequently in the community, and offers a wide range of new career development and research possibilities.
A large portion of the current geriatrics academic faculty throughout the country have received some or all of their training in the VA. In the 1980s, the VA established the Geriatrics Research Education and Clinical Centers (GRECCs) as centers of excellence to improve the care of older Americans. These highly successful programs, now established in 21 VA medical centers nationally, have played a major role in advancing geriatrics knowledge and practice, and promoting geriatrics academic faculty career development, in the U.S. (4). In the 1980s and 1990s, the VA pioneered geriatrics fellowship program development, culminating in the recognition of geriatric medicine a subspecialty by the ABIM. More recently, the VA has launched the VA Special Fellowships Program in Advanced Geriatrics (SFPAG) that provides 2-3 years of intensive junior faculty Career Development Award (CDA) training to physicians in geriatric medicine, geriatric psychiatry and family medicine who have completed their clinical fellowship programs (5).
There are abundant opportunities for career development and research funding at the junior and senior faculty levels, and the VA research budget for this past year was at an all time high. The VA currently offers a range of 3-year renewal entry level and advanced CDAs in basic, clinical and health services research (6). These CDAs offer 75% protected time for research and career development, additional funding to support research activities, and a full-time starting VA salary in the range of $112-120,000/year depending on qualifications. In addition, there are a range of entry level and standard research grant awards in basic, clinical and health services research. In addition, VA investigators are also eligible for all NIH, foundation, and other national and local research grant awards, and it is common for VA investigators to have funding from the VA and multiple other sources. Release time is provided for all peer-reviewed funded grant awards to allow investigators the required research time. All VA faculty have academic appointments at their affiliated university, and collaborative VA/university research and education programs are common.
The VA is in a remarkable period of growth and innovation, and offers an outstanding range of opportunities for career development, enhancing patient care delivery, teaching, and doing research in aging. This is an exceptional time for physicians aspiring to join the next generation of academic leaders in geriatrics to build rewarding, highly productive academic careers within the VA system.
- Ashton CM, Souchek J, Petersen NJ, Menke TJ, Collins TC, Kizer KW, Wright SM, Wray NP. Hospital use and survival among Veterans Affairs beneficiaries. New Engl J Med 349(17):1637-46, 2003.
- Jha AK., Perlin JB, Kizer KW, Dudley RA. Effect of the transformation of the Veterans Affairs Health Care System on the quality of care. New Engl J Med 348(22):2218-27, 2003.
- Petersen LA. Normand SL. Daley J. McNeil BJ. Outcome of myocardial infarction in Veterans Health Administration patients as compared with Medicare patients. New Engl J Med 343(26):1934-41, 2000.
- National VA Geriatrics & Extended Care/GRECC website - http://www1.va.gov/geriatricsshg/
- National VA SFPAG web site - www.grecc-gla.org/sfpag/
- National VA Office of Research and Development website -
http://www1.va.gov/resdev/default.cfm
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