Q&A: Time for a change?
Edward J. Sherwood, MD, a Marine Corps veteran and former chief of medicine and director at the Amarillo Veterans Affairs (VA) Medical Center, spoke to Texas Medicine about the current access-to-care problems for veterans. He worked in the VA system over the course of three decades before taking his current position as associate dean for strategic initiatives at Texas A&M Uni- versity Health Science Center College of Medicine in Round Rock.
Texas Medicine: Were you surprised to hear about the recent access-to-care problems at the VA?
Dr. Sherwood: I’m not surprised. When I was with the VA from 2006 to 2009, they implemented standards for access to care that said many clinic appointments had to be within 30 days of when the veteran wanted it — that’s a little different than when the doctor thinks they need it — and others had to be within 14 days. To set the bar so high is commendable. The problem is that bar proved to be absolutely unachievable in some cases. But people were still being held account- able for achieving it, and some started playing games with the reporting.
Texas Medicine: What, if any, access-to-care challenges did you experience while working at the VA?
Dr. Sherwood: The VA has changed its posture tremendously about purchasing care from the private sector. It was very difficult to do that 30 years ago, and the restrictions both in terms of funding and how much we could pay were oner- ous, so we depended back then on the gener- ous support of [private] physicians. The VA has loosened up on that a great deal, and it is now possible — I won’t say easier — to buy care from the private sector when you can’t provide it in the VA system.
Of course, it’s not always readily available, depending on where you are located. The extent of the [current] problem of providing timely ac- cess to quality care of veterans has varied both geographically and over time. There was a drastic change for the better in the quality and avail- ability of primary care. Over the last three de- cades, VA went from a system where people just showed up and whoever was available saw them to developing a policy where every patient will have a primary care physician. So over the past three decades, most of the issue has been spe- cialty care. In recent years, it has been clear that some of the problem is primary care.
Texas Medicine: TMA physicians want to step up and help, but many report a number of admin- istrative hurdles that get in the way: payment delays and difficulty accessing medical records, to name a few. Were you privy to any of these reported problems?
Dr. Sherwood: While VA has made great strides in creating a culture of continuous performance improvement on the clinical side of the house, that culture and commitment have failed to penetrate the administrative side of the VA. I frequently encountered problems with admin- istrative support services not providing timely, appropriate support to clinical care. I can remember an example in Amarillo when I received notice from the local electric company
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