Some VA doctors lament staffing decisions

A group of physicians at the Veterans Affairs Medical Center in Spokane fears that new staffing decisions may mean too few doctors in the hospital and lower patient care standards.

Beginning in early January, the doctors, physician assistants and nurse practitioners at more than a dozen VA outpatient clinics throughout the region will no longer work hospital shifts that had helped augment the central staff. As a result, doctors at the medical center will stagger their hours to cover the extra shifts.

The changes upset some doctors, who had recommended that VA administrators hire more clinic doctors and keep the hospital rotations intact.

“These moves may leave the medical center short,” said Dr. Maria Yurasek, an internist and infectious disease specialist. She said she was speaking on behalf of other VA physicians.

VA administrators disagree with her assessment.

They say the new staffing model will give the growing number of veterans seeking care better continuity with their doctor or other health care providers.

“We’re doing this to put our primary care physicians back into the clinic,” said Rob Van Bommel, chief of health care administration at the 48-bed Spokane VA Medical Center.

The VA is recruiting more physicians to work in the hospital, potentially having seven hospitalists by this time next year rather than the four now there, said Dr. Gregory Winter, chief of behavioral health and acting chief of staff during the holiday break.

Yurasek said drawing a line between doctors who work in the medical center and those who work at clinics interrupts the continuity of care for the sickest veterans, instead of improving it.

Furthermore, the move may result in clinic doctors losing some of the important skills obtained by working in the medical center.

Yurasek said VA staff physicians made thoughtful recommendations to boost the number of clinic doctors, shed their paperwork and administrative duties, and maintain their hospital shifts.

“When physician recommendations go unheeded by VA administrators, our patients may suffer the fallout,” she wrote in a news release. “Sometimes you just feel like you want to run and hide.”

Van Bommel said the hospitalist and clinic physician issues were handled through collective bargaining and agreed to by management and the union representing VA physicians.

He said the VA believes the agreement will boost medical services to veterans, many of whom are on long waiting lists for doctor visits.

And, he said, clinic doctors always have the means to check on their patients if they have been hospitalized.

“That won’t change,” he said.