VA Health Care

During the last three academic years, the Department of Veterans Affairs (VA) has realigned its graduate medical education program and achieved its goal of training 48 percent of its residents in primary care. It eliminated 251 residency slots in specialty care and converted 714 specialty residency slots to primary care slots, reducing the number of residency slots from 8,910 to 8,659. The major reasons for the changes were VA's decision to increase primary care residency slots and decrease specialty slots and medical schools' decisions to restructure their programs to meet changing demands for physicians or accreditation requirements. VA and medical school officials characterized the changes as mutually beneficial because they were consistent with current health care practices nationally. The changes have not disrupted training, according to VA and medical school officials at six facilities GAO visited. When VA reduced the number of residency slots, those slots generally reappeared at other hospitals affiliated with the medical schools. VA and medical school officials said that some training opportunities also exist at VA's community-based outpatient clinics. However, VA is not pursuing the establishment of such slots because (1) opportunities exist for primary care training in outpatient clinics at VA hospitals, (2) remote community-based clinics present a commuting problem for the residents, and (3) the physicians who would be required to supervise and train residents at the remote clinics might not be able to obtain faculty status at the medical schools.

GAO noted that: (1) the changing health care environment has resulted in less demand for specialty physicians and more demand for primary care physicians; (2) this shift influenced the changes in residency slots at VA; (3) over the last three academic years, VA realigned its graduate medical education program and achieved its goal to train 48 percent of its residents in primary care; (4) VA's strategy eliminated 251 residency slots in specialty care and converted 714 specialty residency slots to primary care slots; (5) these changes reduced the number of residency slots from 8,910 to 8,659; (6) the major reasons for the changes in residency slots were: (a) VA's decision to increase primary care residency slots and decrease specialty slots; and (b) medical school decisions to restructure their programs to meet changing demands for physicians or accreditation requirements; (7) VA initiated the majority of changes in the residency slots at the six facilities GAO visited, but these changes were consistent with the medical schools' own initiatives to meet changing demands; (8) VA and medical school officials characterized the changes as generally mutually beneficial because they were consistent with current health care practices nationally; (9) changes in residency slots have not been disruptive to training, according to VA and medical school officials at the six facilities GAO visited; (10) when VA reduced the number of residency slots, for the most part those residency slots reappeared at other hospitals affiliated with the medical schools; (11) in addition, VA and medical school officials said that some training opportunities exist at VA's community-based outpatient clinics; and (12) however, VA is not pursuing establishment of such slots because: (a) sufficient opportunities exist for primary care training in outpatient clinics located at VA hospitals; (b) remote community-based clinics present a commuting problem for the residents; and (c) the physicians who would be required to supervise and train residents at remote clinics might not be able to obtain faculty status at the medical schools.