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Pittsburgh VA Struggles To Compete In 'Eds And Meds' Economy

Courtesy of VA Pittsburgh Healthcare System.

Reports of secret waitlists and preventable deaths at Veteran’s Affairs hospitals in Phoenix have spurred a nationwide audit of VA healthcare facilities.

The situation in Pittsburgh is not as dire as it is in Phoenix, but the VA facilities here are facing their own unique challenges.

Southwestern Pennsylvania is home to more than 260,000 veterans and their families, one of the largest concentrations of veterans in the United States.

The number of vets seeking care from the VA Pittsburgh Healthcare System has increased 25 percent over the last 10 years, according to Deputy Director David Cord.

“We’ve gone from serving, 10 years ago, roughly 55,000-56,000 unique veterans to last year serving nearly 69,000 unique veterans,” Cord said.

In late May, VA Pittsburgh Director and CEO Terry Wolf revealed to U.S. Reps Mike Doyle and Tom Murphy that that there were 636 newly enrolled veterans waiting for their first primary care appointment.

An audit by the Veteran’s Health Administration, released Monday, showed that of the 70,000 patients scheduled for appointments at the Pittsburgh VA as of May 15, 98 percent of them were served in 30 or fewer days.

“But there is still that two percent that we could do better with,” Cord said. “We can’t lose sight of that two percent.”

The nationwide audit found that the number one reason for waitlists at VA facilities is a lack of available appointment times. That comes down to a lack of medical staff, Cord said.

“We’ve projected or done our best efforts to project what our growth needs will be and then hire accordingly, but in a competitive market such as healthcare, it’s always difficult to maintain those levels even under the best of circumstances,” he said.

Cord said that in southwestern Pennsylvania, the VA is competing with large private sector employers like Allegheny Health Network and UPMC, which can sometimes offer more competitive salaries and benefits as well as research opportunities.

Neither the VA nor UPMC were able to provide salary averages for physicians and nurses, but UPMC spokeswoman Wendy Zellner did say in an e-mail that “UPMC is able to recruit and retain the best and brightest doctors and nurses with our very competitive salaries and benefits.”

Then there’s the fact that the VA hires only registered nurses that also have Bachelor of Science in Nursing degrees.

Mary Ellen Glasgow, dean of the School of Nursing at Duquesne University, said she applauds that decision, because research shows additional training for nurses substantially decreases mortality rates in hospitals.

“But I think one of the issues that we’re all grappling with is producing more nurses and having more nurses be interested in faculty positions,” Glasgow said.

She said a nationwide shortage of nurses and teaching faculty is only exacerbated by the “meds and eds” economy that dominates the Pittsburgh area.

“When healthcare is your primary market and there (are) lots of hospitals, clearly you need more nurses,” Glasgow said.

Cord said the VA in Pittsburgh is doing everything it can to work through the waitlist, and while they were steadily attacking the problem before the Phoenix scandal broke, the public outcry that followed provided a rallying point for dedicating more resources to the problem.

“The staff here reacted in typical VA Pittsburgh Healthcare fashion,” Cord said. “Everybody simply asked ‘What can I do to help?’ and they stepped up to the plate and got the job done.”

As of Monday, the list of vets waiting for appointments for more than 30 days had been reduced from 636 to 240. But to trim the list and keep it down, Cord said medical and administrative staff had to work overtime, which is not sustainable in the long term.

Sen. Bob Casey said there is a glimmer of hope. Late last week, Democratic Sen. Bernie Sanders of Vermont and Republican Sen. John McCain of Arizona agreed to work on a comprehensive bill to address the issues with healthcare delivery at VA facilities.

“My sense of this overall, whether it’s healthcare, whether it’s backlog, or a whole other set of problems, it’s a combination of resources and management, or lack thereof,” Casey said.

The senator said he’s hopeful that a bipartisan bill will solve many of the problems at VA facilities. And when it comes right down to it, said he’s in the “do whatever it takes” category.

“If it means we have to put a lot more resources in the VA to get more doctors, nurses and others, then we have got to spend the money to do that,” Casey said.

David Cord said if he could bend the senators’ ears, there is one thing he’d ask for even before the money for more doctors and nurses: information technology.

Indeed, in Monday’s report, the VHA promised to pursue long-term scheduling software solutions, in addition to strengthening oversight and accountability in appointment scheduling and healthcare access.