With the scandal over care at the VA, cries by national health organizations have intensified for the department to broaden its physician certification guidelines and grant nurse practitioners full-practice authority throughout the system.
Among those leading the charge is the American Board of Physician Specialties, a 54-year-old organization that has fought the federal government for two decades to have its certification process accepted by the VA for hiring physicians.
The organization argues that if it was allowed to join the American Board of Medical Specialties and the American Osteopathic Association as VA certifying bodies, more physicians would seek employment in the federal system.
“The (VA) administration is very backwards,” said Monique Tapie, a spokeswoman for the American Board of Physician Specialties. “They have created this monopoly within the Department of Veterans Affairs … and quite honestly it’s discrimination because a lot of our physicians are veterans.”
Last year, before veteran deaths began surfacing because of delays in care, the ABPS reported that the nation’s VA health system had more than 1,400 unfilled physician positions, which paralleled an overall shortage nationwide.
Though government job sites show physician employment has improved, decreasing to 970 unfilled positions, the care has gotten worse, with long delays and secret wait lists leading to the deaths of more than 60 veterans, including three cancer patients in Augusta who could not get timely endoscopies.
The Augusta VA continues to rebuild. It saw the voluntary resignations of two chiefs of staff: Dr. Michael Spencer earlier this year and Dr. Luke Stapleton in 2013.
Executives at the Augusta VA said the hospital has 178 open positions, including jobs for 151 full-time nurses in the fields of endoscopy, surgery, dialysis, critical care, interventional radiology, accreditation, education and mental health.
The list includes 27 physicians in the specialties of internist, neurology, primary care and orthopedic surgery. Also listed are permanent replacements for chiefs of staff, surgery and pharmacy.
Director Bob Hamilton said the hospital hopes to hire a new chief of staff next month. Spokesman Pete Scovill said it can be difficult to fill vacancies because of competition from the private sector and that all job applicants must complete a thorough credentialing process for employment.
“We set our standards very high, matching the quality of care we want to achieve with the candidate that’s most qualified to help us accomplish our goals,” he said.
Experts say filling the positions is only half the battle.
Besides urging Congress to increase the number of nurses in VA facilities, the American Association of Nurse Practitioners has called on the agency to follow policy recommendations from organizations such as the Institute of Medicine and allow the VA’s 5,000 nurses to practice to the full extent of their education and clinical expertise.
“This will have an immediate and positive impact on the quality and timeliness of care that our veterans receive,” Dr. Ken Miller, the association’s president, said in a news release.
Tapie said the answer to better health care for veterans is the VA joining the Center for Medicare and Medicaid Services and the GI Bill in accepting ABPS board-certified physicians.
“The VA will say it is not in a position to approve certifying bodies, but in its handbook it states that its physicians are certified through either the American Board of Medical Specialties or the American Osteopathic Association,” Tapie said.
Gina Jackson, a member of the VA’s Public Affairs Office in Washington, said board certification is not a requirement for employment of VA physicians; however, she added that by policy, individual facilities verify all board certifications reported by current and prospective employees.
With only 40 percent of emergency medicine physicians nationwide being board certified, Tapie said that could help Augusta.
“When you look in areas such as Augusta, it is really hard to get someone who has done their residency in emergency medicine,” she said. “This could make it easier to find physicians who can help.”