The Veterans Health Administration and Medical Education: In Brief (CRS Report for Congress)
| Release Date |
Revised Feb. 13, 2018 |
| Report Number |
R43587 |
| Report Type |
Report |
| Authors |
Elayne J. Heisler, Analyst in Health Services; Erin Bagalman, Analyst in Health Policy |
| Source Agency |
Congressional Research Service |
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Summary:
In the wake of World War II, an influx of veterans requiring medical care threatened to overwhelm the capacity of the Department of Veterans Affairs (VA) to provide such care. In 1946, the VA began entering into affiliations with medical schools as one strategy to increase capacityâboth in the short term and in the long term. In the short term, some traineesâin particular, those in the later years of trainingâmay provide direct care to patients, thereby increasing provider capacity and patient access. In the long term, training physicians at the VA creates a pipeline for recruiting physicians as VA employees. Current concerns about the VA's capacity to provide access to care have returned attention to the role of medical training at the VA.
The VA is the largest provider of medical training in the United States and is involved in training at all levels: medical students, medical residents, and medical fellows. VA's physician training programs are conducted primarily through its affiliations with medical schools and, in some instances, with teaching hospitals. In general, the purpose of these affiliation agreements is to enhance patient care and education, but some may also include medical research. Under these affiliation agreements, the VA and the relevant educational institution share responsibility for the academic program. The affiliation agreement promotes common standards for patient care, medical student and resident education, research, and staff appointments.
Generally, the VA is not the primary sponsor of medical education. Specifically, the VA does not operate its own medical school, but medical students from an affiliated institution may do a clinical rotation at an affiliated VA facility. Similarly, the VA does not typically operate its own residency programs (called graduate medical education or GME); instead, residents would apply to the medical school or teaching hospital that is the primary sponsor of the residency program and then would spend a portion of their residency training at the VA. The exception to this model is fellowship level training, which occurs after a medical school graduate has completed a residency program. In limited instances, the VA directly operates fellowship training programs in subspecialties that are of high importance to the VA.
The majority of VA facilities and the majority of U.S. medical schools (both allopathic and osteopathic) have affiliation agreements to train physicians.
The VA is the second largest federal payer for medical training after Medicare's GME payments. Medicare GME payments were $11.2 billion in FY2013, compared with VA's spending of approximately $1.5 billion in GME training in FY2015. Funds appropriated for the VA health care system are divided into two major components: General Purpose funding and Specific Purpose funding, both of which support some aspects of physician training.
General purpose funds are distributed at the start of the fiscal year to the Veterans Integrated Service Networks (VISNs) and are used in part to fund administrative costs of residency training programs.
Specific purpose funds are generally administered centrally and are provided to VA medical facilities to fund, among other things, residents' stipends and fringe benefits.
