Gaps in Fresno VA health services send vets out of town
By Barbara Anderson, The Fresno Bee | |
McClatchy-Tribune Information Services |
The small Fresno VA, which struggles to attract and keep doctors and nurses, sends hundreds of patients out of the area each year for surgeries and complex procedures, putting a strain on veterans and their families.
Heatherly's case is but one example. The 68-year-old from
It's been over a month since the surgery and Heatherly's shoulder is healing, but the
Veterans hospitals have come under fire this year for long waiting times for doctor appointments.
The proposed federal legislation could offer relief, but some medical professionals say long waiting times at the Fresno VA are a symptom of a communitywide physician shortage. They doubt if sending veterans to doctors outside the government health system will speed up care.
It's not all bad at the VA in
Where the Fresno VA is limited is the specialty care it can provide and how quickly it can provide it.
The average wait in
And when
The 57-bed
Patients arrive daily in
"We transfer more patients in from
A
Patients are sicker
Going to the
The Fresno VA offers a shuttle bus and many veterans drive themselves. But the hospital spent more than
A ground-ambulance ride from the VA at
Heatherly said he's never tried to take the VA shuttle and he's never needed an ambulance. The drive to the
There's no getting around having to spend a night in the
Patients with serious health problems may have to remain in the
The number of
Patients seen at the Fresno VA are becoming older and sicker, acting director
The volume of patients at the Fresno VA also is growing. Between 2005 and 2013, the health system saw a 25% increase in patients, from 23,642 to 29,486. And the number is expected to increase in coming years.
Across
With more patients, the Fresno VA needs to expand services, but it's limited by how many doctors and staff it can recruit and hire.
For now, the hospital is short 21 doctors and 10 nurse practitioners.
Recruiting physicians is an ongoing challenge. The hospital had four urologists four years ago and now is down to one, Meyer said. "We've been recruiting for two years and no success."
There's a part-time ophthalmologist -- but the hospital could keep two busy, he said. There's no ear, nose and throat surgeon -- the hospital had one, but he retired in
Doctor shortages are not unique to the Fresno VA -- but it has a big disadvantage: It's in a physician shortage area.
Some areas of
Doctors in the Valley earn less money than those in the coastal regions of the state, making it harder to recruit them.
A salary gap also exists between what a specialist can earn in private practice and what the VA pays. According to the 2014 Medscape Physician Compensation Report, physicians in single-specialty private group practices earn an average of
The Fresno VA lost a couple of recruits this year because of salary, said Dr.
But the Fresno VA has made some strides in filling positions, Peterson said.
Two new oncologists will start this summer and fall, he said. The VA has added a cardiologist and UCSF-Fresno is helping to recruit more, he said. Recruitment of a gastroenterologist is in the final stage. The VA is a teaching partner with UCSF-Fresno, and faculty and residents are based there.
Besides the struggle to find and keep doctors, the Fresno VA also has a problem retaining registered nurses.
According to a
The Fresno VA has 32 nurse vacancies, but Meyer said it's doing better filling them than six months ago. "If there was any way we can boost our salaries on this end, that would help us attract nurses," he said.
The hospital also is reviewing its mortality rate from the VA performance scorecard. The Fresno VA scored poorly compared to the other California hospitals in several categories, including pneumonia and chronic heart failure. The hospital also had a higher rate of in-hospital complications.
However, "a team looked at all the pneumonia cases on the list and didn't find any deviation from the standard of care," Meyer said.
The hospital has a heart failure clinic where patients can be followed after discharge from the hospital, but it had a turnover of cardiologists. "We now have two full-time cardiologists," he said.
Letting veterans choose
Valley veterans give the
A
But other veterans said they are unhappy with VA health care in
"I've been to
The shuttle bus ride to
Heatherly says veterans should be allowed to get care from private doctors in their communities if they have to travel long distances to receive specialized care at a VA hospital, regardless of the timeliness of the appointment.
If he was given the option of having surgery with a skilled private surgeon in
Millions of veterans nationwide could have the choice to go outside the VA for health services if
According to the
Under the "Accelerated Care Initiative," the Fresno VA received more than
Some veterans are cautiously supportive of using outside care.
The option of going to a private doctor is a good one, Hawley said, but added: Once you leave the VA system, the private hospital's "motivation is to make a profit."
And health professionals have their own reservations, in large part because of the Valley's chronic shortage of private physicians and specialists.
Doctors already are struggling to absorb thousands of patients newly insured this year through the Affordable Care Act, Palumbo said. "Physicians are having to take on more and more patients and having to spend less and less time with them."
Meyer has mixed feelings about letting veterans be seen by health professionals outside the VA system. It's far easier to track and manage a patient's health from within the system, he said. But he's not opposed to legislation that would make it easier for the VA to provide timely care.
It all depends on whether
The reporter can be reached at (559) 441-6310, [email protected] or @beehealthwriter on Twitter.
___
(c)2014 The Fresno Bee (Fresno, Calif.)
Visit The Fresno Bee (Fresno, Calif.) at www.fresnobee.com
Distributed by MCT Information Services
Wordcount: | 2204 |
Aflac co-founder Paul Amos remembered as man of integrity
Advisor News
Annuity News
Health/Employee Benefits News
Life Insurance News