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VA cuts specialty residents, increases primary care

Dept. of Veterans Affairs officials say patients are happier because continuity of care is improved.

By Jay Greene, amednews staff. Oct. 15, 2001.

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Jason Berendt, MD, splits his residency rotations between the Veterans Affairs Medical Center and MUSC Medical Center, both in Charleston, S.C. While the first-year internal medicine resident hasn't noticed it, he is part of an effort by the Dept. of Veterans Affairs' 172 hospitals and 773 clinics to increase primary care specialists to take care of sicker patients.

Beginning in 1996, the VA embarked on a bold plan to increase primary care residents to 50% of its 8,900 total. As the nation's largest provider of graduate medical education, the VA accounts for 9% of the nation's 98,000 total residents. By 2000, the VA had nearly met its goal, increasing primary care residents to 48% from 38%, according to the Sept. 5 JAMA.

"When we began, everyone felt we needed more primary care doctors," said Stephanie Pincus, MD, VA's chief academic affiliations officer. "We also were moving inpatients to outpatient venues. Now we are looking at whether realigning the residents had any unanticipated side effects."

While some veterans expressed concerns, patient satisfaction scores went up dramatically at VA Heartland Network, an eight-hospital system based in Kansas City, Mo. "The vets found they see the same doctor every time they come in," said Matthew Kelly, Heartland's deputy director. "The residency realignment has been a positive force because in the old model the patient came in and saw whoever was in that day."

Under VA's residency realignment program, primary care residents increased 20.8%, or 715, to 4,156 in 1999-2000 from 3,441 in 1995-1996. Meanwhile, specialty residents declined 17.7%, or 965, to 4,502 from 5,467. [...]