VA standards for health professionals threaten veterans’ care

Gerald E. Harmon, MD , Past President

As a physician and a veteran, I strongly believe that those who have put themselves in harm’s way by serving in our nation’s military deserve the highest-quality health care that we can provide. But a new initiative by the Department of Veterans Affairs (VA) to implement national standards of practice would jeopardize the care our veterans receive, and likely have far-reaching consequences by upending state licensure of health professionals.  

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Put simply, the VA’s initiative—called “The Supremacy Project”—would create a single set of practice standards for all VA-employed physicians, a diverse group that includes 40 specialties and more than twice as many subspecialties. Creating one standard for all physicians is both impractical and unnecessary.

National standards of practice would also be created for 47 nonphysician health care professionals, with each standard developed independent from others and no opportunity for meaningful input from other stakeholders. This siloed approach is inconsistent with how care is delivered today, with its emphasis on physician-led care teams. Just as concerning is that this aggressive action by the VA, which was initiated by the Trump administration, is a maneuver to circumvent state laws and regulations by making it impossible for state medical boards to oversee the physicians and nonphysicians employed by the VA within their borders. We know that in some circumstances and jurisdictions, this lack of oversight would allow nonphysicians to provide care beyond what is permitted under state law. Physicians, as a group, have been silent on The Supremacy Project until now because the VA has not been transparent as it created the initiative. To date, there has been no meaningful opportunity for input or review from the AMA or any state medical or specialty society. After the initiative came to light, the AMA and 102 other physician organizations from around the country sent a letter to VA Secretary Denis McDonough urging him to abandon this proposal, which would negatively impact the more than 9 million veterans in the U.S. who receive their care from the Veterans Health Administration.

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Why VA’s move to nationalize standards of practice is misguided

But that is just one of several fatal flaws contained in the initiative that the VA is advancing. Extensive research has shown that physician leadership is widely recognized as vital to team-based medical care, and that the vast majority of patients prefer to have a physician bear primary responsibility for their diagnosis and treatment.

Each member of a patient-centered health care team brings valuable skills and experience to the task at hand, but none can match the skills and knowledge physicians acquire through four years of medical school, three to seven years of residency training, and more than 10,000 hours of clinical experience and training.

Health care teams function at the highest level when a physician orchestrates the integration and teamwork of multidisciplinary providers and draws on the strengths and talents of each team member to benefit the patient. We must reject any action by the VA that threatens patient safety by allowing non-physician providers to perform procedures and other functions that lie outside their scope of knowledge, their experience and their licensing authority.

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Advocating for veterans' health

I am proud to acknowledge our AMA’s continued support for health care initiatives that directly benefit veterans across our nation. The examples are plentiful.

Our input helped create and shape the Veterans Community Care Program, which allows veterans to obtain medical care outside the VA system when it cannot provide them with adequate or timely care. This program has helped resolve issues surrounding inordinate wait times for care delivery to veterans that came to light in 2014, and has evolved since then in scope and size to offer expanded health care choices to those who have served our country.

Just this past spring, our AMA outlined its support for the legislation pending in the current Congress that would expand community maternity care options for pregnant and postpartum veterans.    

The 150 medical centers and roughly 1,400 community-based outpatient clinics that comprise the VA health system are a tremendous asset, offering comprehensive and in many cases highly specialized care to our veterans, many of whom welcome the opportunity to receive treatment next to others who have also served. We must reject any action that lowers the quality of care our veterans receive.