Expanded GME a solution to veteran’s health care access?

Associate Dean Dr. Patrick Brunett invited to participate in D.C. congressional briefing to discuss solutions to VA patient backlog

Reprinted from July 22, 2014


At the invitation of the Association of American Medical Colleges, Associate Dean for Graduate Medical Education Patrick Brunett, M.D., FACEP, represented OHSU at a July 17 congressional briefing that included Department of Veterans Affairs (VA) Interim Under Secretary for Health Carolyn Clancy, M.D., and AAMC leadership. The briefing was titled Addressing VA Physician Shortages: The Link Between VA & Medicare GME and Other Challenges to Expanding Access.

In a post-briefing recap, the AAMC wrote that:

“AAMC Chief Academic Officer John Prescott, M.D., announced that 161 AAMC-member medical schools and teaching hospitals have indicated that they have capacity to help the VA reduce its patient backlogs. Dr. Prescott also outlined AAMC’s recommendations, including expedited contracting with non-VA facilities, timely reimbursement for care, and expanded VA and Medicare graduate medical education (GME).

AAMC Chief Public Policy Officer Atul Grover, M.D., Ph.D., described VA physician shortages (in both primary care and specialties) in the context of nationwide workforce shortages that are a result of the cap on Medicare’s support for GME. He highlighted the connection between VA GME and Medicare GME, and the necessity to increase federal funding for both.

Patrick Brunett, M.D., associate dean for graduate medical education and clinical professor, Department of Emergency Medicine, Oregon Health & Science University, presented on OHSU’s affiliation with the Portland VA Medical Center and challenges to expanding VA GME independently.”

Associate Dean Patrick Brunett, Washington DCDr. Brunett’s commentary brought the perspective of an academic health center to the well-attended briefing. He described the important role of the Portland Veterans Affairs Medical Center in helping to train the next generation of physicians. In describing the nature of the OHSU-PVAMC partnership, he noted that many of the 800 OHSU residents/fellows participate in training at the VA, and the VA funds about 175 GME positions. However, the VA relies on OHSU for the majority of resident recruitment, training, faculty development, administrative oversight, remediation and support services. Further, the academic health center is the entity accountable to accrediting agencies for educational program quality; the VA does not have this accountability.

“What I describe is fairly typical of the educational partnership between academic health centers and the VA across the country,” said Dr. Brunett.

Dr. Brunett also observed that recent access issues experienced by veterans are emblematic of broader access issues in other communities, especially rural and urban underserved, concluding that expanded GME programs could improve access in these areas as well.