More BS from the VA by Pat Conrad MD


The more I watch the news, particularly when it involves health care, the more healthily, properly, joyously cynical I become. If someone is trying to sell me puppies and sunshine, salvation, or big, institutional compassion, I grab my wallet and scoot. I’m even cynical about veterans.

No, I’m not talking about the actual men and women who took an oath, wore a uniform, and faithfully served our nation. I’m talking about the board game tokens moved around inside the corridors of power, at political rallies, on both Fox and MSNBC, and perfunctorily praised by artificial politicians on designated high days, whose speakers by their actions are clearly uninspired by the objects of their praise. In the same way one cannot criticize Medicare, Social Security, or WICC, one cannot criticize anything to do with veterans, lest he be tarred as “anti-veteran”.

But being pro-veteran might require being “anti-veteran”, at least when it comes to the Veterans Administration. Even as the current secretary of the VA made an amazingly buffoonish gaffe, a new story broke that his creaky clown car of a bureaucracy has done some hilarious, tragic, and utterly predictable hiring.

  • In the past 3 years, only 1 in 11 new hires was an actual doctor.
  • In that same period, 39,000 new positions were filled, and average VA salaries rose 18.7 %. This in a time when real unemployment has remained high, and average wage earners’ earning power has remained very flat.
  • $ 454 million went to the VA legion of 1,060 lawyers; $99 million went to PR workers.

“But, but…!”, I can hear you sputtering, “that’s only a smidge of their overall operating budget of $99. 1 billion!” Okay, you have me there. So why are there ongoing, numerous reports of long wait times for vets? Where are the damn doctors?

Here’s a graph of the relative growth rates of physicians vs. administrators in recent years. Doug has published similar graphs numerous times. If the VA is such a great idea and such a great organization, and so awash in tax dollars, then will someone explain WHY there are inordinate wait times for vets? Are these vets whiners, or liars? Or is it more likely that the VA exists to serve itself, by building up more layered defenses of non-productive, clerical workers, and lobbyists, all with the goal of building public sympathy and cowing feckless politicians on the way there real goal, which is to provide a better appearance of total vet care, while growing the organization further still? It is now painfully obvious to the nation that it has become easier to endure the bad PR over a few dying vets than it is to fire wholesale pointless government clerical workers.

Sure, I know that any major organization will have some slop, needs some lawyers, and has to keep the walls painted and lawns trimmed. All three major party candidates are bellowing that they will pump more money into the VA. But with patients waiting, why didn’t they hire more doctors and fewer administrative parasites? How exactly will more desk jockeys help veterans who need medical care? If that’s where the money went, then I call it a plausible justification to cut the VA budget. Does this mean I want to kill vets?

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  15 comments for “More BS from the VA by Pat Conrad MD

  1. Jaymay
    June 10, 2016 at 6:37 pm

    Wow you people are incredibly nasty and paranoid. There are plenty of sick people to go around. All I was saying is that an NP isn’t just an RN with a couple of online classes. I didn’t appreciate how uninformed you were about an NP. And yes, an ICU nurse, or any nurse, and hopefully any healthcare provider thinks somewhat holistically, because people have families, opinions, beliefs, and fears. Thats not a bad thing to incorporate into how you care for people. We have experience, we get our education and we have to get board certified before we practice. Obviously doctors have more experience and more education overall. I don’t completely replace a doctor, and I don’t want to, because I chose not to go to medical school. In the world of healthcare, there are dumb doctors, smart doctors, dumb NPs and smart NPs. I am not a militant NP, but then again, I’m not going to tolerate being bullied about my career. God forbid I actually want to help take care of people for sake of taking care of them.

    • Doug Farrago
      June 10, 2016 at 7:48 pm

      All of that “other stuff” are your issues. My issue is when you claim that “evidence shows that there is no difference in the level of quality of care received by NPs in their specific roles in comparison to an MD in a similar role”. Not buying it. And how were you bullied? Because you were criticized? No one ever claimed here that there are no roles for NPs or PAs or RNs for that matter. You made that up for a good story.

  2. Pat
    June 5, 2016 at 5:37 pm

    Jaymay, how about if we get some highly recommended, well-motivated LPN’s, give them some additional training in pushing IV meds, and have them run the VA ICU’s? That would free up more RN’s to be nurse-providers, and would save even more money. No need to demand that the LPN’s actually go to the trouble of becoming RN’s, right?

    • Jaymay
      June 10, 2016 at 6:40 pm

      Other than telling you your comment is incredibly stupid, I’m not even going to respond back. You’re an idiot.

      • Pat
        June 11, 2016 at 6:23 pm

        Of course you aren’t, because you can’t. I took your argument to its logical conclusion, to show it to be a fraud. Resorting to name calling is just bonus proof, thanks.

  3. Lees
    June 4, 2016 at 6:05 am

    Now they say that all medical care rendered to veterans at VA hospitals will be provided by nursing staff with no supervision by physicians. Considering that a nurse can take a few online courses and suddenly become a “nurse physician”, I worry about the well being of our veterans who are forced to submit to this lowered standard of care!

    • Jaymay
      June 5, 2016 at 1:47 pm

      Dear Lees, this is quite possibly the dumbest statement I’ve ever seen anyone make about healthcare, especially since you seem to be confusing the title of “Nurse Practitioner” Or a “Doctor of Nursing Practice” with “nurse physician”. A Nurse Practitioner seeking a doctoral level degree in this role typically has several years of experience working in an Intensive Care Unit, where they have worked with the sickest of the sick patients, and where they actually spend a lot of time teaching medical students and even residents how to care for these patients. If you had any knowledge at all about how much an ICU nurse has to know and do even in this role, I don’t think you would be making this type of uninformed statement. Once accepted into a program, a doctor of nursing practice student is required to get about 1000 hours of direct patient care in, either at the bedside or in an outpatient setting, depending on their speciality. All of these clinical hours are being done under the direct teaching and guidance of either an MD, or another NP. It is not a trivial matter at all. They don’t just sign up for a handful of online courses. This degree takes about 3 years of full time classes, and it’s extremely rigorous. Evidence shows that there is no difference in the level of quality of care received by NPs in their specific roles in comparison to an MD in a similar role. More and more NPs will eventually be placed into hospitals and clincs, because they are qualified to practice within their scope and they will become more and more a vital part of our healthcare environment. NPs tend to spend more time with their patients, they look at their patients holistically, and are often not dragged down by meeting RVUs as much as physicians are, which means they have more time to address all levels of patient needs. Doctors are becoming more and more specialized, which I think is absolutely great, because future areas of science and growth are being grasped by these people and they are putting the future of healthcare into place. But a lot of standard, outpatient, and family healthcare can be more than competently administered by an NP or Physicians Assistants. Doctors, NPs and PAs are absolutely vital elements to the future of healthcare, each has their own strengths and we all have to work together to do what’s best, otherwise the person that ends up suffering is the patient. I hope you can reconsider your uninformed opinion of these care providers, because I honestly have no doubt that the VA is making a smart and proactive decision to trust NPs with the care of our veterans. More and more organizations, clinics, and hospitals will be moving towards this practice.

      • Doug Farrago
        June 5, 2016 at 3:22 pm

        NPs and MDs are not the same. Training and education matter. You have less of both. In fact, you prove it in what you wrote. In the same breath where you explain how important training and education is for NPs you then try to state that our MORE EXTENSIVE training then yours does NOT matter. So which is it? I will let this comment go for now but once any other militant NPs start adding their uninformed opinion I will delete you all. Been there with this group and have no problem doing it again.

        • Lees
          June 5, 2016 at 9:15 pm

          Well said and thank you.

          • Doug Farrago
            June 5, 2016 at 10:03 pm

            No problem but they are coming. The militant NPs. Winter is coming. We all need to defend ourselves.

        • Jaymay
          June 10, 2016 at 6:44 pm

          Ok, continue keeping your dialogue a “doctors only” discussion, where views from other professions don’t matter. Tell the nurse to go away!!

          • Doug Farrago
            June 10, 2016 at 7:51 pm

            It’s not doctors only but if you make a comment that is bogus like “evidence shows that there is no difference in the level of quality of care received by NPs in their specific roles in comparison to an MD in a similar role” then you are going to get comments back. Be a big boy or big girl about it.

      • Bridget Reidy
        June 6, 2016 at 7:29 pm

        More holistic? Not when you site your knowledge of ICU medicine as your credential! Spend more time with patients? Not what I’ve seen once put in the same practice environment as physicians. Yes when paid to spend more time, they spend more time, which I do despite not being paid for it, but they want to replace us so they quickly realize that means spending less time. And why the AAFP hasn’t been jumping on these claims that physicians aren’t holistic the past 30 years at least is beyond me!
        What we need if we’re going to keep the baby boomers out of expensive ER’s and ICU’s is people with more training, not less, on how to do that. Nothing else will save money. But it takes time, doesn’t pay, and we’re driving out of practice the few who can do it.

        • Doug Farrago
          June 6, 2016 at 8:51 pm

          Nice, Bridget! NPs are allowed to brag how they are MORE than an RN but we are the bad guys when we brag how we are more than an NP. The AAFP created this mess and should burn for it.

          • Lees
            June 6, 2016 at 11:32 pm

            The AAFP created this mess but it will be the patients who will suffer the consequences unfortunately. It will get worse before it gets better.

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