Debate: Should Nurses Replace Docs at the VA?


With long waits for care and a shortage of physicians, the Veterans Administration proposes hiring more advanced practice nurses and expanding their authority within the system. Some physicians are opposed.

Physician groups are urging all doctors to fight a US Department of Veteran’s Affairs (VA) plan to ease physician shortages at VA hospitals and clinics by hiring more advance practice nurses and letting them perform with “full practice authority.”

According to a notice in the Federal Register, that included nurse practitioners, certified registered nurse anesthetists, clinical nurse specialists, and certified nurse-midwives. That would mean theses advanced practice nurses could work without direct physician supervision, in accordance with the scope of their VA employment.

The VA proposal comes with a public comment period that ends July 25, 2016. Comments can be made here.

The idea does not sit well with some physicians.Though the VA’s money might go further by hiring non-physicians, delegates opposed to that idea said only physicians, or at least physician-led teams, could guarantee veterans get high quality care.

At the American Medical Association’s annual House of Delegates meeting in Chicago this week, delegates voted to approve a resolution co-sponsored by 16 state AMA delegations called “Fixing the VA Physician Shortage with Physicians” and not with nurses.

A key element in the AMA resolution is getting the VA to offer medical school loan forgiveness for physicians who work at the VA. Salaries there are generally lower than for comparable jobs outside the VA, the delegates said.

Delegates who spoke in favor of the proposal urged physicians to go online and write letters of protest to the VA, forms available at two sites and

Delegates also had proposals for ending the VA’s physician shortage. The resolution the group approved calls for the VA to “enhance its loan forgiveness efforts to further incentivize physician recruiting and retention.”

The measures calls on the Public Service Loan Forgiveness Program to “allow physicians to receive immediate loan forgiveness when they practice in a Veterans Administration Facility.” That could be costly: the resolution also noted that the average medical school graduate faces a debt of $181,000, as of 2015.

They also discussed calling for higher salaries for VA physicians, but voted not to make that part of the resolution.

“As soon as we talked pay we started to talk more about ourselves,” said Steven Epstein, MD, a delegate representing the American College of Emergency Physicians, “Let’s keep this focused on the veterans and not ourselves.”

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