VA’s Supremacy Project threaten vets’ health care
As a physician and retired major general in the U.S. Air Force, I firmly believe that the those who have put themselves in harm’s way by serving in our nation’s military deserve the highest-quality health care we can provide.
That is why I am deeply troubled by a new initiative called The Supremacy Project undertaken by the Department of Veterans Affairs to implement national standards of practice, which would jeopardize the care our veterans receive, and potentially have far-reaching consequences by upending state licensure of health professionals.
In basic terms, the VA’s proposal would create a single practice standard for its physician workforce, a diverse group that includes 40 specialties and more than twice as many subspecialties. National standards of practice would also be created for 47 nonphysician health care professionals, with each standard developed independently from others — and with no opportunity for meaningful input from other stakeholders.
This siloed approach is the antithesis of modern health care delivery, which emphasizes physician-led teams of health care professionals who share information and assist in decision-making based on their unique skills.
I am also concerned that this action by the VA, which was initiated by the Trump administration, is a thinly veiled attempt to circumvent state laws and regulations by making it impossible for state boards to oversee the physicians and nonphysicians employed by the VA within their borders. We know that in some circumstances and jurisdictions, this would allow nonphysicians to provide care beyond what is permitted under state law.
The VA has not been transparent about this proposed transformation. To date, there has been no meaningful opportunity for input or review from the American Medical Association 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.
But that is just one of several fatal flaws contained in the initiative that the VA is advancing. We know from extensive research and experience that physician leadership is essential to team-based medical care, and that the vast majority of patients want and expect to have a physician in charge of their diagnosis and treatment. Each member of a health care team — nurses, patient advocates, technicians and others — offers valuable skills and experience. But none can match the knowledge and experience that physicians obtain 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 oversees 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.
The 150 medical centers and roughly 1,400 community-based outpatient clinics that comprise the VA health system are a tremendous asset. They provide comprehensive and often highly specialized care to our veterans, many of whom welcome the opportunity to receive care next to others who have served. Our nation owes our veterans a debt that it can never fully repay. But we can start by rejecting any action that would jeopardize the quality of health care our veterans deserve.
Gerald E. Harmon is president of the American Medical Association and a former assistant surgeon general of the Air Force.