Another issue-

Our Va does not have a separate compensation and claims office.  Now suddenly, we have an enormous increase in ptsd claims, linked to the current financial crisis and recent legislative action.  Every Veteran deserves to have their claim evaluated.

But our VA chief of medicine openly threatened all of the health care professionals. He said that we would lose our jobs if we didn't do C and P's IN ADDITION to attempting to provide health care for our Vets.  So we are taken out of our jobs a certain number of hours a week to to Compensation and Pension (C and P ) claims.  Our medical director openly stated that Veteran care would have to be relegated to emergency only care in some cases, and that the Federal government really didn't care what happened to them, as long as the C and P backlog looks better on paper. They don't want  to hire part timers from the community to conduct these evals.  They want us to do it, and neglect our patients so we can do these.

Many claims are legitimate, but there are also many which are based on websites which tell people how to act during a claims exam, to act sad, to say that nothing is going right, and that they can't work.

Meanwhile the Veterans who need medical care sit and wait.  And they are angry about it.  I am too.

The polls finding that NP's and PA'S care is superior - we need furthe analysis of the findings - is it because the time spent was more or is it better 'salesmanship' or is it because of the less pool of patients and more time on the patients, is it 'compensatory  attention on patients' because they will be critisized easily for missing any patient care issue etc etc, or is it the MD'S are unhappy with their job they do and just 'pushing the career with disgust with what they do' - there are so many factors involved into it. 

It makes me more worried about this trend of midlevels provide better and superior care. This reminds me of 1980's trend in international ophthalmology, specially in African continent and mid level care in Indian ophtalmology. Due to the highest cataract load it was planned and done in some centers in Africa to train high school graduates to do cataract surgery - quite naturally many of these high school grads were able to do the surgery after training - now the notion "high school grads surgical care is superior to ophthalmic surgeons". 

It is NOT the rank of any person as PA or NP or HIGH SCHOOL STUDENT that is inferior - it is the trainaing given, the individuals hard work and ability which differentiates from each other and not being MD OR NP OR PA.

The society as a whole had a plan to train md's and nurses for the health care and if the same society now says NP'S, PA'S are enough and no need of MD'S - there is nothing to worry - The children will only become np's and pa's. 

I hear that every graduating np's will have phd degree included and can be called  Dr in future. 

I did vote for non physicians to speed the access and I do beleive it is the training and not the catergory that is important.

Ravi MD

I find both the article and the question inaccurate, misleading, and in poor taste. As an experienced NP and a VA Primary Care Provider, I pride myself in providing high quality accessible care to the veterans I serve. Numerous studies, including the recent IOM report,  have shown that NPs provide high quality cost efficient care with excellent patient outcomes. I believe that the VA is hiring NPs as Primary Care Providers in their quest to provide excellent accessible care to the veterans they serve and not for the sake of expediency. I also believe that an apology is due to all of the dedicated Federal NPs and PAs who have helped to mahe the VAsystem one of the finest in the country. May I suggest that consideration be given to diversiofying your editorial board to include other members of the VA Health Care Team.

While I agree that a lack of continuity of care is bad medicine, I would point out that Ns. Pracitioners and PA's actually have better outcomes in primary care medicine that physicians in many polls. In addition, patient satisfaction score are definitely in favor of these providers. There already aren't enough MD's to fill all the PC slots in this country.....so, where does that leave everyone?  Rather than looking at non-MD providers as 'settling for second best', look at them as the ideal solution.