By Sandra Basu

WASHINGTON — With 29% more women accessing VA healthcare in the past three years, the agency has a way to go to make sure it meets the needs of female veterans, advocates testified at recent congressional hearings. One key issue is the lack of gynecologists at every VAMC.

“Despite the fact that VA has made tremendous progress to improve services for women, they still lack consistent access to a full range of gender-sensitive healthcare benefits and services,” Joy Ilem, deputy national legislative director of Disabled American Veterans said at a recent House of Representatives hearing.

Lauren Augustine, legislative associate for the Iraq and Afghanistan Veterans of America, added, “The VA specifically needs to expedite planned improvements to VA facilities to support and improve services and care for women.”

Ilem and Augustine were among the panelists who addressed women veterans’ issues at separate House and Senate congressional hearings last month.

VA Chief Consultant for Women’s Health Services Patricia Hayes, MD, told lawmakers there are more than 2 million women veterans in the United States, more than 400,000 of whom use VA healthcare services in FY 2014.

With the recent increase in female veterans seeking VA healthcare services, “We are just getting to the point where we are going to have lots and lots of women at our doorstep,” she told Senate lawmakers.

At the hearings, Augustine and other advocates offered suggestions on how VA could improve care for female veterans, including ensuring women veterans get the respect they deserve.

‘Don’t Matter as Much’

“As one of our members describes it: VA has made great strides in instituting women’s clinics, program coordinators, but it is difficult to believe it is changing when I get letters addressed to ‘Mr.’ when I read my medical chart and I am referred to as ‘him’ when I enrolled at this VA. Eligibility listed me as male. Simple things, but what it says to me is that we still don’t matter as much,” Augustine recounted.

Dawn Halfaker, a veteran who was seriously wounded in combat in 2004, told House lawmakers she was concerned about the coordination of care between VA and non-VA care. She recalled how, when she was pregnant, the DC VAMC handed her a list of maternity care providers but couldn’t endorse any and told her she would need to find someone who would accept VA patients.

“I was surprised to learn that it hadn’t established any maternity care contracts, which left me on my own to find obstetrical care,” Halfaker told lawmakers.

In addition, her credit was jeopardized because non-VA reimbursements took so long that she was directly billed for services.

Coordination and payment of non-VA care must be improved, said Rep. David Roe (R-TN), who said, “Pay the bills. That is not very hard. We ought to be able to do that. That should be fixable.”

The need for more gynecologists also was emphasized by veterans’ advocates.

At the House committee hearing, Hayes said VA has Designated Women’s Health Providers (DWHP) who can provide general primary care and gender-specific primary care at every medical center and 90% of community-based outpatient clinics (CBOCs).

On the other hand, gynecology specialty providers are not available on site at all VA healthcare centers — with 117 VAMCs having on-site gynecologists and 35 without them.

“We are aggressively looking at the workforce issues, exactly where do we strategically expect an additional increase, where we have gaps right now and making sure we hire at those sites. That is part of our workforce planning right now,” Hayes told House lawmakers.

VA intends to hire new gynecologists through funds from the 2014 Veterans Access, Choice and Accountability Act, although Hayes said it is not yet known how many will be hired or whether they all will be full-time vs. part-time.

“We are looking at a workforce model that will tell us exactly how many gynecologists we need at each and every site,” she told House lawmakers.

Legislation to Improve Care

Legislation has been introduced to make sure the changes occur. Rep. Mike Coffman (R-CO) introduced House Resolution 1356, which would require that VA ensure every VAMC has a full-time obstetrician or gynecologist. The bill also directs the Government Accountability Office (GAO) to evaluate VA’s ability to meet the needs of female veterans. An identical bill, Senate Bill 471, was introduced by Senate lawmakers.

The Military Officers Association of America is urging members to send a message of support for the Senate bill to their elected officials, noting that “many VA facilities are currently ill equipped to handle some of the unique needs of women veterans.”

House Committee Chairman Rep. Jeff Miller (R-FL) also said he was requesting that GAO assess VA’s ability to improve the access and quality of healthcare for women veterans.

“GAO last conducted an investigation on healthcare for women veterans in 2010,” he pointed out, “and found that availability of services for women varied significantly across the VA healthcare system and that VA faced a number of key challenges in providing healthcare to women veterans.”