Disclaimer: These are just my opinions through work experience and observation, so take from it what you want. You will find no evidenced-based, double blind, randomized controlled research here, be thankful for that!
Many of you know that I work as a travel physical therapist (PT), which is turning out to be a lucrative career choice for supporting our wanderlust lifestyle. Before hitting the road, I worked at an outpatient clinic for a great therapist-owned company in Indiana for over five years (shout out to Indiana Physical Therapy). I was also working prn at a close to home skilled nursing facility (the best I’ve worked in to date). But I started to have the desire to do something different, which happened to be; sell everything, buy an RV, and take 13-week contracts in various parts of the country in order to fund this nomadic adventure. So far it’s been incredible! This type of change is quite drastic and not for everyone. However, I’m sure many of you have felt some sort of complacency in your life or career, and I was nearing that point (insert: current crazy nomad life)
Since hitting the road, I’ve worked in Bay City, Texas at a skilled nursing facility; Sulphur Springs, Texas at an outpatient clinic; Fort Bragg, California at a skilled nursing facility; and Roseburg, Oregon at the VA hospital in outpatient with a handful of inpatient. This variety has allowed me to see just how different healthcare can be, based on the type of setting and the sector.
There are some big differences I’ve noted between the private sector and the government sector (limited experience/observation in one particular VA region), each with their own advantages and disadvantages. Although the majority of my career has been spent in the private sector, I am starting to get a feel for a government run “business”, if you want to call it that. The private sector as a, “for-profit model” and the government sector as a, “mis-used tax dollars with good intentions model”. (Unfortunately, some politicians claim that “some things are too big to fail”, they clearly have lost sight of the definition of fail and haven’t spent much time at the VA speaking with veterans)
When I first started in August, between two nearby VA facilities (70 miles apart), there were over 300 PT consults not yet scheduled. I was evaluating patients that had PT orders placed in April and May, which seems completely unacceptable. What was an acute condition for a patient, has now transitioned to a chronic one, all because of lack of access to care. You rarely, if ever, see these kinds of wait times in the PT private sector (from my experience). And much of this lack of access to care has to do with all of the “unnecessary” government red tape and “VA clinical pathway policies”. Many non-productive employees (which is way to many for any kind of efficiency to follow), having meetings about the meetings, driving up overhead costs, and delaying treatment, which only hurts the veterans.
Now, I hate to seem too negative because there are a few perks, besides free healthcare for our veterans, to the VA. One being the readily accessible stocked assistive devices, modalities, equipment, etc that we can issue to veterans as needed. Also, having the option to order whatever we need to help improve a veteran’s function is a welcomed bonus, especially when not dealing with insurance or third party payers, like in the private sector. Sending equipment home with a veteran the same day is awesome and has resulted in hugs by patient’s and their families (only slightly awkward for the non-hugger like me). Unfortunately the perks do not outweigh how disheartening it is to see what some of these veterans have to go through to get access to care. Many of my patients drive over 3 hours just to reach a VA facility with appropriate services.
Insufficient funding with limited oversight of a broken system is the greatest downfall of the government sector. This leads to less locations with full services, significantly understaffed facilities, and an underserved veteran population.
Now over the past year, I had begun to grow an appreciation for some type of free healthcare system, that was until I worked 5 months at a VA facility and realized that the government should never run a healthcare system. Don’t get me wrong, there is great care to be had through the VA; if only you could get timely access to it.
I really don’t like to complain about things without having a solution or at least a realistic idea for changing a situation. Currently the VA attempts to remedy this access issue by creating policies for the policies and cutting clinical positions, which in my short time at the VA does not appear to work. It seems the logical steps to help this problem would be to minimize administrative positions and hire more actual productive clinicians. However unrealistic those
ideas fantasies might be, we should still attempt to channel our inner Lorax and Horton to work toward some kind of change.
Even with all of the pitfalls within the VA system, I am thoroughly enjoying my time working with the veterans. Having the opportunity to hear their stories is very rewarding when dealing with all the government bureaucracy. I hope we can find a way to better serve our veterans that have sacrificed more than we know for our freedom.
*the pictures below are of the beautiful Roseburg VA campus