The Culture of the VA

After rotating through different hospital settings, I've noticed that each place has a specific culture to it. Some places, focused on revenue and caring for many well-insured patients emphasize throughput, productivity, and efficiency. Other places that serve uninsured or underinsured patients concentrate on saving money and rationing resources. The VA, on the other hand, is its own sanctuary. Doctors at the VA are salaried; they don't make more money by doing more procedures. The benefit is that there is no incentive to do unnecessary surgeries; however, it also means that indicated surgeries may be delayed. I like it because we make clinical decisions based on what's right for the patient, not whether it may generate more revenue. And while no physician would do unnecessary surgery for profit, it may unconsciously influence us without our awareness. But since the VA doesn't make more money by doing more surgeries, its pace is a lot slower. We take much longer for our surgeries than equivalent private practices. Part of that is the teaching environment of the VA and part of it might be the fact that it's government. But I find that there's less time pressure to get things done, and it reassures me that I can take longer to do something right. Because cost is usually not an issue, VA patients get fairly extensive pre-operative testing. VA patients are less likely to be litigious. They are more accepting of case delays and even cancellations. Eventually, I will have to think about the culture and work environment of my future job, and it's good for me to get a sense of the diversity now.