With Speaker: Edward G. Dudley-Robey MD

HERE IS DR DUDLEY-ROBEY'S SPEECH TO THE NAAC

  • July 11th NAAC Call
  • -
  • Dr Dudley-Robey
00:00 / 00:00

ENCLOSED BELOW IS THE BRIEF THAT WAS SUBMITTED TO THE NAAC PRIOR TO THE JULY 11th PRESENTATION

July 11th Brief for VA National Academic Affiliations Council

Issue: There is no mechanism in place to provide Veteran’s Preference for qualified medical resident candidates seeking a residency position with the Veteran’s Administration.


Key Points:

1. There is no mechanism for the awarding of veteran’s preference in the selection process for VA medical residents. The Veteran’s Administration, in accordance with 38 USC 7406 and 7425 specifically states that the appointment of residents is not subject to the provisions contained within the Veterans Employment Act of 1998 (VEOA) and may  appoint without regard to civil service or classification laws, rules, or regulations. I am petitioning for this to be reconsidered.

 2. The Veterans Affairs Physician Recruitment Act of 2017 (HR 4132) is intended to amend Title 38 to improve educational assistance for health care professionals. This legislation, in part, seeks to provide scholarships for HCPs in order to address physician staffing shortages. Under Section 2, subsection D, the Secretary is specifically authorized to provide a preference for applicants that are veterans, although there is no requirement. If there is an ability to allow veteran’s preference, and particularly during a physician shortage, why would veterans not be encouraged and promoted within the very agency designed to support them?

 3. Additional legislation, the Veterans Healing Veterans Medical Access and Scholarship Program, proposes to provide scholarships to a certain number of veterans.  The very existence of this legislation, including the title, offers recognition of the value in having veterans providing care to other veterans. 

4. Residency programs are funded through federal funding, as are most training sites both directly and through government re-imbursement for services (Medicare, Medicaid, etc.). Participation in government programs across the board requires non-discrimination against a wide range of protected classes, but applications do not inquire (and therefore do not protect) disabled veterans who are applying for medical residency. The Rehabilitation Act states that "no qualified individual with a disability in the United States shall be excluded from, denied the benefits of, or be subjected to discrimination under" any program or activity that either receives Federal financial assistance or is conducted by any Executive agency. Although the VA is exempted, as noted above, from being required to follow such standards, including veteran’s preference in resident selection and admission process, applying such privilege is not prohibited. The VA should not be doing less for veterans hiring than other federal agencies. 

5. The Montgomery GI Bill promotes the education of veterans and is used as the top recruiting tool for the US Military. Many who join the military have as one goal the hopes of attaining an advanced education, but the system fails its veterans / disabled vets who seek to advance a career in healthcare by failing to provide the same veterans preference that most other jobs in the VA and civil service enjoy.

6. The current process places disabled veterans at a disadvantage for receiving these residency positions.

a. Some facilities specifically require residents be ‘fit for active duty’. This, by definition, disqualifies disabled vets and is discriminatory on its face. How does the VA fund residency programs on military bases that a disabled veteran won’t be selected for because he has already served but was injured? This also appears to be in direct conflict with the intent behind the Rehabilitation Act. These are civilian slots, not military. 

b. The VA hires physicians largely from its former resident pool. Therefore, disabled veterans who are not afforded an opportunity to become residents with the VA are far less likely to be hired upon completion of residency.

c. How are US visa requirements / stated VA and Administration goals for putting US citizens first being met if even veterans / disabled veterans are not identified and assisted? Provisions exist to allow for exemptions to the citizen requirements. Physician shortages are apparently the trigger for enhancing scholarship programs. And yet veterans are not being actively sought or given preferred status for resident slots. 

7. The VA is directly violating its Mission and Values, which emphasize caring for and advancing veterans. As has been said by every administration since the War Between the States “veterans come first”. How is this possible for this many positions ( 43k medical resident positions / over 70% of all physicians are trained in the VA system at some point)  to exist in a system set up to aid veterans and not have a way to identify or help qualified veterans / disabled veterans in line with the VA’s stated mission?

Summary

Military veterans have proven their ability to serve with honor and have a proven track record in government service. How can the Veteran's Administration justify any process that places barriers before those who it pledges to serve? Presumably this was an oversight, caused by the complex web of laws and regulations governing Veteran's Preference, civil rights, and non-discrimination, but one that can and should be corrected. Clearly it is advantageous for VA facilities to have veteran physicians and residents caring for the population they are dedicated to serving, in addition to advancing the education and careers of veterans, as recognized in current legislation. 

I respectfully request consideration of the below suggested actions to mitigate this unfortunate circumstance:

Proposed Resolutions:

  • Re-evaluate applying veteran’s preference into the VA and VA contracted residency positions. Consider addressing this issue in current legislation that deals with solutions to the physician shortage and improving the VA system.

  • Consider appointing a department within the OAA to assist veteran candidates who meet the legal requirements for residency positions.

  • Consider re-instituting the old Graduate Medical Officer (GMO) category to provide employment to these qualified candidates.  This will ease the burden of the VA recruiting some providers. Some states have in programs for unmatched candidates and this would be a logical extension of that. It will also help the VA not waste a veteran with a medical degree until they can be matched for a residency slot in line with the VA’s stated employment and educational goals. 

  • Consider amending the relevant provisions under 38 USC that allow for discretion in veterans preference for medical residencies and internships, making it a requirement.

  • Review the above also with consideration for disabled veterans, and consider appropriateness of including the Rehabilitation Act and other non-discrimination laws in the VA resident hiring process.

 

©2020 by Edward G. Dudley-Robey