title: Professionalism, bureaucracy and patriotism: the VA as a health care megasystem.
abstract: The Veterans Administration supports the largest integrated psychiatry service in the country. As our oldest and largest "megasystem," this service offers a unique opportunity for examining distinctive features of such large health care delivery systems. Characteristic experiences of mental health professionals in this system are described and the system is analyzed in terms of its organizational tasks, structure and cultures. Psychiatry will be practiced, in the future, in similarly large scale organizations. Understanding the nature and workings of such organizations is likely to become essential to effective and satisfying professional work.
mesh_terms: D003469:Culture; D003695:Delivery of Health Care; D006040:Goals; D006801:Humans; D011570:Psychiatry; D012945:Social Values; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*