title: Internal practice barriers for non-physician practitioners in the veterans healthcare system.
abstract: As a consequence of the re-engineering of the veterans healthcare system initiated in 1995, non-physician clinicians are functioning with new levels of autonomy and expanded scopes of practice, but they are not consistently being utilized to their optimal potential. A work group appointed by the Under Secretary of Health in 1996 found various barriers to improving this situation: 1) lack of clarity regarding the roles of the non-physician clinicians; 2) lack of understanding of the basis of their credentialing; 3) lack of uniformity of their credentials; 4) non-acceptance by physicians and managers; 5) rigidity of administrative policies; and 6) salary, benefit, and career-advancement issues. The authors recommend ongoing management attention to addressing these barriers both within and outside the VHA system.
authors.affiliation: Department of Veterans Affairs, Washington, DC 20420, USA.
authors.forename: K W
authors.initials: KW
authors.lastname: Kizer
authors.forename: R B
authors.initials: RB
authors.lastname: Norby
mesh_terms: D000488:Allied Health Personnel / Q000193:education / Q000458:organization & administration*; D001291:Attitude of Health Personnel; D002322:Career Mobility; D002568:Certification; D018166:Health Care Reform / Q000458:organization & administration*; D006801:Humans; D007587:Job Description; D008503:Medical Staff / Q000523:psychology; D009936:Organizational Innovation; D016134:Organizational Policy; D017009:Professional Autonomy; D012456:Salaries and Fringe Benefits; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*