Emergency medicine in the Veterans Health Administration-results from a nationwide survey.
OBJECTIVE
We describe emergency physician staffing, capabilities, and academic practices in US Veterans Health Administration (VHA) emergency departments (EDs).


METHODS
As part of an ongoing process improvement effort for the VHA emergency care system, VHA-wide surveys are conducted among ED medical directors every 3 years. Web-based surveys of VHA ED directors were conducted in 2013 on clinical operations and academic program development. We describe the results from the 2013 survey. When available, we compare responses with the previously administered survey from 2010.


RESULTS
A total of 118 of 118 ED directors filled out the survey in 2013 (100% response rate). Respondents reported that 45.5% of VHA emergency physicians are board certified in emergency medicine, and 95% spend most their time in direct patient care. Clinical care is also provided by part-time (<0.5 full-time employee equivalent) emergency physicians in 59.3% of EDs. More than half of EDs (57%) provide on-site tissue plasminogen activator for acute ischemic stroke patients, and only 39% can administer tissue plasminogen activator 24 hours per day, 7 days per week. Less than half (48.3%) of EDs have emergency Obstetrics and Gynecology consultation availability. Most VHA EDs (78.8%) have a university affiliation, but only 21.5% participated in the respective academic emergency medicine program.


CONCLUSIONS
Veterans Health Administration emergency physicians have primarily clinical responsibilities, and less than half have formal emergency medicine board certification. Despite most VHA EDs having university affiliations, traditional academic activities (eg, teaching and research) are performed in only 1 in 3 VHA EDs. Less than half of VHA EDs have availability of consulting services, including advanced stroke care and women's health.
Department of Emergency Medicine, Vanderbilt University School of Medicine, Health Services Research, VA Tennessee Valley Healthcare System, 1313 21st Ave, Nashville, TN 37232. Electronic address: michael.j.ward@vanderbilt.edu.
Michael J
MJ
Ward
Department of Emergency Medicine, Vanderbilt University School of Medicine, Health Services Research, VA Tennessee Valley Healthcare System, 1313 21st Ave, Nashville, TN 37232.
Sean P
SP
Collins
Department of Emergency Medicine, George Washington University, Washington, DC.
Jesse M
JM
Pines
Department of Emergency Services, NYU School of Medicine, VA New York Harbor Healthcare Center New York, NY.
Curt
C
Dill
Emergency Services, Syracuse VAMC, National Director for VA Emergency Medicine, Syracuse, NY.
Gary
G
Tyndall
Durham VA Medical Center, Duke University School of Medicine, Durham, NC.
Chad S
CS
Kessler
D003430:Cross-Sectional Studies; D003625:Data Collection; D004635:Emergency Medicine / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005180:Faculty, Medical / Q000706:statistics & numerical data; D005343:Fibrinolytic Agents / Q000600:supply & distribution; D006176:Gynecology; D006785:Hospitals, University / Q000458:organization & administration / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D009774:Obstetrics; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D020521:Stroke / Q000188:drug therapy; D010959:Tissue Plasminogen Activator / Q000600:supply & distribution; D014481:United States; D014493:United States Department of Veterans Affairs; D000078329:Workforce
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator