Problems with access to care at the Department of Veterans Affairs have been the source of front-page headlines for at least a year. Some of us are asked: Can the VA and military health care system do it all? My answer: Of course not.
More than 2.5 million American combat veterans have fought in longest war in our history, the wars in Afghanistan and Iraq. Thousands of physically and psychologically wounded active duty troops overflow military hospitals. The VHA (Veterans Health Administration), the medical arm of VA, is caring for millions of these recent veterans. But it also treats veterans from many other wars, including those from World War II, Korea, and Vietnam.
As those men and women age, their need for medical care will only increase. So just take into account the older veterans, and then add the recent combat veterans with posttraumatic stress disorder, traumatic brain injury, and physical injuries from the conflicts in Iraq and Afghanistan.
So, to me, “of course not” is an obvious answer to whether the military health care system and VA can do it all.
This should be no surprise. Back in 2007, my former boss, the Army surgeon general, was fired when Walter Reed National Military Medical Center got overwhelmed with the wounded. A consistent theme of overwhelmed military and veterans facilities has emerged.
Yet, I still get asked the question “Is the military and the VA doing enough to take care of wounded veterans?” whenever I do a media interview about PTSD and suicides in soldiers. The reporters tend to ask with a kind of “gotcha” attitude, as if the VA’s struggle to keep up is a secret.
My answer is “They are doing all they can. They are stretched very thin.”
I recently served on an Institute of Medicine committee looking at how well the Department of Defense and the VA delivered care for PTSD. The short answer? It varies. Some VA hospitals deliver stellar care, others not so much. Being swamped was a common theme.
Rather than ragging on the struggling VA, the more productive direction, it seems to me, is to ensure that the civilian health care system is capable of recognizing and treating the psychological injuries of war.
Why involve civilians? For many reasons. A lot of veterans choose not go to the VA, because they receive health care via their workplace or school insurance. Some veterans are too low a priority to be seen. Even for those eligible to receive treatment there, when too full, the VA refers many veterans to the civilian sector.
Fortunately, there have been a lot of efforts to teach psychiatrists about caring for the psychological wounds of war, including:
• The military track at the American Psychiatric Association meeting in Toronto, on its 5th year.
• Webinars and conferences developed by public and private organizations, such as the Substance Abuse and Mental Health Services Administration, and the Massachusetts General Hospital Home Base program.
• Many books and articles by experts in the area of veterans health, for example see Once a Warrior – Always a Warrior b y Col. (Ret.) Charles W. Hoge, M.D., (Guilford, Conn.: Lyons Press, 2010), or my forthcoming book, Women at War (Oxford University Press, 2015).
• The developing medical school curriculum on veteran’s health, spurred by the White House’s Joining Forces initiative.
• An action paper to be presented at this year’s APA Assembly, recommending that all providers inquire about the military status of their patients.
Of course, there is lots of room for everybody – not just health care providers – to join in the mission. As we enter year 14th year of the long war, we all need to help.
Dr. Ritchie serves as professor of psychiatry at the Uniformed Services University of the Health Sciences in Bethesda, Md., and at Georgetown University in Washington.