On August 7, President Barack Obama signed into law the Veterans Access, Choice, and Accountability Act of 2014 (Act). While much press has been given to the Act’s increasing of access to private health care providers, increasing of recruitment of new physicians, and granting to the Secretary of the U.S. Department of Veterans Affairs (Secretary) more flexibility to terminate employees, less attention has been given to the Act’s requirement of the Secretary to increase the number of graduate medical education (GME) positions.

The U.S. Department of Veterans Affairs (VA) already is a leader in medical education and maintains a strong relationship with academic medical centers:

• More than 65% of all U.S.-trained physicians, and nearly 70% of VA physicians, have had VA training prior to employment;
• 50% of U.S. psychologists and 70% of VA psychologists have had VA training prior to employment; and

In 2011:

• 116,794 trainees received some or all of their clinical training in the VA.
• 124 out of 152 VA hospitals and three out of six independent outpatient clinics had affiliation agreements with 114 of 136 allopathic Accredited Medical Schools and 15 of 26 osteopathic medical schools.
• 40 other health professions were represented by affiliation agreements with more than 1,800 colleges and universities.

Under the Act, the Secretary is to do two things:

1. Establish medical residency programs or ensure that already-established medical residency programs have a sufficient number of residency positions at those VA facilities in designated Health Professional Shortage Areas that are experiencing a shortage of physicians. In meeting this obligation, the Secretary is directed to give priority to residency positions in primary care, mental health, and any other specialty the Secretary determines appropriate; and

2. Starting one year from the date of enactment of the Act and for five years thereafter (presumably August 8, 2015 – August 7, 2020), increase the number of GME residency positions at VA medical facilities by up to 1,500 positions. Priority for these positions is to be given to facilities that do not have a medical residency program as of the date of enactment of the Act and which are located in a community that has a high concentration of veterans.

The Act appropriates $5 billion to fund the foregoing activities (along with physician recruitment and facility development).

While implementation details still need to be developed (including a potential increase in approved positions by the Accreditation Council for Graduate Medical Education), the VA will continue to look to academic medical centers and teaching hospitals to further their partnerships with the VA.

Originally, this article was an alert sent to the American Health Lawyers Association’s (AHLA) Regulation, Accreditation and Payment Practice Group. For more information, visit AHLA’s website.

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