ABSTRACT
Following medical school, most newly graduated physicians enter residency training. This period of graduate medical education (GME) is critical to creating a physician workforce with the specialized skills needed to care for the population. Completing GME training is also a requirement for obtaining medical licensure in all 50 states. Yet, crucial federal and state funding for GME is capped, creating a bottleneck in training an adequate physician workforce to meet future patient care needs. Thus, additional GME funding is needed to train more physicians. When considering this additional GME funding, it is imperative to take into account not only the future physician workforce but also the value added by residents to teaching hospitals and communities during their training. Residents positively affect patient care and health care delivery, providing intrinsic and often unmeasured value to patients, the hospital, the local community, the research enterprise, and undergraduate medical education. This added value is often overlooked in decisions regarding GME funding allocation. In this article, the authors underscore the value provided by residents to their training institutions and communities, with a focus on current and recent events, including the global COVID-19 pandemic and teaching hospital closures.
Subject(s)
COVID-19 , Internship and Residency , Physicians , Humans , United States , Pandemics , COVID-19/epidemiology , Education, Medical, Graduate , Hospitals, TeachingABSTRACT
Universal screening for suicidal ideation in primary care and mental health settings has become a key prevention tool in many healthcare systems, including the Veterans Healthcare Administration (VHA). In response to the coronavirus pandemic, healthcare providers faced a number of challenges, including how to quickly adapt screening practices. The objective of this analyses was to learn staff perspectives on how the pandemic impacted suicide risk screening in primary care and mental health settings. Forty semi-structured interviews were conducted with primary care and mental health staff between April-September 2020 across 12 VHA facilities. A multi-disciplinary team employed a qualitative thematic analysis using a hybrid inductive/deductive approach. Staff reported multiple concerns for patients during the crisis, especially regarding vulnerable populations at risk for social isolation. Lack of clear protocols at some sites on how to serve patients screening positive for suicidal ideation created confusion for staff and led some sites to temporarily stop screening. Sites had varying degrees of adaptability to virtual based care, with the biggest challenge being completion of warm hand-offs to mental health specialists. Unanticipated opportunities that emerged during this time included increased ability of patients and staff to conduct virtual care, which is expected to continue benefit post-pandemic.
Subject(s)
COVID-19/epidemiology , COVID-19/psychology , Health Personnel , Mass Screening/methods , Pandemics , SARS-CoV-2 , Suicidal Ideation , Veterans Health , Veterans/psychology , COVID-19/prevention & control , COVID-19/virology , Humans , Mental Health , Physical Distancing , Primary Health Care , Risk Assessment/methods , Telemedicine/methodsABSTRACT
From the Summary: The Department of Veterans Affairs (VA) provides a range of benefits to eligible veterans and their dependents. The department carries out its programs nationwide through three administrations and the Board of Veterans' Appeals (BVA). [1]The Veterans Health Administration (VHA) is responsible for health care services and medical and prosthetic research programs. [2] The Veterans Benefits Administration (VBA) is responsible for, among other things, providing disability compensation, pensions, and education assistance. [3] The National Cemetery Administration (NCA) is responsible for maintaining national veterans cemeteries;providing grants to states for establishing, expanding, or improving state veterans cemeteries;and providing headstones and markers for the graves of eligible persons, among other things. With a vast integrated health care delivery system spread across the United States, the VHA is statutorily required to serve as a contingency backup to the Department of Defense (DOD) medical system during a national security emergency and to provide support to the National Disaster Medical System and the Department of Health and Human Services (HHS), as necessary, in support of national emergencies. These functions are known as VA's 'Fourth Mission.' Since the onset of the Coronavirus Disease 2019 (COVID-19) pandemic, Congress has passed a number of relief measures affecting the VA and its Fourth Mission.COVID-19 (Disease);United States. Department of Veterans Affairs;Veterans--Services for
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From the Introduction: Health care providers are leveraging 'telehealth', which generally refers to a health care provider's use of information and communication technology to provide a health care service, to meet patients' health care needs during the Coronavirus Disease 2019 (COVID-19) pandemic. However, some providers do not have the infrastructure to offer, nor do some patients have the broadband access or connected devices to access, telehealth services. To address these gaps, the Federal Communications Commission (FCC) is administering the COVID-19 Telehealth Program and Connected Care Pilot Program. The goal of both programs is to assist health care providers with providing 'connected care services', which the FCC refers to as 'a subset of telehealth that uses broadband internet access service-enabled technologies to deliver remote medical, diagnostic, patient-centered, and treatment-related services directly to patients outside of traditional brick and mortar medical facilities--including specifically to patients at their mobile location or residence'. [...] This In Focus provides an overview of both programs.Medical telematics;Telecommunication in medicine;COVID-19 (Disease);United States. Federal Communications Commission
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From the Introduction: The Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) is responsible for providing health care benefits to eligible veterans. [...] During the Coronavirus Disease 2019 (COVID-19) pandemic, both routine and urgent in-person health care services are either being postponed or shifted to telehealth by the VHA for those veterans who (1) do not have COVID-19 diagnoses, (2) are not exhibiting symptoms of the disease, and (3) are not at high risk of being affected by the disease. [...] 'Telehealth' generally refers to health care providers' use of information and communication technology to provide a health care service. This In Focus provides an overview of veterans' access to VA telehealth services and discusses two funding activities that aim to assist veterans with obtaining telehealth-related infrastructure during the pandemic.Veterans--Medical care;COVID-19 (Disease);Medical telematics;Telecommunication in medicine;United States. Department of Veterans Affairs
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From the Document: Physical distancing measures and temporary stay-at-home orders associated with the Coronavirus Disease 2019 (COVID-19) pandemic have required changes in service delivery for mental health and substance use (collectively known as 'behavioral health') treatment. Changes have surrounded relaxing privacy requirements required by the Health Insurance Portability and Accountability Act (HIPAA) Rules and increasing use of telehealth to deliver behavioral health treatment and services. Some states have also employed other methods of service delivery--such as mobile units--for treatments that cannot be administered via telehealth, such as medication-assisted treatment (MAT) for opioid use disorder (OUD).COVID-19 (Disease);Telecommunication in medicine;Mental health;Opioid abuse