The Department of Veterans Affairs says it faces a doctor shortage and that contributes to the long waits for veterans needing medical attention–never mind the intentional manipulation of wait times by support staff under the direction of management makes the VA look like it has plenty of manpower for certain tasks.

A controversial new measure would significantly expand the number of medical professionals who are able to deliver care by turning advanced trained nurses into super nurses. As we reported recently, new regulations would allow 93,000 nurses to order and read diagnostic tests, administer anesthesia, prescribe medications, and manage acute and chronic diseases –all without the supervision of a doctor.

Doctors and anesthesiologists are vehemently against this proposal (not surprisingly) as this would be a direct threat to their jobs, authority, and influence. However, doctors are not running to work for the VA.

With 53 more days left for public comment, the undersecretary for health at the VA, David J. Shulkin, discussed with the Washington Post the impetus behind the rule explaining that it could address the unequal distribution of healthcare professionals:

What we know about American medicine is that our supply of health-care professionals is not equally distributed. In rural areas, we have severe shortages. I’ve seen firsthand how difficult it is to recruit to some of the areas where our veterans live. We have a shortage of both nurses and physicians. We are recruiting thousands of doctors and advanced-practice nurses.

In response to opposition from doctors, he explained:

I do not believe they [physicians] understand what our intent in going into this rule-making is. We have embraced team-based health care. We believe in the model. We are not looking to destroy that. We are looking to add to our ability to deliver heath care to veterans in places that don’t frankly have health care for them right now. In areas where it is working, we are not planning on changing that. In fact, we embrace the concept of team-based health care.

On the quality of care he knocked down those concerns as well:

My assessment of the literature, which is vast on this subject in general, is that it has shown that nurses are able to deliver high-quality care, particularly when they are delivering care in settings that are within their competencies and scope of responsibilities. The literature shows very good outcomes.

And if there is a complication with a patient, he says that just as primary care doctors defer and refer to their colleagues who are specialists, so should nurses.

This rule will continue to be controversial, but the public discussion has shined a light on the role of nurses in providing veteran’s care. Some of these nurses are veterans and joined the profession precisely to help heal or care for their fellow comrades:

Nursing assistant Tom Alligood wears camouflage scrubs during his emergency room shifts at the Dorn VA hospital because he says it helps other veteran patients realize they've "walked over the same dirt," the 62-year-old former Army tanker says.

"I need to be around veterans like me. That's where I get my strength, my 'positiveness' from," says the burly former first sergeant who now sports a long, gray braid on his back.

Apparently, empathy is what the VA is looking for when hiring nurses, but not doctors.

The VA needs more than a make-over but the kind of collective redo that the doctors on the show “Botched” do to fix the issues caused by lazy or incompetent medical and cosmetic procedures on patients.

Going forward they can’t continue to follow the same old procedures hoping for better results because those are not likely to come.