Panel Session: To Stay in VA or Not to Stay? That is the Question

​The 2019 Annual Meeting of the AVAS was blessed with several enlightening panel discussions. The initial panel discussion (moderated by George Sarosi, MD and Seth Spector, MD) was on “TO STAY IN VA OR NOT TO STAY? THAT IS THE QUESTION” Kamal Itani, MD (Professor and Chief of Surgery, VA Boston Health Care System) started the discussion on “WHY I STAYED IN VA”. Dr. Itani began our discussion by stating “this was the best career decision I have ever made!” He pointed out that a career in the VA has provided him continued job satisfaction. Among his reasons for staying with the VA, were that the VA provided a stable environment with a work/life balance that could not be found elsewhere. In addition, he is proud to work for a health care system that provides transcontinental care for our Veterans for life. For him, while the VA provides an excellent environment for mentoring staff/trainees as well as for research opportunities, caring for our Veteran patients provides the ultimate reward. For Dr. Itani, while there may be significant challenges, the rewards clearly outweigh the headaches that intervene. He expressed he has never regretted his decision to stay in the VA. Melanie Morris, MD (Associate Professor and Chief of General Surgery, Birmingham VA Medical Center) followed with her talk on “HOW AND WHY I SPLIT TIME IN VA”. Dr. Morris explained her story regarding her decision to split her time between the VA and University of Alabama. She expressed that she experiences several advantages including the ability to provide highly specialized clinical care designed at the academic affiliate for her Veteran patients. In addition, she felt that the leadership opportunities at the VA have expanded her potential in the academic setting. She reminded everyone of the challenges of meeting part-time provider VA mandates, but, in spite of those obstacles, she is satisfied with her decision to split time. Leigh Neumayer, MD MS ​(Professor and Chair, University of Arizona) continued with her explanation “WHY I LEFT THE VA”. Dr. Neumayer began by explaining that when she was employed by the VA she found working for the VA very advantageous. Among those reasons were the incredible opportunities to help our Veteran patients, research opportunities, and teaching opportunities. She reminded us of the lesser known potential for research funding for cooperative studies as well as additional educational opportunities. Among the reasons for Dr. Neumayer’s departure from the VA were the gradual increase in unaddressed infrastructure concerns, her interest in expanding her focus on women’s healthcare, the academic opportunities that required full time commitments, and the difficulty in providing call coverage for two different institutions. Todd Rosengart, MD (Professor and Chair, ​​Department of Surgery, Baylor College of Medicine) concluded with his explanation on “HOW ACADEMIC AFFILIATE CAN SUPPORT”. Dr. Rosengart outlined the following six steps in partnering with the VA: creating a culture of cooperativity, defining expectations, facilitating the partnership, promoting the partnership, reinforcing the partnership and continued reassessment of achievements or failures/obstacles. He explained that there is a constant balance between success and managing hallenges faced in academic surgery (constant competing demands, funding challenges, and burnout challenges). He explained the first step in creating a cooperative culture is to break down the silos. To be successful you must partner with your staff and your VA partners to define the expectations of the partnership. To foster, this partnership, you must build a foundation for innovative programs. Part of this foundation requires stakeholders to address the RVU compensation concerns of those who work for the VA as well as conduct research. Following this, Dr. Rosengart expounded on methods for promotion and reassessment. He highlighted the need for continued social media and CME outreach. We sincerely appreciate the surgeons who took the time out of their busy schedule to participate in the enlightening panel discussion.

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