As he was completing his residency in 1998, hospitalist Peter J. Kaboli, MD, MS, was undecided about his career direction. He didn’t know whether he wanted a clinical job in which he could pursue “quality improvement projects or a job focused on research.”
He entered the Veterans Affairs (VA) National Quality Scholars Fellowship Program, first offered in 1999, and found that he actually enjoyed both pursuits. As co-director of the Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) for the VA Iowa City Health Care System, Dr. Kaboli has continued to pursue his interest in clinical research, exploring such issues as quality indicators to guide prescription of medicines for older adults and regional differences in prescribing quality among older veterans.1,2 He credits his time as a fellow as a definitive period in his career growth.
Dr. Kaboli, who now directs the VAQS Fellowship Program at the Iowa City VAMC, suggests that young hospitalists seeking to focus career directions consider a similar path. In fact, Dr. Kaboli and colleague Greg Ogrinc, MD, MS, senior scholar and director of the VA Quality Scholars (VAQS) Fellowship Program at the White River Junction VA in Vermont, say the VA healthcare system offers several avenues for hospitalists to hone their clinical, research, quality improvement, and leadership skills.
A nearly 15-year history with electronic health records (EHR) and a large population of enrolled beneficiaries make the VA system a rich source of data for understanding systems and improving care, Dr. Ogrinc says.
The VAQS Fellowship Program, offered at eight VA centers nationally, is a 2-year interdisciplinary program that pairs physicians and doctorally prepared nurses. Several sites also provide master’s degree training at an affiliated university. The curriculum is designed to train physicians in new methods of improving the quality and safety of healthcare for veterans and the nation. All eight VAQS centers are affiliated with academic institutions. That’s the case with the program at White River Junction, where VAQS Senior Scholar Dr. Ogrinc also holds dual appointments with Geisel School of Medicine in Hanover, N.H. and The Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H.
Dr. Ogrinc has tracked the VA’s experience with the program since its inception. One summary, published in 2009, notes that one of the strengths of the program is its combination of healthcare improvement curricula with adult learning strategies.3 This, along with mentorship and meaningful projects, serves to prepare physicians to lead improvement initiatives in healthcare quality and safety.
At White River Junction, graduates of the fellowship program follow a wide range of career paths. Dr. Ogrinc says roughly 50% choose to remain with the VA. Wherever fellows land after the program, both Dr. Kaboli and Dr. Ogrinc agree that the two-year delay before going into practice is a worthwhile investment. “The upfront investment in time pays back in the long run,” Dr. Kaboli says.
Additional fellowships offered through the VA include Career Development Awards (akin to the National Institutes of Health career development K awards), often located at VA medical centers designated as Centers of Innovation. They supply research infrastructure and access to data. Some of the centers offering VAQS and patient safety fellowships are co-located with Veterans Engineering Resource Centers, so that cross-fertilization with experts in organizational engineering makes for an additional “rich learning environment,” notes Dr. Ogrinc.
Like all U.S. healthcare systems, the VA is expanding its use of hospitalists.
“There are great opportunities for hospitalists in the VA as salaried physicians, with very reasonable work hours and an excellent electronic medical record,” Dr. Kaboli says.
Dr. Ogrinc points out that residency programs do not always prepare hospitalists for the administrative, system improvement, and organizational responsibilities that often fall under hospitalist purview. “Committee and improvement work can often be seen as bothersome by some,” he says, “especially if they don’t have the opportunity to learn the skills and methods to make their organizations work better from a patient outcome standpoint.”
In addition, either experiencing a fellowship program or simply working in a salaried position with the VA “can round out your skill set, make you a better hospitalist overall, and put you in a position to be a leader as a hospitalist in a practice,” Dr. Ogrinc says.
Dr. Kaboli agrees.
“The future of healthcare reform in this country is embracing the model of the accountable care organization,” he says. “The VA system, with capitated payment, salaried physicians, and comprehensive integrated care, is arguably the largest ACO [accountable care organization] in the country.”
Gretchen Henkel is a freelance writer in California.
- Lund BC, Steinman MA, Chrischilles EA, Kaboli PJ. Beers criteria as a proxy for inappropriate prescribing of other medications among older adults. Ann Pharmacother. 2011;45:1363-1370.
- Lund BC, Charlton ME, Steinman MA, Kaboli PJ. Regional differences in prescribing quality among elder veterans and the impact of rural residence. J Rural Health. 2013;29:172-179.
- Splaine ME, Ogrinc G, Gilman SC, et al. The Department of Veterans Affairs National Quality Scholars Fellowship Program: experience from 10 year of training quality scholars. Acad Med. 2009;84:1741-1748.