The Veterans Administration and Academic Surgery

The Committee on Issues has, for several reasons, thought it important to examine the relationships between the Veterans Administration (VA) and academic surgery. This topic had been suggested a number of times at previous meetings of the Association for Academic Surgery. Many of the members of the Committee are currently working, or have worked, in the VA system. Finally, a number of ongoing events in the Veterans Administration galvanized our resolve to investigate the interplay between the VA and academic surgery. In order to get a feeling for the current situation, one needs to review some historical antecedents. Historical aspects. The concept of delivering health care to veterans is not a new one. Thucydides, in his History of the Peloponnesian War, notes “in the same winter, the Athenians gave a funeral at the public cost to those who had first fallen in this war. It was a custom of their ancestors. . . .” George Washington recognized the indebtedness of the United States to its veterans in 1793 when he wrote “it (benefits) was part of their hire . . . it was the price of their blood and of your independency; it is, therefore, more than the common debt, it is the debt of honor. . . .” Every president since 1865 has supported Lincoln’s vow, “to care for him who shall have borne the battle, and his widow, and his orphan.” In 1924, the Congress provided for hospitalization to veterans of all wars, “without regard to the nature or origin of their disabilities. . . .” Public Law 79-293, signed on January 3, 1946, by President Truman, authorized the establishment of a Department of Medicine and Surgery within the VA with a wide range of missions and authorities. This legislation justified medical education and research as essential to the recruitment of physicians, nurses, and dentists of high caliber to assure quality of care. On January 30, 1946, the VA issued the Bradley-Hawley Policy Memorandum No. 2 which stated the purposes of the relationships between the VA and medical schools. Its charge was, in essence, that reasonable men and women be guided in affiliation so that the VA Hospital staff would be in charge of hospital policy, professional matters, and patient care and that the medical school would be concerned with matters of training and education. It was never intended that either member of equal partnership in affiliation would become predominant. The major concepts of this memorandum are still considered valid by the Veterans Administration Central Office. The VA was interested mainly in improving medical care for veterans, while the goal of the medical schools initially was to expand postgraduate residency training to accommodate the postwar demand for thousands of physicians who had gone into the uniformed services during the war without