The Veterans Health Administration and
Medical Education: A Fact Sheet
Elayne J. Heisler
Analyst in Health Services
Erin Bagalman
Analyst in Health Policy
June 6, 2014
Congressional Research Service
7-5700
www.crs.gov
R43587
The Veterans Health Administration and Medical Education: A Fact Sheet
Contents
Background ...................................................................................................................................... 1
The VA’s Involvement in Medical Training ..................................................................................... 1
Academic Affiliations ................................................................................................................ 2
Academic Appointments ........................................................................................................... 2
VA Funding of Physician Training ................................................................................................... 3
Figures
Figure 1. VA Facilities and Medical Schools, with and without Affiliations ................................... 3
Figure 2. VA Spending on Health Care Professional Education and Training (FY2010 –
FY2016 Advance Appropriation Request) .................................................................................... 4
Tables
Table 1. VA Medical Training at the Trainee Level (2013) .............................................................. 1
Contacts
Author Contact Information............................................................................................................. 5
Congressional Research Service
The Veterans Health Administration and Medical Education: A Fact Sheet
Background
In the wake of World War II, an influx of veterans requiring medical care threatened to
overwhelm the capacity of the Department of Veterans Affairs (VA) to provide such care. In 1946,
the VA began entering into affiliations with medical schools as one strategy to increase capacity
both in the short term and in the long term.1 In the short term, some trainees—in particular, those
in the later years of training—may provide direct care to patients, thereby increasing provider
capacity and patient access. In the long term, training physicians at the VA creates a pipeline for
recruiting physicians as VA employees.2 Current concerns about the VA’s capacity to provide
access to care3 have returned attention to the role of medical training at the VA.4
The VA’s Involvement in Medical Training
The VA is the largest provider of medical training in the United States and is involved in training
at all levels: medical students, medical residents, and medical fellows (see Table 1).5
Table 1. VA Medical Training at the Trainee Level (2013)
Number in Training (2013)
U.S. Total
Trainee Type
Description
VA
(including VA)
Medical
The VA serves as a site for clinical rotations during medical
21,540 105,213
Students
school; this is also called undergraduate medical education.
Medical
Through affiliations with hospitals and academic medical
40,420 94,990
Residents
centers, the VA serves as a training site for medical residents;
this is also called graduate medical education (GME).
Fellows
Through affiliations with hospitals and academic medical
253 20,121
centers, the VA serves as a training site for fellows
(individuals who have completed residency training and are
pursuing additional training in order to subspecialize.)
Sources: VA data from U.S. Department of Veterans Affairs. Office of Academic Affiliations, "Medical and
Dental Education Program," http://www.va.gov/oaa/specialfellows/default.asp?p=1, website accessed June 5, 2014.
1 See U.S. Department of Veterans Affairs, Policy Memorandum No. 2, Subject: Policy in Association of Veteran's
Hospitals with Medical Schools, Washington, DC, January 30, 1946, http://www.va.gov/oaa/Archive/
PolicyMemo2.pdf.
2 The VA reports that nearly 70% of VA physicians had trained at the VA prior to their employment. U.S. Department
of Veterans Affairs (VA). Office of Academic Affiliations, "Mission of the Office of Academic Affiliations,"
http://www.va.gov/oaa/specialfellows/default.asp?p=1, website accessed June 5, 2014.
3 See, for example, CRS Report IN10063, Wait Times for Veterans Health Not New, by Sidath Viranga Panangala; and
Veterans Health Administration, "Interim Report: Review of Patient Wait Times, Scheduling Practices, and Alleged
Patient Deaths at the Phoenix Health Care System," May 28, 2014, http://www.va.gov/oig/pubs/VAOIG-14-02603-
178.pdf, website accessed June 2, 2014.
4 The training of health care professionals is also one of the VA’s statutory missions; see 38 U.S.C. §7302.
5 U.S. Congress, House Committee on Veterans' Affairs, Subcommittee on Health, Healthcare Professionals—
Recruitment and Retention, 110th Cong., 1st sess., October 18, 2007 (Washington: GPO, 2008), p. 40.
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The Veterans Health Administration and Medical Education: A Fact Sheet
Medical school enrollment data from the Association of American Medical Colleges, “Table 26: Total Enrollment
at U.S. Medical School and Sex,†https://www.aamc.org/data/facts/enrol mentgraduate/158808/total-enrol ment-
by-medical-school-by-sex.html, website accessed June 5, 2014; and American Association of Col eges of
Osteopathic Medicine, “ Trends in Osteopathic Medical School Applicants, Enrollment, and Graduates,â€
http://www.aacom.org/data/applicantsmatriculants/Pages/default.aspx, website accessed June 5, 2014. Medical
Resident and Fel ow data from: Sarah E. Brotherton and Sylvie I. Etzel, "Graduate Medical Education, 2012-2013,"
Journal of the American Medical Association, vol. 310, no. 21 (December 4, 2013), pp. 2328-2346.
Notes: Total reflects allopathic and osteopathic enrol ment. Medical students during their first two years are
generally receiving classroom instruction and not clinical training; therefore, they would not be eligible to rotate
to any type of a facility for clinical instruction.
Academic Affiliations
The VA’s physician training programs are conducted primarily through its affiliations with
medical schools and, in some instances, with teaching hospitals. In general, the purpose of these
affiliation agreements is to enhance patient care and education, but some may also include
medical research. Under these affiliation agreements, the VA and the relevant educational
institution share responsibility for the academic program. The affiliation agreement promotes
common standards for patient care, medical student and resident education, research, and staff
appointments.6 Generally, the VA is not the primary sponsor of medical education.7 Specifically,
the VA does not operate its own medical schools, but medical students from affiliated institutions
may do a clinical rotation at affiliated VA facilities. Similarly, the VA does not typically operate
its own residency programs. Instead, residents apply to the medical school or teaching hospital
that is the primary sponsor of the residency program and then spend a portion of their residency
training at the VA. The exception to this model is fellowship level training, where the VA directly
operates fellowship training programs in subspecialties that are of high importance to the VA.8
The majority of VA facilities and the majority of U.S. medical schools (both allopathic and
osteopathic)9 have affiliation agreements with each other to train physicians (see Figure 1).
Academic Appointments
Under affiliation agreements, VA clinicians may be granted academic appointments to medical
school faculty at the discretion of the academic institution based on the clinician’s credentials.
Currently, approximately 70% of VA staff clinicians have a faculty appointment at an affiliated
school of medicine.10 VA staff clinicians may be jointly employed by the VA and the affiliated
6 Drawn from a sample copy of VA Form 10-0094a, “Medical Education Affiliation Agreement Between Department
of Veterans Affairs (VA), and A School Of Medicine and its Affiliated Participating Institutions.â€
7 The VA reports that 99% of its graduate medical education training programs are sponsored by an affiliate. See U.S.
Department of Veterans Affairs, Office of Academic Affiliations, "Medical and Dental Education Program,"
http://www.va.gov/oaa/specialfellows/default.asp?p=1, website accessed June 5, 2014.
8 For more information, see U.S. Department of Veterans Affairs, Office of Academic Affiliations, "Advanced
Fellowships and Professional Development," press release, http://www.va.gov/oaa/specialfellows/default.asp?p=1,
website accessed June 5, 2014.
9 Allopathic medical schools grant a Doctor of Medicine degree (M.D.); osteopathic medical schools grant a Doctor of
Osteopathic Medicine degree (D.O.).
10 Veterans Health Administration, Procurement & Logistics Office, The Academic Affiliate Guide to Health Care
Resources Contracting with the Department of Veteran's Affairs, 2014.
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The Veterans Health Administration and Medical Education: A Fact Sheet
medical center, may volunteer their time as faculty, or the VA may contract with the academic
affiliate for faculty.
Figure 1. VA Facilities and Medical Schools, with and without Affiliations
Affiliated
Not Affiliated
160
140
28
11
120
100
80
124
130
60
40
7
20
3
22
3
0
VA Medical Centers
VA Independent
Allopathic Medical
Osteopathic
Outpatient Clinics
Schools
Medical Schools
Source: U.S. Department of Veterans Affairs, Office of Academic Affiliations, "Mission of the Office of Academic
Affiliations," http://www.va.gov/oaa/specialfellows/default.asp?p=1, website accessed June 5, 2014.
VA Funding of Physician Training
The VA is the second-largest federal payer for medical training after Medicare, which subsidizes
graduate medical education (GME) at teaching hospitals. Medicare GME payments totaled $10.0
billion in 2014.11 Between FY2010 and FY2014 (estimated) the VA has spent $1.2- $1.8 billion
annually on health professionals training, including but not limited to physician training (see
Figure 2). Funds appropriated for the VA health care system are categorized as either general
purpose funds or specific purpose funds, both of which support some aspects of physician
training. General purpose funds are distributed at the beginning of each fiscal year to be used for
basic care, complex care, adjustments for high cost patients, geographic price adjustment,
research support, equipment, non-recurring maintenance, and education support. Specific purpose
11 U.S. Government Accountability Office, Health Care Workforce: Federally Funded Training Programs in Fiscal
Year 2012, 13-709R, August 15, 2013, http://www.gao.gov/products/GAO-13-709R; and Congressional Budget Office,
Medicare, May 2012, Baseline (estimate), http://www.cbo.gov/sites/default/files/cbofiles/attachments/
43060_Medicare.pdf.
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The Veterans Health Administration and Medical Education: A Fact Sheet
funds are distributed throughout the fiscal year to be used for prosthetics, mental health, homeless
grants and per diem program, state home per diems, transplants, readjustment counseling, medical
facility activations, and clinical trainees.
Figure 2. VA Spending on Health Care Professional Education and Training
(FY2010 – FY2016 Advance Appropriation Request)
(not limited to physicians, dollars in millions)
$2,000
$1,800
$1,600
$1,400
$1,200
Specific Purpose
$1,000
(direct training costs)
General Purpose
$800
(indirect training costs)
$600
$400
$200
$0
FY2010
FY2011
FY2012
FY2013
FY2014
FY2015
FY2016
(est)
(est)
(req)
Source: CRS analysis of VA Budget Justifications.
Notes: Specific purpose funds (direct training costs): “Special Purpose funds that are al ocated in the President's
Budget to directly fund the stipends and benefits of VA clinical trainees who rotate through VA medical centers
during the year.†General purpose funds (indirect training costs): “Educational supplement to the Veterans
Equitable Resource Al ocation (VERA) model in support of the indirect costs of VA medical centers that have
clinical training programs. These funds help offset costs such as faculty time, education office staffing,
accreditation costs, and space and equipment needs.â€
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The Veterans Health Administration and Medical Education: A Fact Sheet
Author Contact Information
Elayne J. Heisler
Erin Bagalman
Analyst in Health Services
Analyst in Health Policy
eheisler@crs.loc.gov, 7-4453
ebagalman@crs.loc.gov, 7-5345
Congressional Research Service
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