79–006 

115TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 2d Session 115–867 

VETERANS-SPECIFIC EDUCATION FOR TOMORROW’S 

HEALTH PROFESSIONALS ACT 

JULY 24, 2018.—Committed to the Committee of the Whole House on the State of 

the Union and ordered to be printed 

Mr. ROE of Tennessee, from the Committee on Veterans’ Affairs, 

submitted the following 

R E P O R T 

[To accompany H.R. 2787] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Veterans’ Affairs, to whom was referred the 

bill (H.R. 2787) to establish in the Department of Veterans Affairs 

a pilot program instituting a clinical observation program for premed students preparing to attend medical school, having considered the same, report favorably thereon with an amendment and 

recommend that the bill as amended do pass. 

CONTENTS 

Page 

Purpose and Summary ............................................................................................ 3 

Background and Need for Legislation .................................................................... 3 

Hearings ................................................................................................................... 4 

Subcommittee Consideration .................................................................................. 5 

Committee Consideration ........................................................................................ 5 

Committee Votes ...................................................................................................... 5 

Committee Oversight Findings ............................................................................... 5 

Statement of General Performance Goals and Objectives .................................... 5 

New Budget Authority, Entitlement Authority, and Tax Expenditures ............. 5 

Earmarks and Tax and Tariff Benefits .................................................................. 6 

Committee Cost Estimate ....................................................................................... 6 

Congressional Budget Office Estimate ................................................................... 6 

Federal Mandates Statement ................................................................................. 7 

Advisory Committee Statement .............................................................................. 7 

Constitutional Authority Statement ...................................................................... 7 

Applicability to Legislative Branch ........................................................................ 7 

Statement on Duplication of Federal Programs .................................................... 7 

Disclosure of Directed Rulemaking ........................................................................ 7 

Section-by-Section Analysis of the Legislation ...................................................... 8 

Changes in Existing Law Made by the Bill as Reported ...................................... 8 

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The amendment is as follows: 

Strike all after the enacting clause and insert the following: 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Veterans-Specific Education for Tomorrow’s Health 

Professionals Act’’ or the ‘‘Vet HP Act’’. 

SEC. 2. SENSE OF CONGRESS REGARDING DEPARTMENT OF VETERANS AFFAIRS PILOT PROGRAM FOR CLINICAL OBSERVATION BY UNDERGRADUATE STUDENTS. 

It is the sense of Congress that the pilot program described in section 3(a) should 

be designed to—— 

(1) increase the awareness, knowledge, and empathy of future health professionals toward the health conditions common to veterans; 

(2) increase the diversity of the recruitment pool of future physicians of the 

Department; and 

(3) expand clinical observation opportunities for all students by encouraging 

students of all backgrounds to consider a career in the health professions. 

SEC. 3. DEPARTMENT OF VETERANS AFFAIRS PILOT PROGRAM FOR CLINICAL OBSERVATION 

BY UNDERGRADUATE STUDENTS. 

(a) ESTABLISHMENT.—The Secretary of Veterans Affairs shall carry out a pilot program for a one-year period, beginning not later than August 15, 2021, to provide 

certain students described in subsection (d) a clinical observation experience at medical centers of the Department of Veterans Affairs. 

(b) MEDICAL CENTER SELECTION.—The Secretary shall carry out the pilot program 

under this section at not fewer than five medical centers of the Department. In selecting such medical centers, the Secretary shall ensure regional diversity among 

such selected medical centers. 

(c) CLINICAL OBSERVATION SESSIONS.—— (1) FREQUENCY AND DURATION.—In carrying out the pilot program, the Secretary shall—— 

(A) provide at least one and not more than three clinical observation sessions at each medical center selected during each calendar year; 

(B) ensure that each clinical observation session—— 

(i) lasts between four and six months; and 

(ii) to the extent practicable, begins and ends concurrently with one 

or more academic terms of an institution of higher education (as defined in section 101 of the Higher Education Act of 1965 (20 U.S.C. 

1001)); and 

(C) ensure that the clinical observation sessions provided at a medical 

center have minimal overlap. 

(2) SESSIONS.—The Secretary shall ensure that the pilot program consists of 

clinical observation sessions as follows: 

(A) Each session shall allow for not fewer than five students nor greater 

than 15 students to participate in the session. 

(B) Each session shall consist of not fewer than 20 observational hours 

nor greater than 40 observational hours. 

(C) A majority of the observational hours shall be spent observing a 

health professional. The other observational hours shall be spent in a manner that ensures a robust, well rounded experience that exposes the students to a variety of aspects of medical care and health care administration. 

(D) Each session shall provide a diverse clinical observation experience. 

(d) STUDENTS.—— 

(1) SELECTION.—The Secretary shall select to participate in the pilot program 

under subsection (a) students who are—— 

(A) nationals of the United States; 

(B) enrolled in an accredited program of study at an institution of higher 

education; and 

(C) referred by their institution of higher education following an internal 

application process. 

(2) PRIORITY.—In making such selection, the Secretary shall give priority to 

each of the following five categories of students: 

(A) Students who, at the time of the completion of their secondary education, resided in a health professional shortage area (as defined in section 

332 of the Public Health Service Act (42 U.S.C. 254e)). 

(B) First generation college students (as defined in section 402A(h)(3) of 

the Higher Education Act of 1965 (20 U.S.C. 1067q(a))). 

(C) Students who have been referred by minority-serving institutions (as 

defined in section 371(a) of the Higher Education Act of 1965 (20 U.S.C. 

1067q(a))). 

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1https://docs.house.gov/Committee/Calendar/ByEvent.aspx?EventID=108430. 

(D) Veterans (as defined in section 101 of title 38, United States Code). 

(E) Students who indicate an intention to specialize in a health professional occupation identified by the Inspector General of the Department 

under section 7412 of title 38, United States Code, as having a staffing 

shortage. 

(3) ASSIGNMENT TO MEDICAL CENTERS.—The Secretary shall assign students 

selected under paragraph (1) to medical centers selected under subsection (b) 

without regard for whether such medical centers have staffing shortages in any 

health professional occupation pursuant to section 7412 of title 38, United 

States Code. 

(e) OTHER MATTERS.—In carrying out the pilot program under this section, the 

Secretary shall—— 

(1) establish a formal status to facilitate the access to medical centers of the 

Department by student observers participating in the pilot program; 

(2) establish standardized legal, privacy, and ethical requirements for the student observers, including with respect to—— 

(A) ensuring that no student observer provides any care to patients while 

participating as an observer; and 

(B) ensuring the suitability of a student to participate in the pilot program to ensure that the student poses no risk to patients; 

(3) develop and implement a partnership strategy with minority-serving institutions to encourage referrals; 

(4) create standardized procedures for student observers; 

(5) create an online information page about the pilot program on the internet 

website of the Department; 

(6) publish on the online information page created under paragraph (5) the 

locations of such centers, and other information on the pilot program, not later 

than 180 days before the date on which applications are required to be submitted by potential student observers; 

(7) identify medical centers and specific health professionals participating in 

the pilot program; and 

(8) notify the Committees on Veterans’ Affairs of the House of Representatives and the Senate of the medical centers selected under subsection (c) within 

30 days of selection, to facilitate program awareness. 

(f) REPORT.—Not later than 180 days after the completion of the pilot program 

under subsection (a), the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the results of the 

pilot program, including—— 

(1) the number and demographics of all applicants, those accepted to participate in the pilot program, and those who completed the pilot program; and 

(2) if participating institutions of higher education choose to administer satisfaction surveys that assess the experience of those who completed the pilot program, the results of any such satisfaction surveys, provided at the discretion of 

the institution of higher education. 

PURPOSE AND SUMMARY

H.R. 2787, as amended, the Veterans-Specific Education for Tomorrow’s Medical Doctors Act (VET MD Act), would require VA to 

carry out a three-year pilot program not fewer than five VA medical centers to provide undergraduate students a clinical observation experience. Representative Marcy Kaptur of Ohio introduced 

H.R. 2787 on June 6, 2017. 

BACKGROUND AND NEED FOR LEGISLATION

According to testimony from the Partnership for Public Service 

in March 2016, VA’s considerable recruitment and retention issues 

are worsened by an aging workforce that is increasingly retirement-eligible, creating concerns about the Department’s ability to 

continue providing high-quality benefits and services to future generations of veterans.1 In 2015, GAO found that 42% of VHA’s overVerDate Sep 11 2014 19:49 Jul 31, 2018 Jkt 079006 PO 00000 Frm 00003 Fmt 6659 Sfmt 6602 E:\HR\OC\HR867.XXX HR867
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2https://www.gao.gov/assets/690/681805.pdf. 

3https://docs.house.gov/Committee/Calendar/ByEvent.aspx?EventID=108430. 

4Department of Health and Human Services, Health Resources and Services Administration, 

Designated Health Professional Shortage Areas Statistic. 

all senior leadership was eligible to retire and, by fiscal year 2019, 

one in five VA nurses would be eligible to retire.2

On June 21, 2018, the Government Accountability Office (GAO) 

testified at an oversight hearing of the Subcommittee on Health 

that the physician attrition rate at the Veterans Health Administration (VHA) is of particular concern given that the Health Resources and Services Administration (HRSA) anticipates that by 

2025 the national demand for physician services will exceed supply.3 HRSA’s office of Rural Health Policy Reported in 2017 that 

physician shortages were exacerbated in rural areas where communities struggle to attract and keep well-trained providers.4 This is 

particularly concerning for VHA, with nearly one in four VA Medical Centers located in rural areas. 

H.R. 2787, as amended, seeks to provide opportunities to introduce future medical students to VHA. The Committee believes that 

early engagement with America’s future physicians would help establish VA’s candidacy as a future employer for these students. To 

that end, it would also serve to provide those future physicians familiarity with the medical conditions common among veterans. 

HEARINGS

On June 13th, 2018, the Subcommittee on Health conducted a 

legislative hearing on a number of bills including H.R. 2787, as 

amended. 

The following witnesses testified: 

The Honorable Vicky Hartzler, U.S. House of Representatives, 4th District, Missouri; The Honorable Marcy Kaptur, 

U.S. House of Representatives, 9th District, Ohio; The Honorable Matt Cartwright, U.S. House of Representatives, 17th District, Pennsylvania; The Honorable Clay Higgins, U.S. House 

of Representatives, 3rd District, Louisiana; The Honorable 

Mike Bost, U.S. House of Representatives, 12th District, Illinois; The Honorable Jeff Denham, U.S. House of Representatives, 10th District, California; The Honorable Jenniffer Gonzalez-Colon, U.S. House of Representatives, Puerto Rico; The 

Honorable Brad Wenstrup, U.S. House of Representatives, 2nd 

District, Ohio; Roscoe Butler, Deputy Director for Health Care, 

The American Legion; Jeremy Villanueva, Associate National 

Legislative Director, Disabled American Veterans; Kayda 

Keleher, Associate Director, Veterans of Foreign Wars of the 

United States; Jessica Bonjorni, Acting Assistant Deputy 

Under Secretary for Health for Workforce Services, U.S. Department of Veterans Affairs, who was accompanied by Dayna 

Cooper, MSN, RN, Director of Home and Community-Based 

Programs, Veterans Health Administration, U.S. Department 

of Veterans Affairs. 

Statements for the record were submitted by: 

American Orthotic and Prosthetic Association, Paralyzed 

Veterans of America, and Military Officers Association of 

America. 

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SUBCOMMITTEE CONSIDERATION

On June 27, 2018, the Subcommittee on Health met in open 

markup session, a quorum being present, and favorably forwarded 

H.R. 2787, as amended, to the Full Committee. During consideration of the bill, the following amendments were considered and 

agreed to by voice vote: 

An amendment in the nature of a substitute, offered by Representative Takano of California, which would clarify that it is 

the sense of Congress that the pilot is intended for recruitment 

and educational purposes. 

An amendment offered by Representative Dunn of Florida, 

which would make technical and clarifying corrections to medical professional terminology. 

COMMITTEE CONSIDERATION

On July 12, 2018, the full Committee met in open markup session, a quorum being present, and ordered H.R. 2787, as amended, 

to be reported favorably to the House of Representatives by voice 

vote. 

COMMITTEE VOTES

In compliance with clause 3(b) of rule XIII of the Rules of the 

House of Representatives, there were no recorded votes taken on 

amendments or in connection with ordering H.R. 2787, as amended, reported to the House. A motion by Representative Walz of 

Minnesota to report H.R. 2787, as amended, favorably to the House 

of Representatives was adopted by voice vote. 

COMMITTEE OVERSIGHT FINDINGS

In compliance with clause 3(c)(1) of rule XIII and clause (2)(b)(1) 

of rule X of the Rules of the House of Representatives, the Committee’s oversight findings and recommendations are reflected in the 

descriptive portions of this report. 

STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

In accordance with clause 3(c)(4) of rule XIII of the Rules of the 

House of Representatives, the Committee’s performance goals and 

objectives are to increase opportunities for recruitment of future 

health professionals at VHA and to educate future health professionals about the medical conditions common among veterans. 

NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX

EXPENDITURES

In compliance with clause 3(c)(2) of rule XIII of the Rules of the 

House of Representatives, the Committee adopts as its own the estimate of new budget authority, entitlement authority, or tax expenditures or revenues contained in the cost estimate prepared by 

the Director of the Congressional Budget Office pursuant to section 

402 of the Congressional Budget Act of 1974. 

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EARMARKS AND TAX AND TARIFF BENEFITS

H.R. 2787, as amended, does not contain any Congressional earmarks, limited tax benefits, or limited tariff benefits as defined in 

clause 9 of rule XXI of the Rules of the House of Representatives. 

COMMITTEE COST ESTIMATE

The Committee adopts as its own the cost estimate on H.R. 2787, 

as amended, prepared by the Director of the Congressional Budget 

Office pursuant to section 402 of the Congressional Budget Act of 

1974. 

CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

Pursuant to clause 3(c)(3) of rule XIII of the Rules of the House 

of Representatives, the following is the cost estimate for H.R. 2787, 

as amended, provided by the Director of the Congressional Budget 

Office pursuant to section 402 of the Congressional Budget Act of 

1974: 

U.S. CONGRESS, 

CONGRESSIONAL BUDGET OFFICE, 

Washington, DC, July 18, 2018. 

Hon. PHIL ROE, M.D., 

Chairman, Committee on Veterans’ Affairs, 

House of Representatives, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for H.R. 2787, the Veterans-Specific Education for Tomorrow’s Health Professionals Act. 

If you wish further details on this estimate, we will be pleased 

to provide them. The CBO staff contact is Ann E. Futrell. 

Sincerely, 

MARK P. HADLEY

(For Keith Hall, Director). 

Enclosure. 

H.R. 2787—Veterans-Specific Education for Tomorrow’s Health Professionals Act 

By August 15, 2021, H.R. 2787 would require the Department of 

Veterans Affairs (VA) to establish a one-year pilot program to allow 

undergraduate students to observe health professionals at the department. Under this program, VA would hold 15 observation sessions spread across five medical facilities. Each session would last 

several months and, to the extent practicable, run concurrently 

with a normal academic term. On the basis of information from VA, 

CBO expects that the department would need the following staff to 

operate the pilot program: 

• A nurse program manager (at an average compensation of 

$132,000); 

• An education program specialist (at an average compensation of $111,000); 

• A staff assistant to manage the pilot program (at an average compensation of $78,000); and, 

• Five site coordinators to oversee the program at each location (at an average compensation of $94,000). 

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CBO expects that VA would need support staff prior to the onset 

of the program to select participants and at the end of the program 

to prepare a report for the Congress. On that basis, CBO estimates 

that this bill would cost of $2 million over the 2019–2023 period; 

any spending would be subject to the availability of appropriated 

funds. 

Enacting H.R. 2787 would not affect direct spending or revenues; 

therefore, pay-as-you-go procedures do not apply. 

CBO estimates that enacting H.R. 2787 would not increase net 

direct spending or on-budget deficits in any of the four consecutive 

10-year periods beginning in 2029. 

H.R. 2787 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act. 

The CBO staff contact for this estimate is Ann E. Futrell. The 

estimate was reviewed by Leo Lex, Deputy Assistant Director for 

Budget Analysis. 

FEDERAL MANDATES STATEMENT

The Committee adopts as its own the estimate of Federal mandates regarding H.R. 2787, as amended, prepared by the Director 

of the Congressional Budget Office pursuant to section 423 of the 

Unfunded Mandates Reform Act. 

ADVISORY COMMITTEE STATEMENT

No advisory committees within the meaning of section 5(b) of the 

Federal Advisory Committee Act would be created by H.R. 2787, as 

amended. 

STATEMENT OF CONSTITUTIONAL AUTHORITY

Pursuant to Article I, section 8 of the United States Constitution, 

H.R. 2787, as amended, is authorized by Congress’ power to ‘‘provide for the common Defense and general Welfare of the United 

States.’’ 

APPLICABILITY TO LEGISLATIVE BRANCH

The Committee finds that H.R. 2787, as amended, does not relate 

to the terms and conditions of employment or access to public services or accommodations within the meaning of section 102(b)(3) of 

the Congressional Accountability Act. 

STATEMENT ON DUPLICATION OF FEDERAL PROGRAMS

Pursuant to clause 3(c)(5) of rule XIII of the Rules of the House 

of Representatives, the Committee finds that no provision of H.R. 

2787, as amended, establishes or reauthorizes a program of the 

Federal Government known to be duplicative of another Federal 

program, a program that was included in any report from the Government Accountability Office to Congress pursuant to section 21 

of Public Law 111–139, or a program related to a program identified in the most recent Catalog of Federal Domestic Assistance. 

DISCLOSURE OF DIRECTED RULEMAKING

Pursuant to section 3(i) of H. Res. 5, 115th Cong. (2017), the 

Committee estimates that H.R. 2787, as amended, contains no diVerDate Sep 11 2014 19:49 Jul 31, 2018 Jkt 079006 PO 00000 Frm 00007 Fmt 6659 Sfmt 6602 E:\HR\OC\HR867.XXX HR867
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rected rulemaking that would require the Secretary to prescribe 

regulations. 

SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title 

Section 1 of the bill would establish the short title as the ‘‘Veterans-Specific Education for Tomorrow’s Medical Doctors (VET 

MD) Act.’’ 

Section 2. Pilot program for clinical observation by pre-med students 

Section 2 of the bill would establish three-year pilot program at 

no fewer than five VA medical facilities to provide clinical observation experience to undergraduate students with the goals of improving physician recruitment and increasing awareness among future medical professionals of conditions common to veterans. 

CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

If enacted, this bill would make no changes in existing law. 

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