A joint task force recommends ways the institutions may be able to cooperate in the future. One of these institutions is restructuring some clinical programs to make them attractive for potential future sharing arrangements and the intent of the VISN to purchase services at the lowest cost. One of them commented that contracting is less likely to occur in areas like Chicago or Boston, where the VISN includes several major medical schools and the likelihood of serving as a sole or major provider for the network is low. Impact on Medical Education Programs Respondents reported that the VA reorganization especially impacts educational programs that rely on the VA as a teaching site and a source of support. The Residency Realignment initiative impacts respondents to varying degrees, ranging from no change to date in the number of VA-supported positions to a reduction of several FTEs.
Some institutions anticipate future reductions.
One respondents noted that the reductions in its VA-supported positions were taken by eliminating temporary allocations, and the affected departments understood the transient nature of the positions. However, further reductions would be difficult, because these VA positions are part of an integrated residency program combining multiple sites within the institution's network. Two respondents added that the reductions in VA-supported subspecialty positions may jeopardize the accreditation and continuing viability of some small programs. Respondents also commented that the VA's global shift toward primary care, and the redistribution of training positions within the VISN will negatively impact VA-supported specialty and subspecialty positions. One medical school noted that its VISN comprises seven VA Medical Centers geographically dispersed in three states.