amended by inserting after the item relating to sec-
tion 7311 the following new item: 
‘‘7311A. Quality assurance officers.’’. 
(b) BOARD-CERTIFIED PHYSICIAN REQUIREMENT 
FOR INDIVIDUALS APPOINTED
AS UNDER SECRETARY 
FOR HEALTH.—Section 305(a)(2) of title 38, United 
States Code, is amended by inserting ‘‘shall be a board- 
certified physician and’’ before ‘‘shall be’’. 
(c) REPORTS ON QUALITY CONCERNS UNDER QUAL-
ITY-ASSURANCE PROGRAM.—Section 7311(b) of such title 
is amended by adding at the end the following new para-
graph: 
‘‘(4) As part of the quality-assurance program, the 
Under Secretary for Health shall establish mechanisms 
through which employees of Administration facilities may 
submit reports, on a confidential basis, on matters relating 
to quality of care in Administration facilities to the quality 
assurance officers of such facilities under section 
7311A(c) of this title and to the quality assurance officers 
of the Veterans Integrated Services Networks (VISNs) in 
which such facilities are located under section 7311A(b) 
of this title. The mechanisms shall provide for the prompt 
and thorough review of any reports so submitted by the 
receiving officials.’’. 
(d) REVIEW OF CURRENT HEALTH CARE QUALITY 
SAFEGUARDS.— 
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(1) IN GENERAL.—The Secretary of Veterans 
Affairs shall conduct a comprehensive review of all 
current policies and protocols of the Department of 
Veterans Affairs for maintaining health care quality 
and patient safety at Department of Veterans Af-
fairs medical facilities. The review shall include a re-
view and assessment of the National Surgical Qual-
ity Improvement Program (NSQIP), including an 
assessment of— 
(A) the efficacy of the quality indicators 
under the program; 
(B) the efficacy of the data collection 
methods under the program; 
(C) the efficacy of the frequency with 
which regular data analyses are performed 
under the program; and 
(D) the extent to which the resources allo-
cated to the program are adequate to fulfill the 
stated function of the program. 
(2) REPORT.—Not later than 60 days after the 
date of the enactment of this Act, the Secretary 
shall submit to Congress a report on the review con-
ducted under paragraph (1), including the findings 
of the Secretary as a result of the review and such 
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recommendations as the Secretary considers appro-
priate in light of the review. 
SEC. 4. INCENTIVES TO ENCOURAGE HIGH-QUALITY PHYSI-
CIANS TO SERVE IN THE VETERANS HEALTH 
ADMINISTRATION. 
(a) INCENTIVES REQUIRED.— 
(1) IN GENERAL.—Subchapter III of chapter 
74 of title 38, United States Code, is amended by 
inserting after section 7431 the following new sec-
tion: 
‘‘§ 7431A. Physicians: additional incentives for service 
in hard-to-fill positions 
‘‘(a) LOAN
REPAYMENT
FOR
PHYSICIANS
WHO 
SERVE IN HARD-TO-FILL POSITIONS.—(1) In order to re-
cruit and retain physicians in the Administration in hard- 
to-fill positions (as designated by the Secretary for pur-
poses of this subsection), the Secretary shall repay, for 
each individual who agrees to serve as a physician for a 
period of not less than three years in an Administration 
facility in such a position, any loan of such individual as 
follows: 
‘‘(A) Any loan of the individual described in 
paragraphs (1) through (4) of section 16302(a) of 
title 10. 
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‘‘(B) Any other loan of the individual des-
ignated by the Secretary for purposes of this sub-
section the proceeds of which were used by the indi-
vidual to finance education leading to the medical 
degree of the individual. 
‘‘(2) Each individual seeking repayment of loans 
under paragraph (1) shall enter into an agreement with 
the Secretary regarding the repayment of loans. Under the 
agreement, the individual shall agree— 
‘‘(A) to perform satisfactory service in a physi-
cian position specified in the agreement in an Ad-
ministration facility specified in the agreement for 
such period of years as the agreement shall specify; 
and 
‘‘(B) to possess and retain for the period of the 
agreement such professional qualifications as are 
necessary for the service specified under subpara-
graph (A). 
‘‘(3) Repayment of loans under this subsection shall 
be made on the basis of complete years of service under 
the agreement under this subsection. The amount to be 
repayed under an agreement under this subsection for a 
complete year of service specified in the agreement shall 
be such amount, not to exceed $30,000, for each complete 
year of service as the agreement shall specify. 
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‘‘(b) TUITION
REIMBURSEMENT
FOR
PHYSICIAN 
STUDENTS WHO AGREE TO SERVE IN HARD-TO-FILL PO-
SITIONS.—(1) In order to recruit and retain physicians in 
the Administration in hard-to-fill positions (as designated 
by the Secretary for purposes of this subsection), the Sec-
retary shall reimburse individuals who are enrolled in a 
course of education leading toward board certification as 
a physician for the tuition charged for pursuit of such 
course of education if such individuals agree to serve as 
a physician in an Administration facility in such a posi-
tion. 
‘‘(2) Each individual seeking tuition reimbursement 
under paragraph (1) shall enter into an agreement with 
the Secretary regarding such tuition reimbursement. 
Under the agreement, the individuals shall agree— 
‘‘(A) to satisfactorily complete the course of 
education of the individual described in paragraph 
(1); and 
‘‘(B) upon completion of the course of edu-
cation, to become board-certified as a physician; and 
‘‘(C) upon completion of the matters referred to 
in subparagraphs (A) and (B)— 
‘‘(i) to perform satisfactory service in a 
physician position specified in the agreement in 
an Administration facility specified in the 
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agreement for such period of years as the 
agreement shall specify; and 
‘‘(ii) to possess and retain for the period of 
the agreement such professional qualifications 
as are necessary for the service specified under 
clause (i). 
‘‘(3) The amount of reimbursement payable to an in-
dividual under paragraph (1) for a year may not exceed 
$30,000. 
‘‘(4) Any individual receiving tuition reimbursement 
under paragraph (1) who does not satisfy the require-
ments of the agreement under paragraph (2) shall be sub-
ject to such repayment requirements as the Secretary shall 
specify in the agreement. 
‘‘(5) An individual receiving tuition reimbursement 
under paragraph (1) for pursuit of a course of education 
shall also be paid a stipend in the amount of $5,000 for 
each academic year of pursuit of such course of education 
after entry into an agreement under paragraph (2). 
‘‘(c) PARTICIPATION
IN FEHBP OF PHYSICIANS 
WHO SERVE PART-TIME IN HARD-TO-FILL POSITIONS.— 
(1) In order to recruit and retain physicians in the Admin-
istration in hard-to-fill positions (as designated by the Sec-
retary for purposes of this subsection), an individual not 
otherwise eligible for health insurance under chapter 89 
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of title 5 who agrees to serve as a physician in an Adminis-
tration facility in such a position for not less than five 
days per month (of which two days must occur in each 
14-day period) shall be eligible for enrollment in the health 
benefit plans under chapter 89 of title 5 on a self only 
or self and family basis (as applicable). 
‘‘(2) The Secretary shall administer this subsection 
in consultation with the Director of the Office of Per-
sonnel Management. 
‘‘(d) ADDITIONAL PROGRAMS.—It is the sense of 
Congress that the Secretary should undertake active and 
on-going efforts to establish additional incentive programs 
to encourage individuals to serve in the position of physi-
cian in the Administration, or otherwise practice in the 
Administration, in hard-to-fill positions, including, in par-
ticular, incentive programs to encourage more experienced 
physicians to serve or practice in such positions. 
‘‘(e) CONSTRUCTION.—The incentives required under 
this section are in addition to any other special pays or 
benefits to which the individuals covered by this section 
are eligible or entitled under law.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of chapter 74 of such title is 
amended by inserting after the item relating to sec-
tion 731 the following new item: 
‘‘7431A. Physicians: additional incentives for service in hard-to-fill positions.’’. 
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(b) AFFILIATION OF DEPARTMENT OF VETERANS 
AFFAIRS
MEDICAL
FACILITIES
WITH
MEDICAL 
SCHOOLS.—The Secretary of Veterans Affairs shall, to the 
extent practicable, require each medical facility of the De-
partment of Veterans Affairs to seek to establish an affili-
ation with a medical school within reasonable proximity 
of such medical facility. 
SEC. 5. REPORTS TO CONGRESS. 
(a) REPORT.—Not later than December 15, 2009, 
and each year thereafter through 2012, the Secretary of 
Veterans Affairs shall submit to the congressional vet-
erans affairs committees a report on the implementation 
of this Act and the amendments made by this Act during 
the preceding fiscal year. Each report shall include, for 
the fiscal year covered by such report, the following: 
(1) A comprehensive description of the imple-
mentation of this Act and the amendments made by 
this Act. 
(2) Such recommendations as the Secretary 
considers appropriate for legislative or administra-
tive action to improve the authorities and require-
ments in this Act and the amendments made by this 
Act or to otherwise improve the quality of health 
care and the quality of the physicians in the Vet-
erans Health Administration. 
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(b) CONGRESSIONAL VETERANS AFFAIRS COMMIT-
TEES DEFINED.—In this section, the term ‘‘congressional 
veterans affairs committees’’ means— 
(1) the Committees on Veterans’ Affairs and 
Appropriations of the Senate; and 
(2) the Committees on Veterans’ Affairs and 
Appropriations of the House of Representatives. 
Æ 
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