Las Vegas NV Specialty Logistics

  Unique training opportunities that enhance resident education while addressing specific healthcare needs of veterans are best determined at local and VISN levels.  The CARES initiative was completed in 2003 and approved in large part by May 2004.  As a result, two new inpatient facilities are being built (in Orlando, FL and Las Vegas, NV) and replacement hospitals are planned for Denver and Louisville.  Other facilities may be impacted once the final analysis has been completed. Because of hurricane Katrina, New Orleans is likely to require a replacement VA hospital.  In addition, more than 200 new CBOCs and several mission changes were recommended in the CARES Plan.  However, no resident positions are automatically tied to the activation of newly-constructed facilities. 
   In addition, several existing facilities that have historically been unaffiliated or have limited affiliations have affiliations in the process of being developed or expanded.  There have been few new positions to assist these facilities in meeting their potential for training physician residents. Nevertheless, caution must be exercised in promoting the development of affiliations and training rotations in situations where the affiliate is so distant that an appropriate educational environment and infrastructure may be lacking.
      Existing CBOCs and VA OPCs have been underutilized as sites of residency training due to a number of logistic barriers, but also because of lack of sufficient numbers of residents to undertake rotations to these sites. Despite the rapid expansion of sites of ambulatory care in the VA, from 139 CBOCs in 1998 to over 800 in 2007, CBOCs have only rarely been used for training residents.  One of the CARES Commission’s recommendations, supported by the external Advisory Committee, was to expand residency training in VA’s CBOCs. In the first cycle of the GME Enhancement initiative, 27.6 positions were approved for CBOC or OPC training sites. 
   The current RFP will continue to rectify this situation by providing a mechanism for identifying and funding resident training positions in areas of greatest need. Facilities requesting positions must work with the affiliated sponsoring institution to determine if the educational infrastructure is adequate to meet the needs of the proposed training experience.  Facilities and the affiliated sponsors should jointly consider the adequacy of patient volume, space, and appropriate faculty to provide teaching and supervision. 
   There should be a reasonable expectation that the requested positions will be filled in July of 2008.  Positions may be in any specialty appropriate to the clinical site.  Wherever appropriate, innovative interdisciplinary or inter-professional training opportunities are strongly encouraged. In the case of new or replacement facilities, if positions would be premature in AY 2008-2009, applications should be deferred until a reasonable start date is known.  Early identification of appropriate affiliated program sponsors should also be undertaken. OAA will be pleased to work with you in developing these estimates and developing appropriate affiliations. 

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