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Health Care Tour: “Seeking Patient-Centered Care”

Dorn Veterans Affairs Medical Center (VAMC) and USC School of Medicine

The Issue:

• The 215-bed Dorn VAMC serves nearly two-thirds of South Carolina’s veterans population. The center occupies nearly one million square feet in Columbia, South Carolina. In addition, the medical center works closely with the University of South Carolina School of Medicine.

Findings:

Dorn Veterans Affairs Medical Center

• The center offers a wide-range of medical services to include:
  • General Medicine and Surgery
  • Nursing Home Care and Intermediate Medicine
  • Total Eye Care (including laser surgery, cataracts, eye glasses and contacts)
  • Pharmacy
  • Emergency Care
  • The Emergency Room (E.R.) is open 24 hours a day, 7 days a week, and equipped with 16 beds.
  • The Level 3 E.R. is not prepared to take many major trauma patients.
  • There are no neurosurgeons, cardiothoracic surgeons, or pediatric doctors on staff at the clinic.
  • Fast Track
  • In March, 2008, Dorn VAMC implemented the Fast Track system to help alleviate the workload on emergency care doctors.
  • This triage process allows patients to be seen within 20 minutes of arrival and allows the E.R. to see up to 120 patients per day.
  • This portion of the hospital can utilize nurses to treat the general needs of patients who walk in. This saves resources that would otherwise be spent on emergency room doctors.
  • The Dorn E.R. will see patients in the general population if the clinic is the closest in proximity to the accident.
  • Acute Psychiatry and Substance Abuse Treatment Program
  • Many veterans coming back from combat need mental health services.
  • The psychiatry wing has reduced the number of inpatient beds to below 20 due to a shortage in staff. Funding is available, but professionals are not.
  • If necessary, Dorn VAMC can transfer mental health patients to the Charlie Norwood VA Medical Center in Augusta, GA.

  USC School of Medicine (USC SOM)

  • USC SOM is one of five medical schools created in the mid-1970s under the Teague-Cranston Act.
  • The school was built on a Veterans Administration hospital campus in order to train physicians for medically underserved areas and to benefit veterans and their families.
  • The school has a small class size in comparison with other medical campuses.
  • USC SOM has a class size of 85, whereas the national average is about 150 students (i.e., Medical University of South Carolina).
  • Tuition doesn’t cover the costs of operating the school
  • USC SOM has a 150 million dollar per year budget. Only nine million comes from tuition.
  • Tuition rates are around $20,000/year for in-state, $60,000/year for out-of-state.
  • Current and Upcoming challenges:
  • The cost of tuition and the prospect of low federal reimbursement services are causing students to steer away from medical school.
  • Medical Tourism is on the rise for routine surgeries. While surgery might be equivalent to US quality, provisions for complications are not adequate in most cases.
  • Given these conditions, many expect that the American health care system will soon suffer from a doctor shortage

When: March 25, 2008

Where: Columbia, SC

Hosts: Brian Heckert, Director of Dorn VAMC, Dr. Donald DiPette, Dean of USC School of Medicine

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