By Jonathan Kaupanger
Veterans Affairs was not originally set up to just take care of women.
When VA was created, women made up a very small portion of the military. In fact, women who served in World War II weren’t even considered real vets until Congress fixed that and granted women veteran status in 1980. Since then, the VA has desperately been working to bring its women’s health care up to general US standards, and women’s privacy is a top concern with VA leadership.
Today, the overall veteran population is decreasing at a rate of about 1.5% each year. The woman veteran population is growing at about 1% each year, making women the fastest growing section of American veterans. Women make up about 10% of the total vet population today and by 2040 that number will be just about 16%. VA’s Center for Women Veterans was created by Congress in 1994 and is a major force behind the agency’s push for better care for women veterans.
The VA’s Office of Inspector General released a report last month, documenting the care and privacy standards for women veterans. The report covers health care inspections of 93 of VA’s Community Based Outpatient Clinics (CBOC) in 2014 and 56 CBOCs in 2015. The VA has 800 CBOCs in its healthcare system.
“There are still VA facilities where we are not where we want to be with privacy and environment of care,” said Kayla Williams, Director, Center for Women Veterans. “I get all my care at the DC VA Medical Center and it’s been fantastic. There’s a women’s clinic and it’s very comfortable. It’s very comfortable, it’s a beautiful spa-like environment in the waiting room. Everything about it is great. But I will be honest, not every facility is like that. GAO has issued reports where they’ve found some deficiencies, we’re working very hard to address those, and I’m hopeful that we will have addressed all deficiencies in terms of privacy curtains and locks on doors by the end of this fiscal year.”
The issues Ms. Williams is referring to are all privacy related. In 2014 7.9% of the CBOCs evaluated didn’t have manual or electronic locks for the examination rooms used by women veterans. 17.2% of the CBOCs were also laid out in a way where women, who were gowned for an examination, would have to enter public areas to use a gender-specific restroom. Only one of the CBOCs inspected had examination tables positioned in a way that didn’t facilitate privacy.
In 2015, privacy concerns for women, for the most part, was better. The door lock number went down to 5.4%, the gender-specific restroom issue dropped to 7.1% but the examination table positioning problem grew to two CBOCs.
Another part of VA’s privacy report has to do with Dedicated Women’s Healthcare Providers or DWHPs. The DWHP has a major role in making sure the quality of care for women vets is good. Providers with experience and interest in women’s health issues can be assigned as DWHPs as long as they are willing to keep a higher percentage of women veterans on their panel. A panel is the number of patients they see.
The chief of staff at each VA medical center is responsible for assigning the DWHP as well as maintaining documentation related to each DWHP, including VA mandated training. The report concludes that the Veterans Health Administration has identified those DWHPs with a low percentage of women on their panel and so they would need extra opportunities to maintain their practice skills.
As of September 2015, VA had 2,294 DWHPs. Because some were only part time, this was really more like having 1,864.7 full-time employees (FTE). Slightly under 40% of those FTEs practiced at a VA facility and 60.2% worked out of a VA community-based setting. 1,236 out of the 2,294 DWHPs had less than 10% women veterans in their patient panels.
The report also noted that VA is doing a good job providing gender-specific car for our women vets. In 2014, there were 414,804 women vets who used VA health care (5,338,858 male vets sought care in a VA facility the same year). 195,100 had a gender-specific diagnosis, which means more than half of veteran women were looking for help with non-gender-specific issues.
Most visits for gender-specific care was provided at VA facilities, only 17.5% of the visits were performed at non-VA spaces. Pregnancy related issues were the only category of gender-specific care that was delivered in community hospitals.