Factors influencing ambulatory care education in the U.S. Department of Veterans Affairs.

The Department of Veterans Affairs (VA) is undergoing change in the way it delivers health care. Forces underlying this change include demographics of its population, new fiscal constraints, and the requirements of its academic affiliates. The benefit to the medical school affiliates will be the availability of patients in a structure useful for outpatient teaching of medical students and houseofficers. Barriers to effective delivery of ambulatory health care and education in VA facilities are (1) the historic focus on episodic, inpatient care, (2) continuous changes in eligibility requirements, (3) increases in patient care responsibilities for affiliated faculty, and (4) concomitant withdrawal of resources from the VA at a time when costs of health care and education are increasing. The VA medical centers will be increasingly forced to investigate innovative models for patient care delivery and education in the ambulatory setting.