The future of Veterans Affairs Medical Centers.

In the past four years, the Department of Veterans Affairs (VA) has experienced unprecedented changes in the ways it provides medical care, trains medical residents, and supports its clinical research program. For the most part, these changes have improved the quality and efficiency of care provided to veterans, and they have improved the chances that the VA will survive in an increasingly competitive medical market place. While the changes in priorities for training medical residents and funding clinical research have been designed to be more consistent with the overall mission of the VA, these changes have been stressful for many of the VA/medical school affiliations. Our challenge is to understand and manage these changes so that the many benefits that have derived from more than fifty years of VA/medical school affiliations can be retained.