Future medical education could be endangered by the White House's proposal to cut one-tenth of the Department of Veterans Affairs' healthcare research budget, VA physicians and healthcare academics warned last week.
President Clinton's budget request for fiscal 1998 calls for a reduction in VA medical research funding to $234.4 million from $262 million in fiscal 1997. If Congress were to agree to Clinton's request, it would be the second time in four years the VA's research budget has shrunk.
But instead of shrinking 10.5%, the healthcare academics and research experts-calling themselves the Friends of VA Medical Care and Health Research-said at a Capitol Hill briefing last week that the VA's 1998 research budget should rise 6.9%, to $280 million.
For academic medical centers that share research and educational missions with VA healthcare facilities, the shrinking VA research budget is a repeat of private-sector managed-care trends that have squeezed their own teaching and research budgets.
Like the private sector, the VA is turning to capitation, primary care and other managed-care techniques to keep costs in check and expand access for patients. The agency is also expecting to compete with private providers for the eligible veteran population.
But academic hospitals fear that if the VA emphasizes patient care too much, it will ignore teaching and research. Without the draw of research and teaching opportunities, the skilled physicians who make top teachers could pass up opportunities in the VA healthcare system.
Because about half of all U.S. medical residents receive some training in VA facilities, reduced research funding could imperil the quality of many teaching programs, said Richard Knapp, executive vice president of the Association of American Medical Colleges.
"I think the whole thing is pretty fragile," Knapp said.