Explore UAB

SOM VA right oneFrom left: Louis Dell'Italia, associate chief of staff for Research at the BVAMC and professor of medicine in the UAB Division of Cardiovascular Disease; Susan Laing, associate chief of staff for education at the BVAMC; and Gustavo Heudebert, assistant dean of graduate medical education at the School of Medicine.When WWII ended in 1945, thousands of returning soldiers sought medical treatment through the Department of Veterans Affairs. To meet the challenge of providing quality care for those who had served, the VA established an association with academic medical schools. On January 30, 1946, an agreement called Policy Memorandum #2 was issued to formalize this alliance. This year marks the 70th anniversary of the partnership.

“There wasn’t a way to take care of all of the soldiers who came to the VA seeking medical treatment after the war,” says Susan J. Laing, Ph.D., associate chief of staff for education at the Birmingham VA Medical Center (BVAMC). “So the memorandum gave physician residents an opportunity to train and help provide care for veterans. It has been a very valuable partnership—a wonderful marriage between academic medical centers like UAB and the Department of Veteran Affairs.”

The 131-bed Birmingham VA Medical Center is centrally located in the 86-block area that makes up the UAB campus. It provides acute tertiary medical and surgical care to veterans of Alabama and surrounding states, and serves as a referral center for the surrounding area, with 131 operating beds. A new clinic opened in January a few blocks away from campus to house primary care, mental health, women’s health, audiology, and a pharmacy. The BVAMC also operates seven outpatient clinics in North Alabama. Most staff physicians have joint appointments with the VA and UAB.

“UAB residents have an opportunity to rotate through the largest health care system in the United States,” Laing says. “And they have a chance to work with a lot of patients with medical conditions that they might not see at other institutions. For us, it’s beneficial that they understand the needs and concerns of veterans even if they opt not to work at the VA once they complete their training. Through their experience they gain a perspective of what is involved with veteran care and develop a much better appreciation of caring for America’s heroes.”

Invaluable Experience

Training at the VA complements one of the unique strengths of residency training at UAB in general, which is the exposure trainees get to a highly diverse patient population, says Gustavo R. Heudebert, M.D., assistant dean of graduate medical education at the School of Medicine.

“UAB Hospital represents a microcosm of the city of Birmingham, which complements the types of cases residents encounter at the VA to provide a very well-rounded residency,” Heudebert says. “For example, there are fewer female patients at the VA. On the other hand, residents and fellows training at the VA see a lot of older patients with heart disease, lung disease, liver disease, kidney disease, and cancer. Typically they will see very complex patients who might have two, three, or four diseases together, so they have to learn to juggle those complexities.”

The VA provides substantial financial support for residency training, says John I. Kennedy Jr., M.D., associate chief of staff for acute and subspecialty care in the UAB Division of Pulmonary, Allergy and Critical Care Medicine and medical service chief at the VA. “Through a disbursement agreement, all funding is paid to residents and fellows by UAB, which is then reimbursed by the VA.” According to Laing, this academic year 605 residents and fellows are approved to rotate through 146 available slots, and UAB will receive more than $9 million as payment for their time.

 Kennedy John Clarkson Stephen Fettig David Veterans Administration VA DoctorsFrom left: John Kennedy Jr., associate chief of staff for acute and subspecialty care in the UAB Division of Pulmonary, Allergy and Critical Care Medicine and medical service chief at the BVAMC; Stephen Clarkson, a UAB chief medical resident training at the BVAMC; and David Fettig, a UAB gastroenterology fellow at the BVAMC.The Birmingham VA and most other VA hospitals don’t manage acute trauma, which typically is handled through acute trauma centers such as UAB, Kennedy says. “But we do see patients who have experienced major trauma through their military service and we address subsequent issues that impact their lives and care, such as rehabilitation,” he says. “This is an opportunity for physician trainees to expand their overall familiarity with medical problems that are often unique to the experience of veterans. For example, traumatic brain injury has been well publicized and is a more common injury in returning veterans.”

Research is another area that benefits from the partnership between the VA and UAB. “The VA has centralized medical records throughout the nation so there is an opportunity to probe a large repository of clinical data in order to conduct clinical research,” Kennedy says. “And the data fields are standardized across the country so that is a huge advantage to the research.”

One national research effort that the Birmingham VA is participating in is the Million Veterans Program. The goal of this program is to create a database linking genetic, clinical, lifestyle, and military-exposure information from VA patients to help researchers learn more about the role of genes in health and disease. In August, the project reached a major milestone, enrolling 500,000 veterans nationally. The Birmingham VA has enrolled more than 17,000 veterans in the project, which is already advancing innovative research on the genomics of substance abuse, post-traumatic stress disorder, and chronic kidney disease.

Encounters with History

Stephen Clarkson, M.D., is currently a chief medical resident training at the VA. Clarkson was a history major as an undergraduate and says he especially enjoys working with veterans who have themselves been part of history-making events. “I really like being able to talk with veterans, which is a unique opportunity that you might not have elsewhere,” he says. “I’ve gotten to interact with a couple of World War II vets, which was very meaningful as there aren’t many of them still with us. That’s the part I really like about training through the VA.”

David Fettig, M.D., a gastroenterology fellow at the VA, comes from a military family. “My father and both grandfathers were vets,” Fettig says. “I take pride in caring for veterans. They are America’s heroes and deserve every bit of care that we give them. VA patients play an important role in trainees’ development, and we form some great relationships with them.”

By Jo Lynn Curry