The VACO has been hectic, but things are finally coming "to a close", as he is to report to Pres. Friday, May 31.
The price of all the publicity will be a lot of $. The problem will be whether to buy political position or professional services
I told him I probably would not stay more than a few months more and was looking at Stony Brook. I indicated the resident
program in S has been approved by the American Board, but that there seems to be some problem as far as the VA is
concerned and that I wanted some reassurance before I thought about the situation seriously. He indicated that Soroff had
been in a month ago and that they had had a good exchange. He is heavily dependent on the VAH there. "We also said that
we were not in the business of designating x numbers of resident slots up there; what we did generally was simply to give
the hospital what seemed to be appropriate and then they divvied it up in the way that they thought was right
among the various services, and if they didn't have enough then they could comeback and ask, but everybody always wanted
more than they deserved, so this is up for negotiation locally, not here." He had no knowledge of any trouble with the
Board and wondered if what they were talking about was numbers. I indicated that I was not sure whether it was just numbers,
but that they had a busy medical service with a 2-year head start and that perhaps all the available slots had been filled.
He indicated that in a new establishment like this one VACO does not expect a new service to have to take places away from
a going service to start. There are two factors: one is balance and the other is time VA will feed them up there, but VA is
not going to give them 10 or 12 or 20 and let them take it from there. Lee can see no good reason why this should be awkward.
He may not get as many as he wants, but he should get them and he should get them in proper time.
I pointed out the existence of a going program of training physicians' assistants, and that this should enhance the residency
program by providing coverage of many items which are not educationally advantageous for the resident staff. This would lower
the number of residents to be appointed. Lee liked hearing this because "there are those that feel this is an encroachment
on their programs."
As to VA approval of utilization of physicians' assistants in the VAH there, Lee indicated that VA is hiring them throughout
the system wherever they like to fit them in and has no compunction about giving them jobs and money to do it. "As a
matter of fact, in some places we are training these guys".
Soroff was trying to get both info and permission. For example he wanted to have that VAH specified as an open-heart center.
"My answer to that was that we don't have them in the VA system any longer, feeling that open-heart surgery ought
to be a reasonable part of anybody's repertoire and in a decent medical school hospital, but that 2 things. One is that
we didn't see any good reason why we should designate them a center and therefore imply taking clinical material there
from somewhere else. The second is that he was not getting enough demand on clinical material for us to pay much attention
to open hearts and stuff up there, particularly since he hadn't started a good service on hernias and hemorrhoids and
stuff, and why didn't he pay attention to building a balanced program instead of trying to talk us into buying a bunch
of esoteric stuff he has no customers to use." Lee had asked him if he was interested in transplants also, and Soroff
had indicated that he had been warned that this would be a "dirty word" in the VACO. Lee had said that the only thing
that disturbed him was that someone had given Soroff bad advice. Transplants belong in the same category as open hearts except
that in the New York area the VA does not have a decent transplantation program for various reasons - Bkln, Bronx, or Manhattan.
VA is trying to figure out which place will develop a good program in a center if VA designates it. Soroff was advised to
get his service going first and then he can throw his hat into the transplant ring.
Lee says they plan a U.H. at Stony Brook, that they have the money and will be in business in about 5 years. In the meantime
VA cannot buy everything the medical school needs.
Lee is not still looking for folks in VACO for the reason that Carol Hughes is coming in as Director of Surgery on July 1.
Lee has told Carl he wants him to pick whomever he wants to fill 2 positions on his own staff. He is busy looking around,
"and he ought to know you might be interested.'' I indicated I am not sure I am and would like to think about
it. Lee says, "I would if I were you''.