W. G (Bill) Hefner VA Hospital. Courtesy of Dr. Tushar Vachharajani.

My experience working with Veterans Affairs Health Administration (VHA) has been very satisfying and unique. I feel that VHA offers the right balance and opportunity to both young and mid-career nephrologists. The aging veterans with a myriad of complex problems are always respectful and grateful for the care they receive at a VA Medical Center (see fact sheet about the kidney disease and veteran population) . The VHA offers the right combination of integrated primary care services, pharmacy, home monitoring services, and patient education support to provide optimal outpatient care. The major hurdles one encounters while managing patients in a VA hospital are limited resources for providing dialysis and transplant care.  I see these limitations as a major opportunity to map a career path unlike that chosen by new nephrology graduates.

I was introduced to the VHA system in 2001 because of my desire to settle down in the United States. I joined as a staff nephrologist at the Overton Brooks Veterans Affair Medical Center in Shreveport, Louisiana, primarily to fulfill my immigration requirements.  I considered myself fortunate as I was not only able to continue my academic career, but also saw an opportunity to establish an interventional nephrology service and help design and upgrade the acute dialysis program. I was able to hone my clinical and administrative skills and learn to navigate the complex federal health system. The experience lasted 5 years before I moved full-time into an academic center with a large dialysis program in North Carolina to establish another interventional nephrology program. As a full time academic nephrologist, I felt as if I was not utilizing all my skills and was driven by “RVU craze”. The sense of incompleteness was overpowering, driving me to move back to the VHA system.

Ten years after I completed my fellowship, as a mature and mid-career nephrologist, I was hired as Section Chief at W. G (Bill) Hefner VA Hospital in Salisbury, NC.  The nephrology services provided to over 90,000 veterans in this rural community was limited, disorganized, and primarily outpatient. I saw this as a great opportunity to use all my administrative skills. The first task was to educate the primary care team to identify patients with early CKD and involve nephrology when appropriate. The nephrology clinic was organized to support > 4500 veterans with CKD stage 3B, 4, and 5. A CKD education team was formed with recruitment of a nurse educator, a renal dietitian, a transplant coordinator, and a dedicated social worker. Over the subsequent 3 years, an in-patient service emerged an acute dialysis program and a regular consult team.

With the expansion of the program, basic interventional nephrology services have been established by performing procedures in the operating room. The services will be soon be moving to a new state-of-the-art interventional suite that is under construction. The opportunity to add two outpatient dialysis units will soon bring 128 veterans on maintenance hemodialysis back into the VHA system, thus providing complete care.  An extraordinary support provided by the leadership in Salisbury and my team has motivated me to stay focused and committed to my dreams.

My journey so far has been very fulfilling, though not without frustrations.  These largely stem from providing transplant-related care. Overall, the job satisfaction, excellent lifestyle, and benefits clearly are an attractive. The VA gave me the opportunity to practice the “true medicine” that I learned in medical school without having to worry about the “business aspect” of medicine. VHA jobs (www.usajobs.gov) and opportunities often get overlooked and I hope my experience will motivate others to look for similar opportunities. There are several VA hospitals, especially in rural regions that need dynamic leaders and sincere, hard working clinicians.

Tushar Vachharajani, MD
Chief, Nephrology Section
W.G.(Bill) Hefner VA Medical Center
Prof. of Nephrology
VCOM, Carolinas Campus