Physicians in the Department of Veterans Affairs. Another perspective

There is an ongoing discussion pertaining to the mutually beneficial relationship between the medical centers of the Department of Veterans Affairs (VA) and their affiliated medical schools. An earlier article analyzed the interorganizational conflicts prevalent at times between the VA medical centers and the medical school affiliates and assigned as reasons for such frictions value differences between professionals and administrators as well as between the VA medical centers and the medical schools. I propose somewhat different explanations for such conflicts and draw attention to the inapplicability of some of the old organizational theories that are being overtaken by the dynamics of modern health care organizations and their dependence on total quality management and resource allocation methods driven by diagnosis related groups. Furthermore, the strivings of other health professionals in the VA for equal treatment and the reluctance of physicians to concede coequality to others, the prevalence of risk avoidance as a necessary behavioral attribute for success within the VA, and the prevailing practice of allowing VA physicians to accept salary supplementation from the medical schools are major factors contributing to interorganizational conflicts.