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Maybe I Should Have Taken the Fork
1Veterans Affairs San Diego, San Diego, California David.Bittleman@va.gov.
Annals of Family Medicine
|July 27, 2026
Summary
Workforce reductions and policy shifts in the Department of Veterans Affairs impact care for veterans. System constraints and staffing shortages can lead to moral injury and missed opportunities in patient care.
Area of Science:
- Healthcare policy
- Veterans affairs
- Primary care physician
Background:
- A primary care physician reflects on practicing within the Department of Veterans Affairs (VA).
- The practice occurred during a period marked by workforce reductions, policy shifts, and evolving institutional priorities.
- This context significantly influenced the care provided to veterans.
Purpose of the Study:
- To illustrate how systemic changes shape healthcare delivery for veterans with complex needs.
- To explore the impact of staffing shortages, administrative burden, and reduced support on patients and clinicians.
- To reflect on the challenges and limitations of providing patient-centered care within a strained system.
Main Methods:
- A reflective essay format based on frontline clinical experience.
- Narrative tracing the cumulative effects of systemic changes on patient care.
- Exploration of themes including moral injury, professional responsibility, and bureaucratic vs. patient-centered care.
Main Results:
- Staffing shortages and administrative burdens negatively affect both veteran patients and healthcare providers.
- System constraints can limit the effectiveness of individual clinical efforts.
- A veteran's death by suicide highlighted missed opportunities and systemic failures.
Conclusions:
- Sustaining effective care for vulnerable veterans necessitates institutional trust and adequate staffing.
- Alignment between policy decisions and the realities of clinical practice is crucial.
- Addressing moral injury and professional responsibility is key to improving veteran healthcare outcomes.
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