Internal practice barriers for non-physician practitioners in the veterans healthcare system

As a consequence of the re-engineering of the veterans healthcare system initiated in 1995, non-physician clinicians are functioning with new levels of autonomy and expanded scopes of practice, but they are not consistently being utilized to their optimal potential. A work group appointed by the Under Secretary of Health in 1996 found various barriers to improving this situation: 1) lack of clarity regarding the roles of the non-physician clinicians; 2) lack of understanding of the basis of their credentialing; 3) lack of uniformity of their credentials; 4) non-acceptance by physicians and managers; 5) rigidity of administrative policies; and 6) salary, benefit, and career-advancement issues. The authors recommend ongoing management attention to addressing these barriers both within and outside the VHA system.