[Toughy]

One of the things Dr Bowers talked about was the complete lack of surgical training at every medical school in the country. If the training is not available then you will not get surgeons to do SRS. That is one of the reasons so few surgeons do these types of surgeries.

She is now located in San Mateo (on the peninsula about 20-30 minute drive to SF) and also see patients in Seattle. The Trinidad office is closed. Her being located in San Mateo makes her availabe to UCSF medical school. The SF VAMC is affliated with the UCSF Medical School........consequently we get first rate, cutting edge care. I believe I heard her say she wants to work with UCSF and start a training program for SRS. If UCSF does it, then it's extremely likely the SF VA will end up doing the surgeries.

Theo ...great explanation for how the VA system is set up. Thanks for helping folks understand the VA model. The other thing that affects quality of care at every VA medical facility is leadership. Strong leadership in every facility translates to excellent care.

The VA model should be the single payer model for the entire country. I want to scream every time Obama and others say Medicare for all..........NO NO NO...........VA care for all. There is a pharmacy formulary (which the VA negotiates drug prices, Medicare does not) but it is huge and it's never been an issue for me to get drugs not on the formulary. The doc makes a call to the outpatient pharmacy and I go pick it up. There is no 'this test/procedure/referral must be approved' before it can be done. Physical Therapy gave me a cane to walk with on the spot and a special walker because of the RA in my wrists. No approval required. She ordered (on the computer) the special walker while I was sitting at her desk and it arrived at my house 2 weeks later. I'll stop because it's a derail...sorry