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Notes -
One important thing to consider with the VA is that its level of care is pretty consistent over the entire country. It is "amazingly poor care" relative to many comparable institutions in some urban areas with high quality clinics and hospitals, but amazingly good care relative to what is available privately in many rural communities.
Much as I hate defending the VA I should say that the care can actually be very good at times. Inpatient medical care? Almost always awful. Outpatient care? Some of the clinics are actually excellent. PTSD treatment? Some of those programs are clearly best in the world in class.
Much of this had to do with the specific specialties and staff. Many people at the VA work at a slow pace because they want to be lazy and can get away with it, but some use that slow pace to do things like spending more time with patients which means satisfaction and care can sometimes be better.
Most of us train at the VA at some point though and the VA training experience is comically poor.
My grandmother used to work as an Occupational Therapist at the VA. They were way ahead of most of the rest of the country with a lot of the things she was doing. And, say what you will about the quality of care, the free van trip to the VA for those who needed it was a literal lifesaver.
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