The Department of Veterans Affairs is an important institution for healthcare delivery, education, and innovation

The Department of Veterans Affairs (VA) operates the largest integrated healthcare system in the United States. The network serves 9 million veterans at 1,255 healthcare facilities located in all 50 states, Puerto Rico, Guam, American Samoa, and the Philippines. Orthopaedic surgery is an important component of VA healthcare. I have had the privilege of dedicating my career in the service of veterans at the VA Palo Alto healthcare system. Below are some facts and features of a career at the VA that I have found very appealing.

The VA serves a distinguished patient population. Veterans come from all walks of life and have diverse backgrounds, but they share a common bond of having served their country. In return for their service, the VA is committed to providing veterans with the highest standard of medical care. I am proud to participate in that commitment.

As a large government-funded healthcare system, the VA is highly scrutinized. All healthcare systems have their strengths and weaknesses, and the VA has been subject to highly publicized investigations and findings in the past. In 2014, the VA Office of Inspector General’s audit revealed that the VA had widespread issues with access and wait times. This led Congress to pass the Veterans’ Access to Care Through Choice, Accountability, and Transparency Act of 2014 and subsequently the VA MISSION Act of 2018. These laws aimed to strengthen VA infrastructure, improve employee recruitment and retention, and provide a mechanism for veterans who have difficulty accessing the VA system to go outside the VA for care. Wait times are now carefully monitored, and veterans may seek care outside of the VA when access is an issue. As a result, the VA now competes with private institutions in the healthcare marketplace.

Care at the VA is high quality. A systematic review revealed that VA care in the United States matched or outperformed non-VA care in most categories, including quality, safety, access, and patient experience. Specifically in orthopaedic surgery, veterans receiving total knee arthroplasty in the VA system were found to have lower complication rates and lower readmission rates than veterans having knee arthroplasty at non-VA facilities.

I have found employees at the VA to understand and be driven by a singular mission — to serve veterans. In this light, the VA has been a leader in medical and surgical innovation to achieve this goal. The cardiac pacemaker, radioimmunoassays, liver transplants, nuclear imaging, clinical trials, and treatment for hypertension were among the many medical innovations that VA physicians and researchers have contributed to.

In addition, the VA was a pioneer in adopting an electronic health record system and understanding the power of medical information to coordinate and improve care. The large, integrated, and centralized VA electronic health record is a remarkable and detailed data source that has been used to understand disease and improve care.

The VA was also a pioneer in using data for surgical quality monitoring. Starting in the early 1990s, the VA developed a novel surgical quality-monitoring program that matured into VASQIP (Veterans Affairs Surgical Quality Improvement Program). Improvements in surgical care that resulted from the information in VASQIP led the American College of Surgeons to develop NSQIP (National Surgical Quality Improvement Program) for hospitals outside the VA healthcare system. Orthopaedic surgeons in the VA system have access to internal and external research funding. VA-specific research funding is available only to employees. These research opportunities and collaborations across VA hospitals and in larger studies have enhanced my career.

The VA is the largest educator of medical professionals in the United States. More than 70% of all U.S. practicing physicians have had experience training at a VA facility, and 90% of U.S. medical schools have a partnership with the VA. These partnerships are a result of VA Policy Memorandum No. 2, which was signed in January 1946 after World War II. They facilitate an exchange of knowledge and expertise that is instrumental in enhancing the quality of care provided to veterans, particularly in specialized fields such as orthopaedic surgery. Many VA medical centers are co-located with or near renowned academic institutions, offering opportunities for surgeon affiliation at both institutions. This fosters a collaborative environment that benefits patients, healthcare professionals, and each institution. I have benefited from the close affiliation between the Palo Alto VA and Stanford University.

These partnerships create outstanding teaching opportunities. I have personally found this aspect of my work to be extremely satisfying. In my view, the VA provides an ideal teaching environment. As a joint replacement surgeon, I have found the orthopaedic pathology at the VA to be very challenging, stimulating, and great for teaching.

VA hospitals are a special place. There is a sense of camaraderie, mutual respect, and mission. Veterans often find comfort in receiving care from a system that understands their unique experiences and challenges. This shared understanding fosters a supportive environment where patients feel valued and heard. Last year, I had a veteran in my office who was deciding where he should get his hip replacement. He summed up his feelings this way: “When I go to another hospital, I get the sense that they are doing me a favor. When I come to the VA, I get the sense that the hospital and everyone in it is there for me.”

Nicholas Giori, MD, PhD, FAAOS, is chief of orthopaedic surgery at the VA Palo Alto healthcare system, chief surgical consultant for the VA’s Veterans Integrated Service Network 21, and professor in the Department of Orthopaedic Surgery at Stanford University.

References 

1. VHA 2024 Annual Report. Veterans Health Administration. Accessed Oct. 16, 2025. https://www.va.gov/health/docs/vha-annual-report-2024.pdf
2. Apaydin EA, Paige NM, Begashaw MM, et al. Veterans Health Administration (VA) vs. non-VA healthcare quality: A systematic review. J Gen Intern Med. 2023;38(9):2179-2188. doi:10.1007/s11606-023-08207-2
3. Harris AHS, Beilstein-Wedel EE, Rosen AK, et al. Comparing complication rates after elective total knee arthroplasty delivered or purchased by the VA. Health Aff (Millwood). 2021;40(8):1312-1320. doi:10.1377/hlthaff.2020.01679
4. Rosen AK, Beilstein-Wedel EE, Harris AHS, et al. Comparing postoperative readmission rates between veterans receiving total knee arthroplasty in the Veterans Health Administration versus community care. Med Care. 2022;60(2):178-186. doi:10.1097/MLR.0000000000001678
5. Ten times VA led the way in health innovation. VA News. July 27, 2021. Accessed Oct. 16, 2025. https://news.va.gov/92183/ten-times-va-led-the-way-in-health-innovation/
6. Geppert CMA. What is the VA? The largest educator of health care professionals in the U.S. Fed Pract. 2016;33(7):6-7.