If a doctor doesn't get selected they don't get paid. In no time they'll start providing better service or they'll have to start flipping burgers... cause in the real world people don't put up with jerks who think they're Gods.
Let them function under the same incentive as private doctors.
And the administrators? Same thing... Doctors chose which 'hospitals' they put patients into - the bad ones don't get paid if no one wants to go there. In the real world Hospitals that are dreadful go under. Same should happen here.
Switch the incentives - the change would put the vets in the driver's seats and doctors as trusted professionals offering a 'service for pay.
Patients would go from 'charity cases ' to 'customers' in weeks... this whole mess would start changing.
LOL! My primary at the VA “warned” me that the dermo doc would tell me to “put some ointment on it.”. And basically that’s what happened. The dermo doc “doesn’t care for biologic” drugs so unless the rhemo doc prescribes it for me, no go. The primary won’t do it because it’s “outside his scope.” I’d been on the same med for 8 years on the outside with no ill effects. Second opinion? Only one dermo and my opinion of him is he’s an ass. LOL!