At the Raymond G. Murphy VA Medical Center in Albuquerque, returning veterans from conflicts in Iraq and Afghanistan can expect one post-deployment visit that includes lab work, primary and gynecological care, a visit with a social worker and time with a psychologist. Veterans arrive at the Women’s Comprehensive Care Clinic at 7:30 a.m. and, four hours later, they are done.
The streamlined visit is one feature of the clinic, designed to be a “one-stop shop” for female veterans, says Carole Donsbach, women veterans program manager for the New Mexico VA Health Care System. The clinic opened in 2009, part of a national VA effort to offer more seamless care for female veterans.
The clinic offers primary care, such as monitoring chronic diseases like diabetes; gender-specific care, like cervical and breast cancer screening and birth control; as well as behavioral health help for conditions like post-traumatic stress disorder and sexual trauma and referrals for more extensive treatment.
“If these problems are not addressed initially, down the line it will reduce quality of life for the veterans,” Donsbach says.
The clinic is available to eligible female veterans over 18. That includes veterans from World War II through Operation Enduring Freedom, Operation Iraqi Freedom and Operation New Dawn, says Dr. Megan Babcock, medical director of the women veterans program for the New Mexico VA Health Care System and section chief for the clinic.
The clinic, like the entire VA, must meet the health needs of a growing number of female veterans, who are younger than their male counterparts and use the system more often. Every day Babcock also sees women who lost private insurance and now use the VA, she says.
According to a 2009 report on female veterans who used the VA health system, women using VA services had nearly doubled in the last decade and more than half had a service-connected disability, making them eligible for lifelong medical care. About 8 percent of veterans and 12 percent of recent veterans are women.
Women who use the VA tend to be younger than male veterans. As of 2009, 86 percent of female veterans who used the health system were under 65, compared to 54 percent of males.
The average female veteran is 48 but 85 percent of recent female veterans are under 40, Donsbach says. Of that group, 58 percent are 20-29, and more likely to need contraceptive and prenatal care. Pregnancies among female veterans in New Mexico doubled in the past two years, she adds.
In 2009 and 2010, the top conditions among women treated at the VA were PTSD, hypertension and depression, according to the VA.
With the comprehensive care clinic, the intent was to create a welcoming place that would bring most services for women to one place, according to Pamela Crowell, acting associate director for the New Mexico VA Health Care System. The clinic uses a patient-centered care model, in which a team of providers coordinates care for each patient.
“Our message to women veterans is this is not your father’s VA,” she said in a written statement. ” … Our intent is to have the environment more feminine and focused on women’s health care needs much like services offered in the community. Additionally, we know that women often bring young children to doctor visits, so we wanted to make sure that children are welcome in the waiting area.”
Lucia Pillera, 25, an Air Force veteran who served from 2007-2010 in Iraq and Kuwait, moved to Albuquerque from Michigan this year. In Michigan, where she had to drive nearly two hours to reach the VA, she waited first for a post-deployment visit, then for a women’s health checkup.
In Albuquerque, she did everything at once, including her Pap test and birth control evaluation. Since mental health services were in the clinic she also didn’t have to feel embarrassed about seeing a counselor, she says.
“I would rather be here for that long than have to come back in two weeks,” says Pillera, adding that a private doctor might not understand her needs like a VA doctor.
“And,” she jokes, “they provide lunch.”
Health needs at the clinic often depend on the age of veterans, Donsbach says. The four-hour assessment is popular with young veterans without chronic conditions who work, attend school or care for parents or children.
“They love it,” she says. “They’re very busy. You have to make things very convenient for them.”
In addition to standard exam rooms, the clinic has a triage room for women who come to urgent care with problems like dehydration that can be treated in the clinic. Other features include osteoporosis screening, walk-in mammograms and same-day visits for acute care.
The clinic also has a pain management program that combines individual and group therapy sessions focusing on topics like acute versus chronic pain and conflict management.
There are also 13 community clinics in New Mexico that offer the same comprehensive care for women. When small clinics do not have a staff psychologist, veterans connect remotely via video conference, or telehealth.
Before the comprehensive clinic opened, the VA had fragmented care for women, with primary and gender-specific care in different offices, Donsbach says. When she sent letters to New Mexico veterans explaining the change, “my phone rang off the hook for a month,” she says. Since 2009, the number of patient visits has doubled.
“It’s been extremely successful,” Donsbach says. The no-show rate is less than 1 percent, she says.
Part of Donsbach’s work is to spread the word about the clinic. While there are 16,000 female veterans in New Mexico only 4,000 use the VA as their medical home, about 75 percent of them in Albuquerque, she says.
“We are looking for women who may not know they have their own clinic here,” she says.