Background and History of UC-VA Relations
In an effort to attract higher-quality physicians to serve at VA Hospitals, the VA Administration began entering into affiliations with nearby universities around the country to offer joint appointments to their physicians.
A Joint VA-University appointment would enable the holder to have an academic appointment at a nearby university and provide the opportunity to obtain research funding through the submission of grant applications through the partnering university. Veterans would enjoy higher quality medical care and the partnering university would be able to expand its medical faculty and have greater access to training opportunities for its medical students and residents.
UC San Diego’s Medical School opened in 1965 at the beginning of a budget crunch. Limited state funds were available for medical faculty FTEs, and for constructing buildings. While UC San Diego acquired the county hospital in Hillcrest from San Diego, the hospital was located a distance from the campus, and there was still the problem of limited FTEs and research space on the campus.
The construction of the VA hospital next to the campus was a win-win solution. UC San Diego was able to higher more faculty without much increase in costs, plus the new VA hospital provided much-needed laboratory space for these new faculty.
Joint appointments at UC San Diego “wrapped” around the VA appointment. Faculty were guaranteed a set salary between the two institutions, with UC San Diego making up the difference if the VA appointment was reduced for any reason (such as changes in demands of the VA medical service). At the time, VA salaries were low, so the VA benefited since they were able to offer higher compensation without having to come up with the extra dollars.
Initially, NIH could not allow compensation for work done on NIH grants by VA employees. The Federal Government took the position that as federal employees, VA faculty were already compensated by the federal government. Over time this became a bigger and bigger issue with joint appointment faculty since the feeling was they were putting in far more hours than the VA 40-hour work week. UC San Diego faculty took the lead in lobbying NIH for change. NIH was granted an exception by the Federal government to allow compensation for “reasonable” additional effort on NIH grants, outside of the federal 40-hour workweek.
On 8/11/89, NIH issued a new NIH Guideline which “Clarifies how [applicants] may assure peer reviewers and staff that the time proposed for a particular project is available from among their total professional commitments, including that to the VA.” The 8/11/89 NIH Guide spelled out the requirement to have Memorandums of Understanding (MOUs) on file for joint VA/University appointments for investigators on NIH proposals.
It reaffirmed “the longstanding practice which permits VA investigators to conduct research through affiliated universities which avoiding conflicts of commitment among their total professional responsibilities…” out of its concern “that investigators have the time available to carry out the proposed research” and that “there is no possibility of dual compensation (University plus VA salary) for the same work….”
The Memorandum of Understanding (MOU) signed by both the University and the VAMC was to provide assurance that there was no possibility of “dual” compensation.
A joint appointment was defined as “a total set of professional responsibilities mutually arranged by the university and an affiliated VA hospital. The combination of teaching, research, consulting, administration, and clinical activities at both the university and the VA comprises 100% of an individual’s total professional responsibilities.
The PHS Policy Statement, replaced by the NIH Policy Statement 10/1/98, through the years has consistently stated that “The joint VA/university appointment of the investigator constitutes 100 percent of his or her total professional responsibilities. NIH will recognize such a joint appointment only when a university and an affiliated VA hospital are the parties involved.”
According to the 8/18/89 Guide, “The VA commitment should be expressed as hours per week, such as 25 hours (based on a 40-hour work-week). This commitment does not necessarily limit the corresponding university appointment to 15 hours per week, but the individual’s overall set of responsibilities must meet the test of reasonableness.”
Discussions and correspondence between COGR and NIH regarding 8/8 appointees arrived at a 60-hour work week (40 hours for an 8/8 VA appointment plus an additional 20 hours of University time) as meeting the test of “reasonableness”. However, a 60-hour work week was never written into NIH policy. While UC San Diego accepted 60 hours as the basis for MOUs, and in fact, other institutions around the county have adopted other hourly maximums for their work week.
UC San Diego began budgeting salary for joint VA faculty effort. But unfortunately, due to the method, the School of Medicine used to set up UC-VA appointments in the payroll system, initially the entire guaranteed salary was used as the institutional base pay rate for grant applications.
Meantime, UC San Diego’s VA was concerned about unreimbursed costs it was absorbing for the conduct of research in its hospital. UC San Diego offered to share a portion of its overhead with the VA for those projects, but the problem was in providing access to those funds. University regulations did not permit UC San Diego to set up a spending account for the VA to access Turning the funds over to the VA was a problem, since any monies coming into a
VA account, was by law, to be handled as an offset to the VA budget.
This was also a problem for industry-sponsored clinical trials at the VA – any clinical trial income was treated as an offset. The result was there was no incentive for VA doctors to conduct clinical trials. Congress finally granted the VA permission to establish affiliated non-profits for the purpose of negotiating and accepting clinical trial funds without losing those funds to the VA administration. The San Diego VA established its local Veterans Medical Research Foundation for this purpose.
As negotiations between UC San Diego and the VA over sharing the cost of research conducted in VA space came to an impasse, the VA Research Office finally announced in the late 1990s that for any research conducted in VA space, grant applications would have to be submitted through its VMRF. Faculty were threatened with loss of their VA space if they failed to comply, and VMRF began to submit NIH grant applications that previously would have been submitted through UC San Diego. An affiliation agreement between UC San Diego and VMRF was finally signed in 1999 recognizing VMRF’s right to submit grant applications for UC San Diego faculty, and also allowing for the receipt of joint personnel agreements (JPAs) to reimburse UC San Diego for salary paid to faculty and staff working on VMRF awarded projects.
In 2004 additional changes to joint UC San Diego-VA faculty appointments came about due to a directive from UCOP altering the way faculty appointments and salaries were to be handled. Originally at UC San Diego, faculty with joint appointments were set up in the payroll system with their 100% combined salaries, and with their VA income entered as an offset. This provided the basis for using the 100% joint salary as their institutional base in grant applications but was unfortunately illegal since it also provided those faculty with credit in two retirement systems for the same pay. A major effort was undertaken in 2004 to reeducate faculty regarding the change and served as the basis for the VA salary worksheet and statement used in UC San Diego grant applications.