My mission is making sure that our veterans get the highest quality care possible.

Monitoring the Pulse of the VA

One month each year, Dorothy Ann Snow, ’79, does something few other physicians in management positions would think of doing: she volunteers to see patients.

With a team of interns, residents and medical students, Snow, chief of staff of Veterans Affairs Maryland Health Care System in Baltimore, makes rounds through the sprawling veterans hospital in Baltimore. She examines patients, reviews charts and scans X-rays. “You name it, we have it: heart failure, infectious diseases,” says Snow. “I like doing the doctor thing. It’s in my blood.”

It is fresh blood and new ideas that are shaping the Department of Veterans Affairs’ nationwide medical care system into one of the finest facilities in the country. For years, the department and its hospitals were roundly criticized for delivering poor quality of care to veterans and for operating inefficient and ineffective health care facilities. But with heavy investment in technology and a willingness to experiment with new ideas, the VA’s health system has become a model enterprise. “My mission is making sure that our veterans get the highest quality care possible,” says Snow, 50.

Last October, Snow was named the VA Maryland Health Care System’s chief of staff after a 25-year career with the institution. It is a daunting job, 60 hours a week easily, and big enough to swallow her in reams of administrative quick sand and endless meetings. She supervises all clinical services at the VA medical centers in Baltimore and Perry Point, as well as six community out-patient clinics throughout the state and the Baltimore VA Rehabilitation & Extended Care Center that treat 51,000 veterans. She also helps manage a $330 million annual budget, 2,500 full-time employees, and about 575 physicians. “It is definitely the most challenging and rewarding job I have ever had other than being a mother,” says Snow, who has a daughter in college, and is associate professor of the department of preventive medicine and epidemiology at the medical school.

The wars in Iraq and Afghanistan haven’t made the job any easier. VA hospitals back up the Department of Defense (DOD) hospitals in wartime. If high casualties overwhelm DOD hospitals, patients are sent to the VA hospitals. Snow says nearly 500 vets and “active military personnel” have come through the VA health system in Maryland in recent months as part of a training program. VA physicians are treating veterans who have had limbs amputated, suffered strokes, brain injuries or have suffered sexual trauma. Some have required inpatient therapy. “We expect more to come,” Snow says. “There is an extremely high rate of post-traumatic stress disorder, and the percentage of women (casualties) is much higher than in previous conflicts. The percent of people who were coming out having symptoms of sexual trauma is higher as well.”
VA physicians under Snow are seeing a large number of soldiers with brain injuries and limbs that have been severed. “The armor is better for the body but not necessarily for the limbs,” she says.

Snow grew up in Silver Spring, Md., when the nation was under the cloud of another war—Vietnam. The second youngest of seven children, Snow was raised in a medical household, but in her case both parents practiced medicine. Her mother’s office was attached to the house, and she tagged along on house calls with both parents. “I was always fascinated by medicine,” says Snow. “The biology of the human body, how cuts heal and how we get well after being sick. The human body is awesome.”

Although her father died in 1991, Snow’s mother, who is 91 and a family practitioner, still practices medicine. She’s been sidelined by a fractured hip, but is determined to come back, according to Snow.

Snow attended Dartmouth College and graduated from Maryland in 1979. She interned at the University of Maryland Hospital/Baltimore VA Medical Center, focusing on internal medicine. In 1982, she was hired at the medical center, but did a residency in preventive medicine at Johns Hopkins University School of Hygiene and Public Health. She became a post doctoral fellow of epidemiology at Johns Hopkins in 1985.

In the early part of her career at the VA, Snow’s interest was preventive medicine and finding ways to keep veterans healthy and preventing illness before it occurred. She looked at ways of improving compliance with screening for colorectal cancer and other illnesses. Soon, the VA became interested nationwide in similar performance measures and preventive programs. Snow liked working with veterans whom she saw as an under-served group. “That and the public health aspect very much attracted me,” Snow says. “Initially, I was content providing care, but very soon I realized that in order to work well with the system, I had to get into it and offer changes that would make it better.”

Snow’s resume is packed with committees and task forces ranging from critical care screening to medical staff quality improvement to quality management/patient safety. Her position as chief of staff and her heavy involvement have helped Snow develop a clear understanding of the VA.
But twice a year, two weeks at a time when she volunteers to see patients, she gains an even deeper perspective. “It is very much like the CEO of McDonalds going in and flipping burgers,” Snow concludes. “It’s taking the pulse of the medical center. It allows us to see how we could do things differently. We see what is working well and what is not working well. Without that I wouldn’t be an effective chief of staff.”