I've never been a big fan of V.A. medical care. As us Viet Nam era guys age in and get to need more services, waiting times for an appointment can get long. Medical care is expensive; budgeting by Uncle Sam doesn't keep pace to fully provide for the increasing demands older people make. V.A. is fine for free Viagara, hearing aids, and Rx refills.
You have all seen horror stories about quality of care at V.A. facilities. While these are mostly isolated instances jumped on by the media, they do happen. What really concerns me is quality though. Think about it. If you're an M.D. knocking down $300,000 in private practice, what will make you decide to leave that money to make $150,000 at the V.A. ? Often it's because you can no longer get malpractice insurance at an affordable rate because of what insurance companies call "experience rating". Translated that means you have lost some malpractice cases. Or you have lost your hospital privileges which means that hospitals and doctors have serious questions concerning treatment protocols.
It is not necessary to have a state medical license to practice in a Federal facility. Worst instance was some surgeon I saw (on 60 Minutes) who was a real butcher so he joined the Navy at age 48 to make a living doing orthopaedic surgery since he no longer had a license. It's not that you can't find a lousy Doc. in private practice, but the low pay makes it easier to find one in a state run place. it's also sad that $150,000 constitutes "low pay".