Houston’s VA hospital has been designated as the most complex in the entire VA system and one of the largest federal facilities in terms of physical size. It serves veterans from Houston and dozens of other surrounding counties. As a quaternary referral center for veterans, the Houston VA provides all types of medical services, from primary care to subspecialty medicine, liver and kidney transplantation to advanced therapies for cancer. It has recently been approved to start an advanced heart failure, LVAD, and cardiac transplant program. At the VA, our residents rotate on general medicine wards, subspecialty consults, neurology and ICU teams, as well as general medicine and specialty outpatient clinics.