Congress is exploring ways to help the Department of Veterans Affairs improve its recruitment and retention of top doctors and dentists, who federal officials say are increasingly being tempted by better pay in the private sector.
The Senate Veterans Affairs Committee, chaired by Sen. Arlen Specter (R-Pa.), is scheduled to vote on legislation today that would revamp the VA pay system to allow the department to offer more lucrative salaries to some physicians and dentists, including hard-to-hire specialists. The department also would be able to adjust pay according to changes in the market.
The administration, VA employees and several lawmakers have cited inadequate physician pay as a critical problem in a system that provides health care to 7 million veterans nationwide.
In a letter to Congress last year, VA Secretary Anthony J. Principi wrote that the pay system for physicians, which has not changed since 1991, offers "insufficient flexibility" for the VA to remain competitive in hiring many medical specialists.
"VA is facing a critical situation," Principi wrote. "Several shortages of qualified physician specialists currently exist throughout the country in specialties critical to the VA's health care mission."
VA pay lags behind that of the private and academic sectors by 35 percent or more in such specialties as anesthesiology, radiology, cardiology, urology, oncology and orthopedic surgery, he wrote.
As an example, the VA can pay a maximum starting salary of $170,000 a year to a newly trained anesthesiologist, far less than the $220,000 starting salary such a doctor would earn in the private sector, said Mari Horak, associate chief patient care services officer for the VA.
"The difficulty the VA faces grows more acute each year," she said yesterday, noting that the pay disparity can grow over time because VA doctors are limited to salary increases based on longevity.
"We're seeing an inability to recruit [specialists] and, as a result, increasing contract costs because we need to provide that service," Horak said. "And when we can't employ the physicians, then we have to obtain the service on contract" with private physicians.
Specialists are not the only ones who earn below-market pay at the VA, officials say. At the start of the fiscal year in October, the department had 9,381 full-time physicians (and 5,147 part-time physicians) drawing an average full-time salary of $152,672, Horak said. Meanwhile, the average entry-level salary for instructors at medical schools was $138,900, and for full professors, it was $227,100, she said.
Regarding dental care, the VA has 652 full-time dentists earning an average salary of $139,700, Horak said. In the private sector, the average income for family practice dentists was $183,500 in 2003.
Bill Booher, executive director of the National Association of VA Physicians and Dentists, said his members do not expect to be paid as much as their private-sector counterparts. For one thing, VA doctors do not have to pay for malpractice insurance, he said. Still, the salary gap must be narrowed if the VA hopes to entice professionals to spend a career there, Booher said.
"If you can't keep pace financially with the private-sector market, then you are not going to be able to attract the quality of physicians and dentists that our veterans deserve," Booher said.
Donald Mooney, a spokesman for the American Legion, said the nation's largest veterans organization supports congressional efforts to improve VA physician pay. There have been no votes on the issue in the House.
Specter will ask his committee to vote on a proposal that would create a 15-step pay system with base salaries for all physicians ranging from $90,000 to $133,000, a committee spokesman said. The VA could add to base pay for specialists by establishing higher pay ranges based on at least two surveys of comparable private-sector salaries. The proposed system would ensure that all doctors receive regular increases based on longevity and cost-of-living adjustments. The VA would not be able to cut physicians' pay once it had been set, the spokesman said.
"Senator Specter, the administration and the employees themselves have been working together to update the VA physician salary structure," said Charles Robbins, a spokesman for the senator. "We believe the result will be good for the veterans, good for the VA and good for skilled doctors."