Agency understaffing was a key flaw exposed during last year’s scandal over the cover-up of long patient wait times at the Department of Veterans Affairs. It has too few health-care employees to timely serve the wounded warriors and others among its clientele.
Congress and President Obama reacted by approving the Veterans Access, Choice and Accountability Act of 2014. It became law in August and authorized $5 billion for the department to hire medical professionals and social workers.
How as VA responded?
Slowly, was the consensus at a House Veterans Affairs’ health subcommittee hearing Friday. It also revealed differences, perhaps it’s really competition, among the groups of health-care staffer organizations, each of which say VA needs more of its kind.
Yet, even though Thomas Lynch, an assistant deputy VA undersecretary, told the panel that “we don’t move fast enough,” the facts he presented show a respectable effort to get the job done.
The department plans to add 10,000 workers to its Veterans Health Administration crew of 200,000 medical professionals and clinical support staff by the end of fiscal 2016, according to Lynch. “To date, VHA has recruited more than 2,500 additional medical professionals and support staff leveraging the Choice Act resources, approximately 25 percent of the overall target,” he said.
Reaching 25 percent of a large target in nine months doesn’t sound so bad for government work, or the private sector, either. Humans can be produced in that amount of time, but it takes VA longer, perhaps too long, to produce new hires. But it’s not just VA. Hiring barriers remain across government, but most agencies don’t have the scrutiny VA gets.
The latest probe was led by Rep. Dan Benishek (R-Mich.), who is the chairman of the health subcommittee and was a contract physician at a VA facility in Iron Mountain, Mich. “The department’s ability to effectively and efficiently recruit, on-board and retain qualified medical professionals to treat veteran patients is seriously fractured,” he said. “For example, the . . . outpatient clinic in Sault Ste. Marie, Michigan, has not had a physician on staff for at least two years.”
He had little patience for the VA officials who testified, cutting Lynch off before he could finish answering Benishek’s questions. Lynch’s bureaucratic-speak, on such things as “the application of productivity standards to clinical resource management,” may have frayed the chairman’s nerves.
“I think VA’s overly bureaucratic hiring process,” Benishek said, “is also a significant factor in this facility’s inability to recruit a physician for multiple years running.”
Representatives of VA health-care staffers also complained about a hiring process that can’t get out of first gear.
Joan Clifford, immediate past president of the Nurses Organization of Veterans Affairs, complained about “the lack of a strong infrastructure for human resources,” a “complex hiring process” that is “very slow to review applications online” and “significant delays in hiring personnel.”
Nichol L. Salvo of the American Podiatric Medical Association spoke from personal experience. “The gap between a staff departure to the time of filling the position is in excess of one year” for podiatrists, said Salvo, a former VA employee who now volunteers her services. “I am personally aware that my position was assumed by a podiatric physician 14 months after my separation.”
Like the other employee organization representatives, Samuel V. Spagnolo, president of the National Association of Veterans Affairs Physicians and Dentists, made a pitch for profession-specific issues. The elevation of other professions has resulted in the “greatly diminished” role of the physician “as the leader of medical care” in the VA system, he said, and that “is a primary cause, if not the primary cause, of difficulty in recruiting and retaining doctors.”
“In the name of cost savings and efficiency, nurses have been granted authority over physicians and judge and evaluate competency of physicians and dentists,” Spagnolo added. “Physicians are being loaded with additional duties more appropriate for non-physicians, such as typing letters, filing, follow-up calls, patient reception and preparation.”
He also took an apparent swipe at the increased role of physician assistants and others, as their representatives sat at the witness table with him.
“There is a growing trend to add non-physicians, and there is a growing concern that a veteran may never be seen or treated by a physician while a patient in the VA system,” he said. “Veterans are seen by non-MD doctors without ever realizing they have not seen a medical doctor. We believe this is dangerous for patients and their families and may raise ethical issues.” Despite additional funding, he said, employees report that hiring “critically needed patient-care staff is harder than before.”
Hiring is just the front end of the problem. Retention is at the other end.
Nearly one-third, 31.5 percent, of the employees in VHA’s “top occupations quit in the first five years of employment,” according to the agency’s 2014 Workforce and Succession Strategic Plan. “Nearly half (49.3%) of the employees who quit between FY 2005 and FY 2007 did so within the first year.”
To paraphrase a statement to the committee from the American Federation of Government Employees, which represents about two-thirds of the VA workforce — today’s recruitment success is tomorrow’s retention problem.