Before Veterans Affairs Secretary Bob McDonald announced a restructuring of the agency on Monday, the day before Veterans Day, much of the focus on the new agency chief has centered on whom he has — or hasn't — fired.
McDonald has been chided for not moving fast enough to oust people involved in the wait-times scandal that shook the agency earlier this year, despite legislation making it easier for him to do so. Arizona senators John McCain (R) and Jeff Flake (R) have been vocal critics of McDonald's speed, and House Veterans Affairs Committee Chairman Jeff Miller (R-Fla.) has expressed concern about it as well.
In a "60 Minutes" interview that aired Sunday night, McDonald defended himself, saying he had proposed the dismissal of 35 employees and was considering actions against up to 1,000 more. "We've got to make it stick," McDonald said. "We propose the action, the judge rules, and the individual has time to appeal."
But while the spotlight has been on such firings, McDonald's biggest and most important challenge appears to actually concern hiring. McDonald has said the agency needs 28,000 more doctors and nurses in order to keep up with the current requests for appointments by veterans. So, until he fixes one of the problems that led staff members to manipulate wait-time records in the first place — that demand for services far outstripped supply — all the terminations and online suggestion boxes in the world will do little to help.
Whistle-blowing doctors have, after all, blamed clinical shortages for the mess at the Phoenix hospital, where the fiasco first surfaced. "I had veterans who had survived WWII, who'd survived Pork Chop Hill, who'd survived the Battle of Fallujah, who had gone through so many situations of combat where it's a life and death situation," VA physician Katherine Mitchell told 60 Minutes. "And yet I could not guarantee their safety in the middle of metropolitan Phoenix in my E.R., because we didn't have adequate staffing and training."
McDonald's chief deputy, Sloan Gibson, seems to agree. Gibson, who served as acting secretary in the immediate aftermath of former VA head Eric Shinseki's resignation, told 60 Minutes that the problems he's seen in visits to local sites have been "leadership failure, mismanagement, and chronic underinvestment in the system."
McDonald is taking on some of this challenge himself, visiting medical school campuses to personally recruit doctors and nurses and even calling them on the phone to encourage them to join. He's given raises to doctors in order to bring their salaries more in line with private-sector opportunities, and seems to understand it is his responsibility to rehabilitate the VA's reputation so more talented clinicians want to work there. Yet all of this comes at a time when there's a projected shortage of doctors in the general population, and when doctors are increasingly seeking jobs with less red tape.
Convincing Congress to budget the VA with enough resources to hire that many people will likely be tough. Some legislators are already arguing that VA workers need to be more efficient, and others are floating the idea of expanding the new private voucher program, which allows veterans to use outside medical providers if their wait time is long or they live too far from a VA hospital.
There's little doubt a more efficient system is needed, yet some level of greater hiring is needed as well. And given the reputation hit the agency has taken, that won't be easy. McDonald relayed a story to NPR host Robert Siegel on Monday, in which he coincidentally sat in front of an Air Force veteran on one of his first trips to Phoenix on the job. They started talking and it turned out the veteran's daughter was going to medical school, and that the father had suggested she work for the VA. Yet the daughter's response had been, "dad, haven't you been listening to the radio — or don't you know what's going on? Why would I want to work for the VA?"
Hiring alone will hardly fix an organization in need of modernizing, restructuring and culture change. It won't correct the lax performance standards or the broken bonus system that contributed to problems in the past. But it is a big part of the solution — and perhaps an even harder one to get right than cleaning house quickly.