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Opinion Loss of VA health-care providers grows as demand for care increases. Will service suffer?

A visitor leaves the Sacramento Veterans Affairs Medical Center in Rancho Cordova, Calif., on April 2, 2015. (Rich Pedroncelli/AP)

Two trend lines in veterans’ health care are not encouraging.

Demand for Department of Veterans Affairs (VA) services is going up, but so are losses among the agency’s health-care providers.

Annual VA outpatient medical appointments rose by 20 percent, or 17.1 million visits from fiscal 2011 through 2015, according to a new Government Accountability Office report.

But also increasing during that period was the number of staffers in five critical occupations who left the agency. In 2011, 5,897 physicians, registered nurses, physician assistants, psychologists and physical therapists said goodbye. By 2015, that number had grown to 7,734. The rate of loss rose from 7.3 percent to 8.2 percent. The GAO said similar problems affect other health-care organizations because of national shortages and increased competition for clinical employees.

“These staffing shortages directly impact patient care and makes the work of these dedicated employees even more difficult,” said J. David Cox Sr., president of the American Federation of Government Employees, which represents VA staffers.

VA, however, released a flurry statistics to show service is good. Among them, in May, 96.7 percent of appointments were within one month “of the clinically indicated or Veteran’s preferred date,” 85.6 percent were within one week and 21.6 percent were the same-day.

“Improving VHA’s (Veterans Health Administration) ability to forecast, recruit, and retain a workforce continues to be a priority,” the department wrote in a response included in the GAO report.

VA is trying to improve staffing levels with various initiatives. Among other things, it has increased pay for certain health professionals “to close the pay gap with the private sector and to make VA an employer of choice,” according to an agency statement. “With more competitive salaries, VA will be better positioned to retain and hire more health-care providers to care for veterans.”

Breaking down the numbers, GAO found that 28 percent linked their departures to issues involving advancement and 21 percent to dissatisfaction with aspects of the work. “Voluntary resignations and retirements accounted for 84 percent of VHA’s losses from the 10 occupations with the highest loss rates annually from fiscal year 2011 through fiscal year 2015,” according to the report.

The good news is that nearly two-thirds were generally satisfied with their jobs.

Paralyzed Veterans of America’s (PVA) Executive Director Sherman Gillums Jr. said the report echoes what his organization has been saying, particularly about nursing shortages.

“Nurse staffing directly impacts the number of available operating beds for paralyzed veterans requiring initial rehabilitation, acute care, and annual evaluations. Because of under-budgeting and inadequate staffing, VA was forced to use excessive overtime hours and flawed staffing methodologies as band aids to make up for a problem that required more serious intervention,” he said. “This had led to costly turnover and low morale among staff, not to mention artificially suppressed demand due to open but unstaffed beds, all of which render care less than optimal.”

PVA and VA have worked on a new staffing formula that calculates staff needed for patients with severe disabilities. “We hope to see it implemented sooner rather than later,” Gillums added.

In addition to the national shortages in these occupations, VA also has to overcome the stigma associated with the headline grabbing scandal over the coverup of long patient wait times that erupted two years ago. Staffing shortages apparently contributed to the long waits, then the coverup tarnished the agency’s reputation, which probably didn’t help with recruitment.

“The GAO report points out what DAV (Disabled American Veterans) has been saying for years,” said Garry Augustine, executive director of DAV’s Washington headquarters. “The primary reason for veterans’ access problems and waiting lists is there are not enough doctors, nurses and other health-care providers to meet the demand.”

Sen. Richard Blumenthal (D-Conn.) said he requested the GAO report because “understanding the needs of VA’s workforce is absolutely fundamental to ensuring the Department is able to meet growing demands for its services. It’s simple: a VA that is able to attract and retain good employees will also be able to provide continuous services and the highest quality care.”

Read more:

[VA health care is both good and in need of ‘dramatic change’

[DOJ won’t defend measure that facilitates VA firings]

[VA plans to offer salary boost to attract new doctors]