The Department of Veterans Affairs gets good grades for effort, but it still has much work to do in the recruitment and retention of physicians to serve those who faced death for their country.
When the Government Accountability Office says “challenges remain,” it means an agency has problems — in this case, too few doctors. Pay is an issue, but so is the department’s personnel management. A recent GAO report about the Veterans Health Administration, the component providing health care through 1,252 facilities, including 170 medical centers, outlines three major management troubles related to its doctor shortage:
- “VHA’s data on the number of physicians that provided care at VA medical centers (VAMC) were incomplete.
- “VHA provided VAMCs with guidance on how to determine the number of physicians and support staff needed for some physician occupations, although it lacked sufficient guidance for its medical and surgical specialties.
- “VHA used various strategies to recruit and retain its physician workforce, but had not comprehensively evaluated them to assess effectiveness.”
These points indicate that part of the problem lies with the agency inadequately diagnosing personnel problems, making it difficult to solve them.
“VHA hires more than 2,800 mission-critical physicians annually,” Debra A. Draper, GAO’s director of health care, told a House Veterans’ Affairs subcommittee hearing last month. “Yet, physicians have consistently been identified by VHA as a critical staffing priority due to recruitment and retention concerns.”
She told the panel that the agency didn’t know how many contract doctors it uses and had limited information on the number of its physician trainees. The result — “VHA data underestimated the total number of physicians providing care in its medical centers, leaving it unable to ensure that its workforce planning processes sufficiently addressed gaps in staffing.”
Garry Augustine, Washington executive director of Disabled American Veterans, urged VA to develop a more “systematic approach” to personnel management. “The VA needs to do a better job of determining shortages and developing a plan to fill vacancies,” he said during a telephone interview.
The American Legion called the shortage “a critical issue.”
“By not adequately staffing VHA, VA’s capacity to serve veterans suffers and forces more veterans to seek health care in the private sector at greater cost to the American taxpayers,” said Legion spokesman Joseph M. Plenzler. “We strongly urge the Department of Veterans Affairs to fill these vacancies with highly qualified health-care providers as quickly as possible. Our veterans deserve it, and our overstretched VA employees deserve it.”
There were 1,673 vacant physician positions as of March, according to data that VA provided to the Federal Insider on Friday. In all occupations departmentwide, the personnel shortage was 33,642, about 90 percent in health services.
Peter Shelby, the former assistant secretary of the VA Office of Human Resources and Administration, tried to shine a more favorable light on the vacancies in his testimony. “The scope and scale make vacancy numbers often quoted in the media seem very high,” said Shelby, who since left the VA. “Taken in context, VA’s vacancy and turnover rates are very low. We fluctuate between 9 and 10 percent, which compares very favorably with the private sector.”
Along those lines, Curt Cashour, the department’s press secretary, said by email that the “VA has made phenomenal progress since January of 2017 when it comes to staffing. Overall vacancies are down, VA’s vacancy rate is less than its turnover rate, and our total number of positions has increased by nearly 15,000.”
Beyond the bureaucratic problems of human resource and data management is the age-old issue of pay. VA docs get too little of it.
Officials at one VA hospital told GAO last year that “their chief of cardiac surgery, whose salary was close to $395,000 left to work for a private hospital in the community where his salary was close to $700,000.”
For Max Stier, president and CEO of the Partnership for Public Service, that’s an example of the need to make federal pay more market-sensitive. This is “perhaps the clearest example of the way in which outdated and inflexible personnel systems limit the department’s ability to recruit and hire,” he said.
He cited a new VA Office of Inspector General report that says “outdated OPM [Office of Personnel Management] classifications affected their ability to offer competitive salaries and advancement opportunities within the organization. This resulted in facilities being less competitive in attracting new staff and retaining highly skilled staff.”
Staffing is a widespread problem in the agency, VA Inspector General Michael J. Missal said.
“Our analysis showed that 138 of 140 facilities listed the medical officer occupational series … as experiencing a shortage, with psychiatry and primary-care positions being the most frequently reported,” his testimony said. “Of the 140 facilities, 108 listed the nurse occupational series … as experiencing a shortage, with practical nurse and staff nurse as the most frequently reported.”
Turnover among VA’s human resource professionals also is a big problem because they devise strategies to recruit and retain doctors.
“A large number of relatively new HR specialists,” Stier told the hearing, “means more preparation and work required to make sure the agency implements new rules and programs effectively.”