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

The Department of Veterans Affairs, facing intense scrutiny amid reports of widespread dysfunction and a push by the Trump administration to outsource more medical care, has tens of thousands of full- and part-time vacancies nationwide, according to data compiled by veterans advocates, lawmakers and federal unions.

Most urgently, the agency’s health-care network needs thousands of primary care physicians, mental-health providers, physical therapists, social workers — even janitorial staff, Sen. Jon Tester (Mont.), ranking Democrat of the Senate Veterans’ Affairs Committee, told The Washington Post in an interview. Of equal concern, he said, VA lacks enough human
resources personnel to vet candidates and make the hires.

“It’s crippling our ability to deliver health care to our vets,” Tester said. “ . . . It’s effectively pushing veterans outside the system.”

President Trump, and the conservative groups advising him, has seized on the long waits many veterans face at government facilities as grounds for aggressively expanding a program that enables patients to seek services from private providers at taxpayer expense. The proposal is deeply divisive, however, with opponents, including Democrats and Republicans in Congress, saying the effort could further weaken VA.

Trump fired Veterans Affairs Secretary David Shulkin late last month after legislation directing a modest expansion of the program failed to make it into the budget approved by Congress. Shulkin also had become entangled in a public feud with other Trump appointees, embarrassing the White House .

Trump’s nominee to replace Shulkin is Ronny L. Jackson, the president’s White House physician and an admiral in the Navy. Jackson has faced early opposition from lawmakers and veterans advocates, who worry he lacks the managerial experience necessary to effectively lead an agency as big and as challenged as VA.

Jackson has said he has “what it takes.”

The agency’s acting head, Robert Wilkie, told employees last week that he intends to “make a difference” for as long as he is in the position.

Max Stier, president and chief executive of the nonprofit Partnership for Public Service, said that when Trump took office, he put into place a federal hiring freeze that has been a particularproblem for VA as it looks to add staff. While doctors were exempt from the hiring freeze, the human resources professionals needed to make the hires were not, he noted, citing a 2017 report by the Government Accountability Office. VA’s human resources division remains short-staffed and continues to struggle with hiring even after the freeze was lifted, Stier said.

VA officials said the vacancy rate in the human resources department is 11.5 percent, or 540 employees. That has not affected “our numerous staffing successes,” said Curt Cashour, a VA spokesman, who noted the department has added nearly 15,000 slots since Trump came into office.

Across the agency, there were more than 33,000 full-time vacancies as of early March, Cashour said.

“Historically, one of the main benefits of working at the VA is stability. Unfortunately, people working in the health-care field are increasingly not viewing the VA as stable, and it is making recruitment more difficult because of that,” said Randy Erwin, president of the National Federation of Federal Employees. “It is a real problem.”

A Senate hearing is scheduled for Wednesday to confirm Paul R. Lawrence to become VA’s undersecretary for benefits, a key post that has gone without a permanent leader since October 2015. Lawrence is a retired Army officer and vice president of the consulting firm Kaiser Associates ; his nomination is considered non-controversial.

The role of undersecretary for health also remains vacant. Cashour said VA is “making steady progress” in its search for a permanent appointee.

“VA has made phenomenal progress during the Trump administration when it comes to VA staffing,” Cashour said.

More than one-third of veterans enrolled in the VA system — which serves 9 million veterans a year at 1,200 hospitals and clinics — now receive care from private doctors.

At a hearing before he was fired, Shulkin spoke about the difficulty in hiring doctors and nurses, mental health care professionals and benefits claims officers. The agency offers lower pay than the private sector does and involves a tedious, government-mandated recruiting process.

It is not clear what is Jackson’s philosophy regarding outsourcing care. But health-care experts and veterans advocates say the private system is also overwhelmed by long wait times. Outsourcing more care is not the solution, said Rick Weidman, executive director of policy and government affairs for Vietnam Veterans of America.

“You can’t just toss millions of veterans into the private health-care system, which wasn’t built to care for their specific needs as vets,” he said. “The VA needs full staffing. It’s irresponsible and not fair.

Eric Yoder contributed to this report.