Shulkin: ‘Significant Challenges’ Continue for VA in Care Access, Staffing

by U.S. Medicine

July 8, 2017

By Sandra Basu

Battle Mountain Sanitarium (now part of the Veterans Affairs Black Hills, SD, Health Care System) was part of the National Home for Disabled Volunteer Soldiers, which provided care for Union veterans after the Civil War. The VA now is trying to determine what to do with its older facilities. Photo from the National Park Service.

WASHINGTON—VA has done a “significant job in improving access to care for clinically urgent veterans,” but veterans are still waiting too long for new appointments in primary care and mental health at 30 of its locations nationwide, VA Secretary David Shulkin, MD, said in an update on his 100th day in office.

“Veterans are waiting 60 days or more for new appointments in primary care and mental health at 30 of our locations nationwide. So we still have more to do,” said Shulkin, who previously was the VA’s under secretary for health.

Also a challenge is timely follow-up appointments, he noted during an update presented at the White House. The focus was on 13 areas of significant risk for VA.

“Ten percent of the time when a provider wants a follow-up appointment in a specific time frame, we’re not meeting that provider’s clinically assessed time for a veteran to come back,” Shulkin explained.

When it comes to improving access to care for people with clinically urgent needs, he suggested that VA is faring better, adding that the agency has now developed same-day services in every one of its 168 medical centers for primary care and mental health.

“And in fact, today, over 22% of veterans are seen on a same-day basis,” Shulkin advised.

He also explained why he chose to provide an update at this time.

“I wanted to come out and to talk about these 13 areas, our assessment of where the problems are,” he said. “I want to be held accountable to fix this. I’m going to need help to fix it—from Congress and from other organizations.”

The issues on the list have “different timelines” to address them, Shulkin noted, because some require legislative action, among other actions.

His remarks come as the administration has been touting its FY 2018 budget request of $186.5 billion on Capitol Hill. The VA secretary said the budget request “will allow us to accomplish a great deal of what’s on this list to modernize the system.”

Staffing Issues

Staffing is one of the most difficult problems faced by the VA, according to Shulkin, who said that currently it takes, on average, 110 days to onboard a nurse in the VA and 177 days to onboard a nurse practitioner.  

VA Secretary David J. Shulkin, MD, (left) met in mid-June with Rep. Bruce Poliquin (R-ME) on the agency’s priorities. Photo from Shulkin’s Twitter feed.

“That’s just too long,” he emphasized. “VA doesn’t have a position management system, so it’s very difficult for us to track what jobs are open. And an organization our size needs that in order to meet the needs of our veterans and have the right resources for them. We’re going to establish a fully functioning management manpower office by December of this year, which is a first step in a position management system to be established.”

Salaries for healthcare providers are also an issue, he stated, explaining that low salaries for many of VA’s healthcare providers and prosthetic professionals make it difficult to recruit and retain the best professionals.

“In 2016, the mean salary for a biomedical engineer in the country is $85,620. The national average for biomedical engineers in the VA is $65,677 or 25% below the private sector,” he pointed out.

If VA “can’t compete with private sector salaries,” Shulkin warned, “we’re going to be unable to retain qualified providers and support staff.”

To help with these shortages, he said the agency is pursuing legislation “that would expand graduate medical education training opportunities to be able to train more health professionals to stay in the VA system.”

VA is also working with the Uniformed Services University “to train more medical students who then would serve in the VA for 10 years after their education,” according to his presentation.

Capital Assets

When it comes to capital assets, Shulkin said VA will work with Congress to develop a modernization plan to allow the agency to use its “buildings in a better way” and to “stop supporting vacant buildings and underutilized buildings.”

“Our buildings and our facilities are increasingly fallen into disrepair,” he continued. “We have a facility condition assessment report that identified $18 billion would be required to fully remediate our buildings now, including structural/seismic and electrical/mechanical improvements that need to be done.”

He shed more light on his plan late last month in announcing that VA will dispose of all its vacant buildings in 24 months, either by demolishing or setting for reuse.

Nationwide, VA currently has 430 vacant or mostly vacant buildings that are, on average, more than 60 years old. Of those 430 buildings, VA has begun disposal or reuse processes on 71.  Of the remaining 359 buildings, Shulkin said VA will begin disposal or reuse processes on another 71 in the next six months, and plans to initiate disposal of the final 288 vacant buildings within 24 months.

In addition, VA will review another 784 non-vacant, but underutilized, buildings to determine if “additional efficiencies can be identified to be reinvested in veterans’ services.”

“We owe it to the American taxpayer to apply as much of our funding as possible to helping veterans. Maintaining vacant buildings, including close to 100 from the Revolutionary War and Civil War, makes no sense and we’re working as quickly as possible to get them out of our inventory,” Shulkin said in announcing VA’s plan to dispose of its vacant buildings.

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