VA Facing Critical Healthcare Staffing Shortages in Near Future

by Stephen Spotswood

October 9, 2019

Replacing Retirees Hampered by Lower Salaries

Navy Vice Admiral Raquel Bono, DHA director, addresses attendees of the Female Physician Leadership Course during a presentation this past. Military Health Service photo

WASHINGTON—Oversight agencies are sounding the alarm that VA is plagued with large staffing shortages in critical areas, including physicians, registered nurses, physician assistants, psychologists and physical therapists, as well as human resource specialists.

This shortage, and the barriers that stand in the way of VA hiring and retaining employees, could become increasingly problematic in the next few years as more employees become eligible for retirement, according to the warnings.

According to a March 2019 Government Accountability Office report, about 30% of VA employees who were on board as of Sept. 30, 2017, will hit retirement age by 2022. That same report notes that lack of effective succession planning will hamper VA’s ability to develop a pool of potential staff to meet the organization’s mission over the long term.

Similar difficulties have been spotlighted by VA’s Office of the Inspector General, which has developed a report on VA hiring every year since 2015. The 2018 report was the first to break down needs on a facility by facility basis. A review of the 140 VA medical centers found that 138 were experiencing shortages in medical professionals, with psychiatry and primary care at the top of the lists. Of those 140, 108 also reported nursing shortages. Among nonclinical positions, HR specialists and police were most often cited.

Michael Missal, VA’s inspector general, told legislators at a hearing last month to expect similar results with its 2019 staffing report, which is expected to be released this month.

“The facility-specific results underscored how different the clinical and nonclinical needs are from one facility to another,” Missal told the House VA Committee. “We have consistently recommended that VA develop and implement a staffing model that identifies and prioritizes staffing needs at the national level while allowing flexibility at the facility level.”

Such a plan butts against the perennial hiring challenges reported by VA medical directors, however. The three most frequently cited are: a lack of qualified applicants, noncompetitive salaries and high staff turnover.

Lower Compensation

According to Daniel Sitterly, VA’s assistant secretary for human resources, VA lacks the flexibility of the private sector medical facilities that it’s competing against for top talent. As health demand increases and shortages of professionals grow, private sector employers are quick to adjust to changes in local labor markets and modify starting salaries and compensation packages accordingly. VA is forced to attract top talent willing to take lower compensation in order to work with an organization with “a noble mission,” Sitterly said.

For example, the San Francisco VAMC is located in one of the highest cost-of-living markets in the United States. Highly specialized surgeons in that market average nearly $800,000 in yearly salary and bonuses. VA is capped at about 50% of that rate. These statutory limits on total compensation mean that VA must contract out critical healthcare services, such as surgery and interventional radiology.

VA’s hiring difficulties are shared with government agencies as a whole, explained Robert Goldenkoff, GAO’s director of strategic issues. “Structural issues impede these agencies’ ability to recruit, retain and develop workers. These issues include outmoded position classifications and pay systems, ineffective recruiting and hiring processes, and challenges in dealing with poor performers.”

High turnover at the top levels also hinders hiring, Goldenkoff noted. “Leadership continuity is very important, because, if you have a plan in place, leaders set the tone. And if there’s consistent turnover, much of that never happens, or it’s just much more difficult to happen when essentially the people at the top are temporary employees.”

Asked how Congress can help with this high-level turnover, Sitterly said he would love more authority to offer medical center directors a higher salary. “While I have direct hire authority for medical center directors, I can only pay them at $156,000 a year if they’re not Title 38. By fixing that, it will improve our ability to hire senior level directors.”

The Association of American Medical Colleges predicts a shortfall of 120,000 physicians nationwide by 2030. Asked what VA is doing to prepare for this, Sitterly said that VA would like to have the ability to create their own dedicated pipeline of clinicians.

“[We’d like Congress to] give the VA authority to provide salary support to send medical students to the Uniformed Services University,” Sitterly declared. “As the DoD moves their health agency model around, I think you’ll find—and we’ve spoken to the university’s dean about this—that they have excess capacity. We’d love to grow our own doctors.”

The DoD also is pushing to recruit more qualified physicians and foster diversity. This spring, more than 100 competitively selected physicians gathered in Falls Church, VA,  to attend the Military Health System Female Physician Leadership Course, sponsored by the DoD Defense Council for Female Physician Recruitment and Retention.

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