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.