In the fall, David Hernandez, MD, (left), a reconstructive surgeon at the Michael E. DeBakey VAMC in Houston harvests a forearm free flap for the reconstruction of a large nasal defect. Source: VA photo
WASHINGTON, DC — The Senate VA Committee has advanced sweeping bipartisan legislation that would allow VA to raise the salary cap for physicians to above $400,000. The hope is that this will make the department more competitive with the private sector during the hiring process. The legislation also would require VA to pay licensure fees for employees, reimburse education costs and keep Congress more up to speed on its hiring efforts.
The VA Clinicians Appreciation, Recruitment, Education, Expansion and Retention Support (CAREERS) Act would give the VA secretary approval to waive any physician pay limitation on a case-by-case basis “if the secretary determines it is necessary for the recruitment or retention of critical healthcare personnel.” This “mission-critical” waiver applies to all VA physicians, podiatrists, optometrists and dentists whose current salary potential is capped at $400,000.
The constraint of the salary cap has resulted in VA having to get creative in recent years, as the demand for specialty physicians has far outpaced supply. That includes luring physicians to VA with flexible scheduling and telework options, a robust benefits package, and pushing annual bonus offers to their limit.
However, that hard salary ceiling has remained a significant barrier to hiring. In a report on VA’s hiring crisis released by the Veterans Healthcare Policy Institute in 2020, interviews with VA leaders found that specialists in their region could easily make $500,000 in the private sector and that many hospitals were struggling to fill vacancies because candidates could not afford to buy a home in the city’s housing market.
The legislation was put forward by Committee Chairman Jon Tester (D-MT) and Sen. John Boozman (R-AR), both of whom cited difficulty in attracting physicians to their states.
Difficulties in Hiring
“As I go around the country, whether it’s in rural Arkansas or rural wherever, it’s difficult to get any sort of healthcare professionals, much less at the VA,” noted Boozman at an abbreviated hearing last month to discuss the legislation.
Boozman also lauded another component of the bill — one targeting vacancies at VAMCs.
The VA Healthcare Policy Institute report that looked at physician staffing also examined facility directors and found that they make roughly 25% less than their private sector counterparts, yet many hold greater responsibility. The CAREERS Act gives the secretary power to raise the salary cap on those positions, as well. As part of that waiver, the secretary would have to consider the individual’s level of experience, complexity of the assignment and the labor market where the hospital is located.
This component of the legislation comes with a timeline. If a VA medical director is tasked to a different position by the secretary, the Senate committee must be notified within 90 days. If that role remains unfilled for more than 120 days, the secretary must appoint an acting director. Every 30 days after that, the secretary must submit an update and, after 180 days, must either bring that individual back to their former position or begin the process to hire a permanent replacement.
“In Fayetteville, Arkansas, we went more than 18 months without a director,” Boozman told his fellow committee members. “Leadership makes a difference. As a result, what this would do is say within 180 days, you need to get someone in there permanently.”
This legislation comes less than a year after the passage of the RAISE Act, which boosted the salary cap for VA nurses to $203,000. According to VA, this led to almost immediate pay increases for nearly 10,000 nurses.
The CAREERS Act includes other ways to make the VA more appealing to potential recruits. If the bill is passed, VA will take on the cost of licensing exams or certifications for any recipient of a VA scholarship. It would also raise the maximum incentive pay for VA pharmacist executives from $40,000 to $100,000 and allow nurse executives to qualify for “special pay.”
In exchange for these new hiring powers, the current draft of the bill has Congress asking for a few things in exchange. The first is that VA strengthen its workforce training when it comes to treating older veterans.
The legislation would require VA to expand its Rural Geriatrics Team Training program to no fewer than one rural site in every VISN and will require the expansion of Geriatric Patient Aligned Care Team (PACT) models to every medical center in the department. It also would require VA to provide continuing professional education to clinical staff that provide care to veterans who have Alzheimer’s or dementia.
The bill also would require a number of reports over the next few years.
VA would be asked to:
- Conduct a study on improving recruitment and retention at community living centers;
- Conduct a study on the structure of its Geriatric PACT model; and
- Provide annual reports on hiring and retention of medical center directors.
The VA Inspector General would also conduct a study on VA’s use of these new hiring authorities to fill vacancies, and any vulnerabilities or inconsistencies in that authority.
The committee voted Feb. 16 to send the bill to the full Senate.