At Townhall, He Said Doctors Want to Work for Veterans
VA Secretary Denis McDonough, left, answered veteran’s question at a broadcasted townhall on Veteran’s Day at the DCVAMC. VA photo
WASHINGTON, DC — For many high-demand medical professions, VA will likely never be able to fully compete with the private sector, regardless of the breadth of benefits the department can offer, according to VA Secretary Denis McDonough.
The admission came during a broadcasted Veterans Day town hall, where McDonough answered questions from veterans, family and caregivers. While those questions covered a variety of topics, many of them centered around VA staffing difficulties and the delays in care that result from it.
Answering a question about employee retention and why a veteran was seeing physicians at his local clinic come and go so frequently, McDonough said, “We want to make sure we’re investing in our people. As we use these pay authorities [provided in the PACT Act], in some cases we’re still not making our docs whole. If you’re a gastroenterologist at VA, you can just walk across the street and make [three times] what you’re making at VA. We’re not going to be the lead payer in any market. We just want to be a degree or two more competitive.”
He added that, for VA physicians, money is not the driving motivation.
“When these docs come to work with us, they’re coming here because they want to work for our vets,” he said. “They’re not in this for the money. We don’t have to make them fully whole. We just need to be a little more competitive.”
VA has been engaged in a hiring surge this past year, bringing in more than 61,000 new employees at VHA and 32,000 more at VBA. This was timed with the surge in demand seen by the passage of the PACT Act—expansive legislation that increased benefits and care for veterans exposed to toxic substances during service. The legislation contributed to a 40% increase in benefits claims and approximately 400,000 new enrollees in VA healthcare.
“We had a very aggressive hiring year so that, when we reach veterans, and they come in, we’re ready for them,” McDonough declared.
Despite the increase in staff, VA is increasingly referring veterans to care in the community, which they are required to do if a veteran cannot be scheduled for an appointment at a VA facility in a timely manner—20 days for primary care and 28 days for specialty care.
“Over the course of the last three years, we’ve seen the amount of care we provide in the community grow by about 15-to-17% a year,” McDonough explained. “It is an increasingly large part of the care profile that we offer. So much so that 40% of the care we offer today through VA is offered in the community.”
Some veterans, however, find the wait for care with community providers can be just as long as at VA.
“Some markets in the community are frankly even more saturated than VA is,” McDonough explained. “We’re trying to make sure we have better data, so you and other veterans who are getting referred to the community can make an informed decision.”
Part of the problem might lie with individual medical centers and inconsistent practices for when veterans are referred out into the community, he added.
“Our processes might still be sporadic,” McDonough said. “There are still places where it’s maddening, and I know that it’s maddening. … We just have to tighten those down. We just have to get better about providing care in house.”
The VA secretary also fielded questions on hot-button topics, including VA’s promise to add gender-affirming surgery to their care portfolio. That declaration in the summer of 2021 angered conservatives, while the lengthy rule-making process that followed has frustrated veterans seeking such care.
“The next step on rulemaking is with me now. I said many times that I would be the one to defend that decision when I make it,” McDonough said. “And, for a lot of different reasons, I’ve determined that I’m not yet ready to do it. But I will do it.”
McDonough added that, whenever gender-confirming surgery is added to the care the department provides, it will be because of the “uniform recommendations from our clinicians.”
“I was surprised by the unanimity of the recommendation,” McDonough said. “What were the clinical considerations in this? One thing really sticks with me. … Untreated gender dysphoria is among the leading causes of suicide. I assume that simple but troubling fact is one of the reasons our clinicians feel as strongly as they do about providing this service.”