Making sure healthcare providers find their way into the VA system and stay there is the job of VA’s National Recruitment Service (NRS), and it’s not an easy one. Here is an ad to recruit nursing. VA photo

WASHINGTON — Even VA’s harshest critics regularly admit that VA provides world-class care to its veterans and that VA facilities are staffed by some of the most compassionate, hardest-working providers in any healthcare system in the country. Making sure those providers find their way into the VA system and stay there is the job of VA’s National Recruitment Service (NRS), and it’s not an easy one. 

Larry Elliot and James Marfield are the associate directors of the NRS and share the job of providing a bird’s-eye view of VA’s recruitment needs, both now and in the future. Marfield arrived at VA in 2008; Elliot in 2012. Both are retired Air Force with backgrounds in physician recruitment.

The NRS itself has only been around since 2009. It began as a two-year pilot project in seven VISNs, after which VA decided to roll it out nationwide.

“We now have a recruiter in each VISN. Those recruiters bring industry best practices across the country,” Elliot explained. “We’re pretty limited. There are only 22 members on our team and over 170 major sites of care. We’re trying to help these facilities develop more robust on-the-ground recruitment programs.”

“When I worked at a facility—I was the first recruiter they hired—there was a real need for case management,” Marfield added. “Someone to own the overall process. That was a really big need: synthesizing, expediting and providing an enhanced candidate experience.”

When NRS began its work in 2009, one of the biggest hurdles was the prevailing belief that the federal sector did not provide the best experience for a job candidate—a belief that Elliot and Marfield conceded was based partly on fact. 

“Our goal was to become the single touchpoint for everybody. [Recruiters] are an advocate for the candidate as well as for that clinical service line,” Marfield explained. “That challenge still exists to some extent, but we’re light years better than we were in 2009.”

Their biggest challenge now is one that’s facing healthcare systems worldwide—how to compete for talent in the midst of a growing shortage of physicians. The Association of American Medical Colleges estimates that the United States could see a shortage of between 54,000 and 139,000 physicians by 2033. 

“The competitiveness in the marketplace is continuing to grow,” Elliot explained. “[2033] sounds like it’s a long time away, but that’s a short 12 years. Those are staggering numbers. The market continues to get more and more challenging, so we as an organization need to be aware of that and be proactive and not reactive and do everything we can to maintain a competitive edge.”

That edge is dulled somewhat by federal regulations that cap a federal employee’s salary at $400,000. VA remains competitive by offering a robust benefits package, flexible telework options, the ability to continue teaching while employed at VA and the chance to work on complex cases. 

“We’re still able to recruit effectively because of those benefits, offering a better work/life balance and a better practice model that focuses on veteran outcomes and not revenue,” Marfield explained. 

However, as private sector salaries continue to rise, that $400,000 cap could become a greater impediment, they said, with some subspecialty’s salaries approaching $1 million.

“At some point, if a neurosurgeon is making $2 million, it’ll be a hard sell to ask them to work for $400,000,” Marfield said. 

Private sector hospitals also have an edge when it comes to their recruiting department. The average hospital has seven full-time recruiters. In larger cities, that number goes up to 10.  

While the future might be challenging, the pandemic and its ramifications have highlighted some of the strengths of the VA system. While private healthcare systems that are dependent on patient revenue have shed employees as nonessential care has been canceled, VA has remained relatively stable. 

“We’re pretty fiscally stable as an organization,” Marfield explained. “If you’re a smaller community hospital trying to manage your budget and you have significant amount of revenue tied up in elective surgeries and you stop doing that because of COVID, oftentimes that resulted in furloughs.”

VA also has an existing pipeline of young physicians—those who receive at least a portion of their training at its facilities. VA trains over 120,000 people a year, and it’s estimated that approximately 65% of U.S. physicians received some of their training at VA.

“We find that a lot of those physicians, whether they trained as a medical school student, resident or fellow, felt a connection to our mission,” Elliot explained. “They enjoyed training in our system. The day-to-day conversations they got from the physicians working in the system was generally pretty positive. That kind of stuck with them.”

VA’s reputation as a good place to work has grown beyond word-of-mouth among physicians. Last September, Forbes named VA one of the best employers in 17 states. The magazine also ranked VA as a top employer for new grads in 2020. 

However, at the end of the day, one of the biggest things that VA recruiters look for is something that might not be found on a resume.

“I always try to get a feel for their motivation for serving veterans. I look for a direct connection to the military. Do they have a family member serving now?” Elliot said. “What we really look for is a connection to VA’s mission.”