VA Still Well Short of the Doctors It Needs Despite Small Gains

The Veterans Affairs Department saw a slight net increase last year in the number of doctors and other in-demand workers it employs, according to a new report, but still remains critically short of the onboarding it requires.

The Veterans Health Administration netted 774 medical officers last fiscal year, VA’s inspector general found, with most gains offset by the doctors who left the department. VHA added employees in four of its five most “critical need” occupations, but the trend of attrition nearly offsetting those gains held for each position. As a result, the IG said, VA made little progress in its capacity to treat veterans more quickly.

“The overall gains were reduced by high loss rates and did not significantly impact availability of staff in critical needs occupations,” the auditors said.

The IG began determining the occupations with the largest staffing shortages in fiscal 2014. Medical officers and nurses have remained the most critical positions in every year through fiscal 2017. Psychologists, physician assistants and medical technologists rounded out the top five in the most recent report, unaltered from fiscal 2016. VA Secretary David Shulkin said earlier this year the department maintained 45,000 job vacancies.

The IG cited VA for failing to create staffing models to anticipate its biggest staffing shortfalls on a facility-by-facility basis. The auditors first recommended the analyses more than two years ago, but the department has still failed to implement such a system.

“In the absence of facility-specific staffing targets or an operational staffing model, determining whether facilities are making meaningful progress in filling critical staffing shortages is challenging,” the IG said. “Without staffing models, VA leadership is unable to ensure that staffing is consistent and sufficient.”

A bill President Trump signed into law in August could help VA with those efforts. To help with recruiting, the law requires VA to create a standardized exit survey for departing employees and a database of every vacancy that is critical or difficult to fill. It will launch a virtual human resources academy within VA to ensure those employees maintain an adequate understanding of recruiting and retention strategies. Former VA employees will also face an easier process to return to the department and medical military personnel transitioning into civilian life will see boosted recruiting efforts.

The law also provided direct hire authority for positions with a “severe shortage of candidates,” as well as for certain qualified recent graduates and post-secondary students.

Retention issues continue to plague VA’s efforts to staff up, with 60 percent of doctors who left their positions resigning or transferring to other positions. VHA refers to those individuals as “regrettable losses.” Most of the remaining departures were the result of retirements. Recruiting is also a major barrier to VA’s onboarding. Last year, when Shulkin was head of VHA, he told Congress applications for clinical positions were down 78 percent.

VHA has created a working group to examine its regrettable losses and determine ways to keep employees in critical positions from leaving. It submitted a draft of its findings to VHA leadership this month. The IG told leadership it should review that report and implement “effective measures to reduce such losses.” The auditors also said VHA should expand its use of staffing models and incorporate more data in them so it can anticipate veterans’ medical needs.

VA’s acting Secretary for Health Poonam Alaigh agreed with the IG’s recommendations but said the problems were not unique. She added the department has netted 5,000 health care providers over the last five years.

“As the nation’s largest integrated health care delivery system, VHA workforce challenges mirror those of the health care industry as a whole,” Alaigh said. “Industry demand for clinical staff in all health care sectors exceeds the supply of appropriately trained health care professionals to meet projected nationwide health care needs.”