Lawmakers probe health care staffing shortages at VA

In the face of a critical shortage of health care professionals at the Veterans Health Administration, stronger incentives are needed to attract top talent into the workforce, group representatives told a House subcommittee Thursday.

"Shortages in health care staff threaten the VHA's ability to provide quality care and treatment to veterans," Joseph Wilson, assistant director of veterans affairs and rehabilitation for the American Legion, told the House Veterans' Affairs Subcommittee on Health.

By 2020, nurse and physician retirements are expected to create a shortage of about 24,000 physicians and almost 1 million nurses nationwide, according to government estimates. Further complicating the shortage is a lack of teaching faculty and classroom space in universities, which caused more than 42,000 qualified applicants to be turned away from nursing schools last year, the American Association of Colleges of Nursing reported separately.

Joy Ilem, assistant national legislative director for Disabled American Veterans, testified that VHA's shortage of nursing staff, coupled with inadequate funding, has resulted in hiring freezes in some hospitals. VHA has required overtime, reduced flexibility in tours of duty for nurses, and limited locality pay, she said.

Additionally, the increasing need for rehabilitation services among veterans is boosting demand for physical therapists across the VA system, said Jeffrey Newman, chief of physical therapy at the Minneapolis VA Medical Center. The VA has not kept pace with current professional practice standards, he said. VA qualification standards, for example, only require a therapist to obtain a bachelor's degree and do not recognize the doctorate of physical therapy degree, he said.

"Not only is this severely out of date with current minimal education requirements, but it is not competitive with clinical settings outside the VA system," Newman said.

William Feeley, deputy undersecretary of health for operations and management at the VA, said that while the VA is facing workforce challenges, it has effectively boosted its efforts to attract quality professionals.

In April, for example, the agency launched the VA Nursing Academy, designed to increase the number of nursing faculty in schools, increase student nursing enrollment by 1,000 and promote innovations in nursing education through enhanced clinical rotations in the VA. "VHA research shows that students who perform clinical rotations at a VA facility are more likely to consider VA as an employer following graduation," Feeley said.

The VA also provides new hires with student loan repayments, with an average payout of $17,000, Feeley said. In addition, employees may receive scholarships of up to $32,000 to obtain additional health care degrees, he said.

In 2006, VHA contracted with CACI Strategic Communications to conduct a pilot program to test and recommend innovative recruitment methods for hard-to-fill health care professions. CACI conducted a 60-day study at the North Florida and South Georgia Veterans Health System, with the goal of increasing the number of qualified applicants coming into the system as well as reducing the administrative time between application receipt and job offer.

The marketing campaign generated 10,261 inquiries into new nursing positions, with 115 of those resulting in applications, said Jim Bender, communications services manager for CACI. The study also found that VA's hiring times can be reduced from 72 days to 25 days, largely by automation to eliminate delays in paper-based mail and processing, he said.

Still, witnesses noted that funding is critical to the VA's recruitment and retention needs and urged lawmakers to provide the financial support and direction necessary to address short- and long-term health care needs. Witnesses also recommended that the committee provide oversight to ensure sufficient staffing levels and regulate the VA's use of mandatory overtime.

"While we applaud what VA is trying to do in improving its nursing programs, these competitive strategies are yet to be fully developed or deployed," Ilem said. "Congress must provide sufficient funding through regular appropriations that are provided on time, to support programs to recruit and retain."