VA bill signed into law, now doc-recruitment challenge looms

(Story updated at 5:05 p.m. ET on August 8.)

President Barack Obama has signed a bill that not only gives the Veterans Affairs Department billions more to contract out care for vets but also roughly $5 billion to hire more medical personnel. However, experts caution that the VA will need to do a superior marketing job to lure doctors away from the private sector. The process could prove challenging, they say.

The lion's share of the $16.3 billion called for in the bill Obama signed is for the VA to use in paying private providers to treat vets who can't get an appointment in 30 days at VA hospitals or clinics. Also covered are veterans who live more than 40 miles from a VA facility.

Approximately $5 billion is set aside for hiring more VA doctors, nurses and other medical staff, with the remaining $1.3 billion allocated to open 27 new VA clinics across the country.

The VA has said it would need to hire about 10,000 additional clinical staff, including about 1,500 physicians, to turn its current waitlist woes around.

Hiring new doctors can happen quickly because it is normally done at the facility level, said Dr. Maryann Hooker, a neurologist at Wilmington (Del.) VA Medical Center and a local president for an American Federation of Government Employees chapter in Delaware. But “the question is whether the people exist,” Hooker said.

Those following the medical employment market say that, unlike in other countries where reports have surfaced of doctors struggling to find work, there's no doctor unemployment problem in the U.S. So, with a limited pool of potential candidates, the VA will need to market to its strengths, namely flexibility and the ability to help new hires pay down their debt loads.

Private hospitals tend to have clinicians sign noncompete clauses, which can make it hard if a doctor wants to move on. That's not the case within the VA, said Dr. Jane Orient, executive director of Association of American Physicians and Surgeons.

The VA also has a nearly unrivaled medical school loan repayment program for providers that private industry doesn't compete with, Hooker said. Hours tend to be more manageable because most of the procedures that take place at VA facilities are outpatient-related.

But first and foremost the VA needs to be willing to pay up, especially for specialists, according to Dr. Atul Grover, chief public policy officer at the Association of American Medical Colleges.

VA salary ranges generally don't match what doctors can make in the private sector. A doctor performing invasive cardiac surgery at the VA can expect to make $98,967 to $385,000 annually, for example, according to a January 2014 Office of Human Resources Management report. In the private sector, the salary range is $421,000 to $556,632, according to Modern Healthcare's 21st annual Physician Compensation Survey.

In most instances, the amount of the money the VA can pay to specialty providers is capped at certain levels. But administrative procedures exist that allow facilities to override those caps, Grover said. The process to do so can be burdensome, he noted, but it may be one the VA needs to undertake to attract new physician talent.

The VA mission to serve those who defended the country could prove another recruitment tool, as can its nearly unrivaled medical school loan repayment program for providers, Hooker said.

But recruitment isn't the only staffing issue the VA faces, retention is an ongoing issue. On average, 28.8% of all employees who were newly hired by the Veterans Health Administration between fiscal 2005 and fiscal 2007 quit within the first five years of employment, according to a 2014 VA report. Of those losses, nearly half occurred within the first year, and 71.9% occurred within the first two years.

“One of the problems is that the VA sometimes does a bait and switch, where they promise you one salary, you take the job, and then they'll come back and say the regional board denied it so we're actually going to pay you less,” Hooker said. “Sometimes they'll even say you actually owe the government money.”

Another impediment to retention could be a VA tendency to spread doctors too thinly in a given region, leading to burnout and departures, said Marilyn Park, legislative representative at the American Federation of Government Employees.

Follow Virgil Dickson on Twitter: @MHvdickson



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