The Veterans Affairs Department is only one-tenth of the way toward meeting VA Secretary Robert McDonald's goal of hiring 28,000 new clinical professionals.
The Veterans Access, Choice and Accountability Act enacted last year delivered a $5 billion cash budget infusion to fund the hiring spree.
Several factors are slowing the progress, according to associations testifying on behalf of VA physicians, nurses and other clinicians before a House subcommittee Friday. A significant one, they said, is that the hiring process is too slow and bureaucratic.
The Veterans Health Administration has a clinical workforce of about 200,000—which includes 23,000 employed physicians—working at its 144 hospitals and 749 clinics.
McDonald announced the goal of hiring 28,000 new clinicians in November as the department responded to a scandal involving excessively long waits for veterans to get services. The VA is seeking to hire 10,682 clinicians by Sept. 30, 2016, using $2.2 billion in Choice Act funding. The 2,600 new recruits hired so far with money from the legislation represent 25% of that total.
It can take two to six months before a decision is made on hiring a VA nurse, Joan Clifford, immediate past president of the Nurses Organization of Veterans Affairs, an association representing VA nurses, testified Friday before the House Veterans' Affairs Committee's Health Subcommittee.
It isn't unusual for top candidates to take another job from outside the VA while the agency remains mired in its bureaucratic process, Clifford said.
Clifford added that the VA's use of nurse practitioners is hampered by state laws that grant them varying degrees of clinical authority. She advocated for the passage of H.R. 1247, the Improving Veterans Access to Quality Care Act, which would supersede state laws and create uniform scope of practice regulations for nurse practitioners, nurse midwives and certified registered nurse anesthetists.
Rep. Mike Coffman (R-Colo.), however, said officials at the state level were better qualified to make scope-of-practice determinations. Clifford replied that she works for the VA in Boston where they see veterans from Maine and New Hampshire. She noted that assessing the authority nurse practitioners have under different state scope-of-practice laws complicates staffing decisions.
Dr. Samuel Spagnolo, president of the National Association of Veterans Affairs Physicians and Dentists, said new hires don't stay very long because professionalism has eroded, in part because too few administrators have clinical backgrounds.
“They come to work with great enthusiasm,” he said, but six months later, they are tired and frustrated. “So, they leave.”
Part of the problem, Spagnolo said, is that VA doctors are also required to do multiple clerical tasks, escort patients to and from the exam room, and help them get undressed and dressed—all while being ordered to see more patients.
But, despite the need for more clinicians, the VA is not pursuing more physician assistants, instead focusing its hiring drive on physicians and nurses.
Rubina DaSilva, president of the Veterans Affairs Physician Assistant Association, said the VA is the largest employer of physician assistants with 2,020 on staff. She added that 32% of that number are veterans—herself included.
However, the VA has only 83 open physician assistant positions, DaSilva said, and those jobs are not being advertised and there are no plans to recruit more physician assistant using the Veterans Choice Act funds.