President Donald Trump's recent executive order to claw back federal workers' time from union duties will shake up medical staff operations at Veterans' Affairs health centers as the VA is poised to roll out the expanded VA Choice program.
The White House executive order announcement specifically called out 470 VA employees as targets — including 74 nurses —who spent 100% of their work time on union business while on the department's payroll. Supporters of the president's move say this will force VA clinicians to focus on taking care of patients instead of union duties and stem the bleed-out of VA money for high salaries of health staff who aren't treating patients.
The May 25 order cuts the hours unionized federal workers can spend on union business to 25% of their work time and bolsters government agencies' ability to fire federal workers for poor performance. Unsurprisingly, it riled unions and their advocates. The largest federal workers union, American Federation of Government Employees (AFGE), sued Wednesday to block the order from taking effect, arguing that it will drive medical staff out of the VA health clinics and accelerate the shift of veterans to private care as the agency implements VA Choice reforms.
Trump's move takes aim at what is known as "official time," with curbs that some GOP legislators on the House veterans affairs committee have been agitating for over the past year. Since 1978, federal workers have been able to collect agency pay for the hours they spend on union business including collective bargaining and filing grievances. Congress authorized federal compensation for official time as part of the Civil Service Reform Act.
Veterans service organizations are staying quiet about the executive order, but some Senate aides are privately sounding notes of caution.
One Senate staffer said it's up to the VA to soften potential harm for VA clinicians during the order's implementation. The policy could make it more difficult for providers in states where a single union member represents all the surrounding VA medical staff and may not be able to handle all the grievances filed. The order also bars staff from using office space within VA centers to do union work.
The order isn't a new idea. Rep. Jodey Arrington (R-Texas) sponsored a bill that would essentially codify into law a stronger version of the official time curbs included in Trump's executive order so they hold past the current administration.
Arrington's bill, already passed out of the House VA committee, would block medical clinicians such as nurses, physicians and anyone making more than $100,000 per year from using official time at all unless they receive a waiver from the VA secretary. All other employees could only spend 25% of their time on union work, similar to Trump's order. The VA would have to start tracking employees' use of official time as well. The upper chamber's companion bill by Sen. Ted Cruz (R-Texas) doesn't allow for a waiver.
It will be difficult for the Senate's razor-thin Republican majority to secure the 60 votes necessary for passage. For now, all eyes are focused on how the VA implements the order.
The limit of official time for VA medical staff could be significant for some medical centers, according to data on VA employees from fiscal years 2014, 2015 and 2017 compiled by the Government Accountability Office and obtained by Modern Healthcare.
On a grand scale, the numbers can look diminutive. The VA health system has about 80,000 clinicians nationwide, about 60,000 of which are nurses. Official time accounts for about $32.5 million in salaries as of fiscal 2017, according to data from the Government Accountability Office. This was up from about $22 million in fiscal 2016.
But in a few cases a single VA medical facility — Tampa, Fla. and Milwaukee, Wisc. — had more than 20 nurses at least working part-time on union business. The money diverted to official time was also significant for individual VA centers. Boston's VA health system paid three nurses working 100% official time salaries ranging from $115,000 to $138,000.
Nursing staff — registered nurses, practical nurses, staff nurses and nursing assistants — accounted for majority of the medical employees working on official time. Salaries of the registered nurses frequently range above $100,000 per year and were as high as $142,000 in 2017. The salary of one physician who reportedly spent 100% of her time on union work in fiscal 2014 and 2015 was more than $212,000.
The GAO data does not break down how many hours per day VA employees who didn't work 100% official time spent on union business versus VA business.
Although nurses make up the majority of medical staff working official time, the GAO data shows that physicians, psychologists and dentists, as well as pharmacists, addiction therapists, caregivers and technicians, have been working full-time on union business.
In total, GOP House VA committee staff project Arrington's bill would limit official time for almost 840 VA employees, more than 481 of which were working 100% on union business. The number of staff working on official time grew by nearly 90 from fiscal 2016 to 2017.
AFGE lambasted the move as an attack by the Trump administration on the civil service and a drive toward what its officials call the privatization of the VA healthcare system. The union also opposed the recently passed VA Mission Act, which consolidated all the community care programs in the VA under VA Choice and expanded eligibility for veterans who want to seek care from private physicians or hospitals.
"This will create many opportunities for VA to privatize care," said Marilyn Park, AFGE's lobbyist for VA issues.
Park worries that the order, combined with the VA Accountability and Whistleblower Protection Act signed into law last year, will drive medical staff away and make the VA health centers less competitive with private providers as the expanded VA Choice program rolls out. Reporting requirements that make complaints against a clinician public can be career-destroying, she said.
"This is the latest but not the first attack on licensed medical professionals," Park said. "You can risk destroying their careers as they can be accused of things they get reported for. It has direct effect of access, safety and quality of care."