The VA has the most difficulty filling jobs in “critical need” occupations including medical officer, nurse, psychologist, physician and medical technologist, an IG report has said.

The VA has become something of a poster child for the government’s difficulties in recruiting and retaining employees in high-demand occupations, with more than 40,000 vacancies at any one time, the large majority in the Veterans Health Administration, its largest branch. The report said the agency suffers from “the relatively long onboarding process and challenges in finding suitable candidates” and needs to do better in predicting future staff needs and losses and in hiring to prepare for them.

The report said that while the department did increase the number of employees in four of those five occupations in 2016, “most of the gains in staffing replaced existing losses rather than providing additional capacity to deliver health care.”

Of those leaving from those occupations, up to 60 percent were what the report termed “regrettable” losses–those who resign or transfer to another agency–while up to 45 retired and the rest left for other reasons. “Regrettable losses are staff that potentially could have stayed on at VHA and represent a missed opportunity for VHA to retain staff,” it said.

It noted the VA recently completed a study of such losses including a review of “turnover intentions, exhaustion, and burnout indicators” but concluded that more study is needed before it could translate those findings into action.