Turnover of employees at the VA is especially high in several health care-related occupations where the department has the greatest needs, and many of those who leave do so because of dissatisfaction with the workplace, GAO has said. The report examined VA’s roughly 200,000 positions in 45 clinical occupations, finding that annual turnover has increased by about a percentage point in the last five years to above 8 percent both overall and in five occupations where the department has the greatest shortages, including physicians and registered nurses. Of those who left, 36 percent retired and the rest resigned or left for other reasons, such as the end of a temporary appointment. In examining data from exit surveys the VA conducts, GAO found that 28 percent of those who left the five top shortage occupations cited advancement issues and 21 percent cited dissatisfaction with the work including concerns about management and obstacles to getting their work done. Also, 31 percent said they were dissatisfied with senior management; only 30 percent said their supervisor tried to change their mind about leaving; and half said that benefits such as alternative work schedules or student loan reimbursements would have encouraged them to stay.