Federal Manager's Daily Report

Aurora, CO- July 2019: Patients being picked up and dropped off at the new and very busy Rocky Mountain Regional VA Medical Center, part of the Veterans Health Administration that carries out the VA's healthcare program.

The VA’s inability to offer salaries that are competitive with the private sector’s for certain occupations and a lack of qualified applicants remain the major reasons for understaffing in its medical occupations, according to an IG report.

In addition it said that for top management positions, laws designed to hold managers more accountable “go too far without providing recourse” for them to defend themselves against allegations.

The report closely follows a recent House hearing where witnesses from the GAO and elsewhere described burnout and high attrition as among the effects of persistent and widespread vacancies.

An audit of medical facilities for the 2018 calendar year found that 96 percent reported a “severe” shortage in at least one occupation and 39 percent said the same of 20 or more occupations. Medical officer and nursing occupations were the most commonly named—within the former, psychiatry was the most common, named by 61 percent of facilities—while in non-clinical occupations HR management was most commonly cited, by 51 percent.

The numbers of reported severe shortages across facilities declined by 12 percent from the prior year, but “the reasons for those shortages did not change,” it said. Many facilities said the problem with non-competitive salaries persists despite use of incentives such as student loan repayments—which they said are hampered by under-funding and difficult approval processes.

The salary issue “was particularly prominent in areas with high costs of living and strong private sector competition,” it added.

The report also found that non-competitive salaries and a lengthy hiring process were the main reasons for high vacancies among top positions at medical facilities. It added that “heightened public scrutiny and implementation of the VA Accountability and Whistleblower Protection Act have demotivated applicants and created barriers in hiring medical center directors.”

VA officials said that that law and other policy changes enacted in response to the VA scandals of recent years “made medical center director positions unappealing, leaving current directors feeling vulnerable and dis-incentivizing applicants.”