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The VA’s proposal to a special commission on restructuring its facilities to meet what it calls future needs says that to staff those facilities the department also will need new and expanded recruitment, retention and pay authorities “given the competitive health care market.”

It says that while the nation overall faces shortages of primary care physicians, specialty physicians, psychiatrists, nurses and other medical specialists, the problem is especially severe at the VA. The department “faces challenges due to lower salaries than commercial competitors in some markets” and further operates many facilities on more rural areas where recruitment and retention of providers, especially specialists, is difficult, it says.


Other important trends, it said, include increased usage of virtual care and a shift from inpatient to outpatient settings that “will require continued training and competency development.”

Among the recommendations are: new incentive and bonus authorities for mission critical positions; broader authorities to waive pay caps; expanding coverage of the specialty education loan repayment program; authority to remove locality pay limits for remote employees; raising the pay cap for pharmacists; raising pay rates for specialized and critical health care occupations and police; expanding coverage for nurse executive special pay; and simplifying the process to recruit non-citizens for critical health care occupations.

Meanwhile, the recently enacted continuing budget measure for the current fiscal year contains provisions that had made some progress as a separate bill, raising the pay caps for certain VA medical personnel from the current Level IV of the Executive Schedule (now $176,300). It raises the cap for advanced practice registered nurses and physician assistants to Leven I (now $226,300) and the cap for other registered nurses to Level II (now $203,700).

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