[House Hearing, 114 Congress]
[From the U.S. Government Publishing Office]
LEGISLATIVE HEARING ON DRAFT LEGISLATION TO IMPROVE THE AUTHORITY OF
THE SECRETARY OF VETERANS AFFAIRS TO HIRE AND RETAIN PHYSICIANS AND
OTHER EMPLOYEES OF THE DEPARTMENT OF VETERANS AFFAIRS
=======================================================================
JOINT HEARING
before the
SUBCOMMITTEE ON HEALTH
joint with
SUBCOMMITTEE ON ECONOMIC OPPORTUNITY
of the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED FOURTEENTH CONGRESS
SECOND SESSION
__________
WEDNESDAY, MARCH 16, 2016
__________
Serial No. 114-60
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.fdsys.gov
______
U.S. GOVERNMENT PUBLISHING OFFICE
25-123 WASHINGTON : 2017
-----------------------------------------------------------------------
For sale by the Superintendent of Documents, U.S. Government Publishing
Office Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800;
DC area (202) 512-1800 Fax: (202) 512-2104 Mail: Stop IDCC,
Washington, DC 20402-0001
COMMITTEE ON VETERANS' AFFAIRS
JEFF MILLER, Florida, Chairman
DOUG LAMBORN, Colorado CORRINE BROWN, Florida, Ranking
GUS M. BILIRAKIS, Florida, Vice- Minority Member
Chairman MARK TAKANO, California
DAVID P. ROE, Tennessee JULIA BROWNLEY, California
DAN BENISHEK, Michigan DINA TITUS, Nevada
TIM HUELSKAMP, Kansas RAUL RUIZ, California
MIKE COFFMAN, Colorado ANN M. KUSTER, New Hampshire
BRAD R. WENSTRUP, Ohio BETO O'ROURKE, Texas
JACKIE WALORSKI, Indiana KATHLEEN RICE, New York
RALPH ABRAHAM, Louisiana TIMOTHY J. WALZ, Minnesota
LEE ZELDIN, New York JERRY McNERNEY, California
RYAN COSTELLO, Pennsylvania
AMATA COLEMAN RADEWAGEN, American
Samoa
MIKE BOST, Illinois
Jon Towers, Staff Director
Don Phillips, Democratic Staff Director
SUBCOMMITTEE ON HEALTH
DAN BENISHEK, Michigan, Chairman
GUS M. BILIRAKIS, Florida JULIA BROWNLEY, California,
DAVID P. ROE, Tennessee Ranking Member
TIM HUELSKAMP, Kansas MARK TAKANO, California
MIKE COFFMAN, Colorado RAUL RUIZ, California
BRAD R. WENSTRUP, Ohio ANN M. KUSTER, New Hampshire
RALPH ABRAHAM, Louisiana BETO O'ROURKE, Texas
SUBCOMMITTEE ON ECONOMIC OPPORTUNITY
BRAD WENSTRUP, Ohio, Chairman
LEE ZELDIN, New York MARK TAKANO, California, Ranking
AMATA RADEWAGEN, American Samoa Member
RYAN COSTELLO, Pennsylvania DINA TITUS, Nevada
MIKE BOST, Illinois KATHLEEN RICE, New York
JERRY McNERNEY, California
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
----------
Wednesday, March 16, 2016
Page
Legislative Hearing On Draft Legislation To Improve The Authority
Of The Secretary Of Veterans Affairs To Hire And Retain
Physicians And Other Employees Of The Department Of Veterans
Affairs........................................................ 1
OPENING STATEMENTS
Honorable Dan Benishek, Chairman, Subcommittee on Health......... 1
Honorable Brad R. Wenstrup, Chairman, Subcommittee on Economic
Opportunity.................................................... 2
Honorable Julia Brownley, Ranking Member, Subcommittee on Health. 3
Honorable Mark Takano, Ranking Member, Subcommittee on Economic
Opportunity.................................................... 3
WITNESSES
Max Stier, President and Chief Executive Officer, Partnership for
Public Service................................................. 4
Prepared Statement........................................... 28
Roscoe G. Butler, Deputy Director of Health Care, National
Veterans Affairs and Rehabilitation Division, The American
Legion......................................................... 6
Prepared Statement........................................... 36
Carlos Fuentes, Senior Legislative Associate, Veterans of Foreign
Wars of the United States...................................... 8
Prepared Statement........................................... 42
Carolyn Clancy, M.D., Deputy Under Secretary for Health for
Organizational Excellence, Veterans Health Administration, U.S.
Department of Veterans Affairs................................. 9
Prepared Statement........................................... 44
Accompanied by:
Elias Hernandez, Chief Office, Workforce Management and
Consulting, Veterans Health Administration, U.S.
Department of Veterans Affairs
STATEMENTS FOR THE RECORD
American Federation of Government Employees...................... 47
National Association of VA Physicians and Dentists............... 49
Veterans Affairs Physician Assistant Association................. 52
Nurses Organization of Veterans Affairs.......................... 57
Merritt Hawkins.................................................. 58
Paralyzed Veterans of America.................................... 63
Disabled American Veterans....................................... 65
Iraq and Afghanistan Veterans of America......................... 68
Reserve Officers Association..................................... 69
American Podiatric Medical Association........................... 74
LEGISLATIVE HEARING ON DRAFT LEGISLATION TO IMPROVE THE AUTHORITY OF
THE SECRETARY OF VETERANS AFFAIRS TO HIRE AND RETAIN PHYSICIANS AND
OTHER EMPLOYEES OF THE DEPARTMENT OF VETERANS AFFAIRS
----------
Wednesday, March 16, 2016
U.S. House of Representatives,
Committee on Veterans' Affairs,
Subcommittee on Health,
Washington, D.C.
The Subcommittees met, pursuant to notice, at 2:04 p.m., in
Room 334, Cannon House Office Building, Hon. Dan Benishek
[Chairman of the Committee] presiding.
Present: Representatives Benishek, Wenstrup, Bilirakis,
Zeldin, Roe, Costello, Huelskamp, Coffman, Bost, Abraham,
Brownley, Takano, Ruiz, Titus, Kuster, O'Rourke, McNerney.
OPENING STATEMENT CHAIRMAN DAN BENISHEK
Mr. Benishek. Good afternoon. The Subcommittee will come to
order. Welcome to today's joint Subcommittee on Health and
Subcommittee on Economic Opportunity legislative hearing on
draft legislation to improve the authority of the secretary of
veterans affairs to hire and retaken physicians and other
employees of the Department of Veterans Affairs.
Thank you for all joining us here today. As I said before,
providing a top-notch health care and benefits that our
Nation's veterans deserve is impossible without an equally top-
notch workforce. VA's future depends on VA's ability to
officially recruit and retain highly qualified and highly
motivated professionals at all levels. Unfortunately, hiring
remains a serious challenge across the department, a challenge
that will only grow as VA's current staff gets older and
increasingly eligible for retirement and the private sector and
health care and benefits landscape gets increasingly
competitive.
The draft bill that we will be discussing this afternoon
would simplify and shorten the VA's hiring process, strengthen
VA's ability to bring the very best employees onboard, most
importantly, ensure a robust workforce is available to serve
our veterans for years to come, contains a number of VA
legislative proposals that would improve the department's
ability to recruit and fairly compensate key leaders and grant
schedule flexibility for critical medical personnel.
It also contains other important provisions that would,
among other things, increase training for VA human resources
employees, create a centralized recruiting database to assist
in identifying interested applicants for vacant positions,
eliminate compensation panels that would lengthen the hiring
process for incoming physicians, and unnecessarily take
existing providers away from direct patient care, and allow
certain aspiring VA leaders to participate in an executive
management fellowship program to gain valuable private sector
experience that could be used to improve the VA's performance.
I am grateful to be here today with Dr. Wenstrup, the
Chairman of the Subcommittee on Economic Opportunity, to be
working with him and other Members of our two Subcommittees on
this very important issue. I thank you all for being here and
now yield to Dr. Wenstrup for any opening statement he may
have.
OPENING STATEMENT OF BRAD R. WENSTRUP
Mr. Wenstrup. Well, thank you, Dr. Benishek and good
afternoon. And thank you to everyone with us here today.
I look forward to our discussion today, as we have spent
several months working on this proposal and listening to key
stakeholders and holding a joint roundtable last December to
begin the discussion on the language and to ensure we are doing
this right.
I know this Committee has focused heavily on accountability
and while I think it is of the utmost importance, I think it is
important that we also focus on the hiring and retention of
high-quality employees within the department so that our
veterans receive the best services possible.
Last year, I made a commitment to several of our colleagues
to also focus on improving the hiring process at VA, and I am
excited about the work that has been done to package some
common sense provisions together. I would note that this is
still a draft bill. Let me just say that again, this is still a
draft bill, and I look forward to the feedback that we will
receive today so that we can make necessary changes to make the
bill as close to perfect as possible.
I do want to keep my comments short so we can get to our
witnesses and their testimonies and questions, but before I
yield back to Dr. Benishek, I do want to make a couple of
comments about the testimony and views VA provided to us today,
which I have to say are somewhat minimal at best, at this time.
I am disappointed the department was unable to provide
views or comment on a majority of the provisions that are in
this bill. We want your opinion. And I understand that we only
gave VA a couple weeks' notice about this hearing, and I know
the OMB bureaucratic process is not known to be speedy, but
this is not the first time the department has seen this bill or
a version of this bill, as a draft was provided to the VA last
November in preparation for our roundtable in December. So, I
do hope to hear more from VA on these issues because we need
your input.
And with that, I yield back.
Mr. Benishek. Thank you, Dr. Wenstrup.
I will now yield to Ms. Brownley, Ranking Member of the
Subcommittee on Health, for any opening statement she may have.
OPENING STATEMENT OF JULIA BROWNLEY, RANKING MEMBER
Ms. Brownley. Thank you, Mr. Chairman.
And I want to thank you and Chairman Wenstrup for holding
this hearing today. I would also like to thank the witnesses
here today who have joined us to provide their expert views on
the discussion draft we have before us.
This draft legislation is another step forward in revising
hiring practices at the Department of Veterans Affairs. As with
any legislation, as Mr. Wenstrup said, we should make every
attempt to scrutinize the provisions and understand the
unintended consequences that may arise from good intentions
contained in the bill.
This draft includes my common sense provisions including
setting competitive pay levels for medical center and network
directors and ensuring that emergency room doctors and staff
have the scheduling flexibility needed to provide quality
services when they are needed. I support the effort to
institute competitive pay for VA medical center directors. The
West Los Angeles VA Medical Center, which serves my veterans in
my county, in Ventura County, recently hired its first
permanent director in more than two years. I believe that
making medical center directors' salaries more comparable with
market rates would go a long way towards attracting and keeping
the most-qualified candidates and filling the leadership vacuum
that exists in many of the veteran-integrated service networks.
I appreciate the concerns many of the witnesses have
brought to your attention in their submitted testimony. I also
have some concerns about the draft bill. In particular, I hope
that we can work to come to an agreement, particularly, on
Section 9 which modifies the existing veterans hiring
preference. I would like to understand the pros and cons of
this section better so as we move forward, we are not putting
the VA at a disadvantage when competing for executive talent
with other agencies in the private sector.
I look forward to hearing from our guests today on their
thoughts on improving the system, and, again, I thank both the
Chairmans for calling this hearing.
Mr. Benishek. Thank you very much.
I will now yield to Mr. Takano, the Ranking Member of the
Subcommittee on Economic Opportunity, for any opening statement
that he may have. Mr. Takano?
OPENING STATEMENT OF MARK TAKANO
Mr. Takano. Thank you to both Chairmen for holding this
hearing. Thank you, Chairman Benishek.
Over the past three years, the Veterans' Affairs Committee
has worked hard to reform the VA, particularly, as it involves
the discovery of health care by the Veterans Health
Administration. During this time, we have focused much of our
discussion and our disagreements on how easy we should make it
for the VA to fire employees. We have also focused on the
important role of VA whistleblowers and how we can best protect
them from retaliation.
Today, we have the opportunity to discuss another important
element of employment at the VA, a draft bill that seeks to
improve VA's ability to attract, hire, and retain the best
employees and providers. The draft legislation is a good
starting point. I am encouraged by common sense solutions such
as granting VA providers to work more or less 80 hours per bi-
weekly work period. I want to thank my colleague Dr. Ruiz for
introducing this idea. I just thanked you, Dr. Ruiz.
I also support--you had a great idea with this 80 hours per
bi-weekly work period--I also strongly support incentivizing
more student veterans to pursue graduate medical education
programs in mental health fields, and hope we can do more to
encourage graduates to work at the VA.
I want to ensure we do not dilute Veterans' Preference or
cut out valuable H.R. procedures for the sake of efficiency,
but today I plan to listen to the hopefully robust discussion
on these sensitive topics.
So, again, I thank the Chairmen for bringing this bill to
us to discuss and improve before it is introduced.
Thank you also to the VSOs, the VA, and other
representatives who have come to join in this discussion. I
look forward to hearing how we can help VA improve its hiring
policies.
Thank you, and I yield back, Mr. Chairman.
Mr. Benishek. Thank you, Mr. Takano.
Joining us on our first and only panel is Max Stier, the
President and Chief Executive Officer of the Partnership for
Public Service; Mr. Roscoe Butler, the Deputy Director of
Health Care for the National Veterans Affairs and
Rehabilitation Division of The American Legion; Carlos Fuentes,
the Senior Legislative Associate for the Veterans of Foreign
Wars of the United States; and Dr. Carolyn Clancy, the Deputy
Under Secretary for Health for Organizational Excellence for
the Veterans Health Administration of the U.S. Department of
Veterans Affairs; accompanied by Elias Hernandez, the Chief
Officer for Workforce Management and Consulting.
Thank you all for being here this afternoon. Mr. Stier, we
will begin with you. Please proceed with your testimony. You
have five minutes.
STATEMENT OF MAX STIER
Mr. Stier. Thank you very much for holding this hearing and
for the work you have done here.
The problems you are addressing are problems that face the
entire government, but I would say that you are the best
Committee on trying to address them, so kudos to you. Also, I
wanted to thank you for the great work you have done with your
own staff, because they have been exceptional to work with, and
that is critical for you, for the legislation, and bluntly, for
the country.
This is an incredibly important issue. Three facts that
stand out to--one of them is the limited demographic diversity
that exists at the VA. In 2015, it was only two-thirds of 1
percent of VA's workforce was under the age of 25. So, think
about that, two-thirds of 1 percent, and only 5.35 percent were
under the age of 30. So that is one devastating fact. Second,
only around a half of 1 percent of new hires since 2012 have
been under the Pathways Program, which is the primary way that
agencies are supposed to be hiring either student interns or
recent college graduates. The third devastating fact is a
recent study that showed that ratings of government agencies on
the statement, ``My agency is unable to recruit the best
employees,'' should VA and its components were at or near the
top. That is the backdrop that you are seeing here. It is so
important.
I have three areas, where I think you are really doing
important work on this bill. One involves the talent itself. A
couple of things that are powerful and you have heard in some
of the opening statements that you made, supporting market pay
for your medical directors, is very important. You are not
going to get the talent that you need in that area unless you
do that.
We would argue at the Partnership that the pay system, more
generally, in the Federal workforce is broken. It was built in
1949. It was about internal equity when you had a clerical
workforce. The whole thing should be based on market
compensation in a world in which that is the way we have to
compete for talent. That may mean some folks are paid more,
some folks less, but that is the right way to do it. But you
are going in the right direction with that.
Secondly, you improve the Pathways Program, which brings
student interns and new college graduates in--in very important
ways. That is going to be very important to do. One thing I
would add is you have to encourage the VA to actually use the
authority--and I will come back to this--the legislation is a
starter pistol; it is not at the end of the day. You have given
them tools, but I hope you will do oversight to make sure that
they use that authority you are providing them.
On data, you can't manage what you don't measure. I think
in this bill you are requiring a number of data points to be
collected around hiring effectiveness. It will give you real
insight into whether VA is doing its job well, and that is
critically important.
And then on leadership accountability, the idea of holding
the political appointees to the same standards as career
leaders is absolutely essential. Across government, you have
political appointees, 4,000 of them. Few are in VA, but you
still don't have the normal line of sight for the career people
that stacks up their performance plans against the objectives
of the organization which starts with the leadership. You need
clarity about what they are trying to achieve, how they are
being held accountable, and then it cascades into the rest of
the organization. That is really important.
Three things that I think you could do better with this
bill. One, for the passport idea, it seems to me that the re-
employment of former employees is extremely important. Right
now, the authority allows for only a one grade increase. I
would suggest that that is an unnecessary restriction. If
someone spends time in the VA or some other agency, which is
the other piece of this, they ought to be able to come back if
they have developed skills that they can then bring back to the
organization more than just one grade up.
Secondly, I am troubled by the expansion of Veterans'
Preference to the SES. Veterans' Preference is incredibly
important. However, in the context of what the VA is dealing
with right now with its SES, it is a troubled place. They can't
recruit people right now. This is not the time to make it more
difficult. There are other things that could be done that I
think would be more powerful and less concerning.
And, third, on the executive management fellowship program,
the cap needs to be raised from 30. Right now you have over
7,000, by our account, eligible participants; 30 just doesn't
make any real difference. The question has arisen, well, if you
got a challenge for getting talent in, do you really want to
send your people out? The answer is yes. You want to grow and
develop your people. You will retain your talent better if you
do it, and, bluntly, we think it should be a two-way program,
so you can bring folks from the private sector in and that will
also help you get great talent and refresh the workforce, which
is so important.
The so last issue is: this is not just about the
legislation, as I mentioned; it is about the enablers--your
oversight is going to be absolutely essential to ensure that
the VA is doing the work that it needs to do and these
provisions are funded.
Happy to answers questions. That is as fast as I can talk.
Thank you.
Mr. Benishek. Good job, Mr. Stier, in talking fast.
Mr. Stier. I should say I am Stier and it is pronounced--
Mr. Benishek. Stier.
Mr. Stier [continued]. --you know, if you look at it, it
looks like Stier. Anyone who says Stier, ordinarily, you are
like, you don't know how to pronounce words, but parents decide
pronunciation, so what can I do? So, it is Stier.
Mr. Benishek. Yeah. No, no, no, that is fine. Great.
Perfect. Thank you very much.
Mr. Stier. Thank you.
[The prepared statement of Max Stier appears in the
Appendix]
Mr. Benishek. Mr. Butler, I will recognize you now for five
minutes.
STATEMENT OF ROSCOE G. BUTLER
Mr. Butler. Thank you. For nearly two decades, The American
Legion has been expressing concerns about staffing shortages
for physicians and medical specialists in the VA. We've seen
this because we have been there as part of our ongoing System
Worth Saving task force visits that evaluate VA health care in
every VISN, from rural to urban, and we have tried to make sure
VA is fully staffed to provide high-quality, efficient care to
meet the needs of local veterans.
Chairman Benishek, Wenstrup, Ranking Member Brownley,
Takano, and distinguished Members of the Subcommittee on Health
and Economic Opportunity, on behalf of National Commander Dale
Barnett and The American Legion, and the country's largest
patriotic wartime service organization for veterans, comprising
over two million members and serving every man and woman who
have served, and worn the uniform for this country, we thank
you for the opportunity to testify regarding the draft
legislation regarding improving the authority for the Secretary
of Veterans Affairs to hire and retain physicians and other
employees of the department.
As reflected in our written testimony and through the eyes
of The American Legion's System Worth Saving Program, which I
frequently participate in, we have tracked and reported
staffing shortages at every VA health care system across the
country. We see the staffing shortages throughout the VA, and
we feel it is getting worse, and not improving. The American
Legion's System Worth Saving 2014 executive summary found that
several VA medical centers continue to struggle to fill
critical leadership positions across multiple departments.
These gaps have caused communication breakdowns between
medical center leadership and staff that works within these
departments; therefore, for the reason outlined in our written
testimony, The American Legion fully supports Sections 2, 3, 4,
5, 8, 9, 11, 14, and 15 of the draft legislation to improve
hiring practices at the Department of Veterans Affairs.
However, Section 7 gives us great concerns. As it currently
stands, VA has over half of their critical leadership positions
either unfilled or filled by individuals on an interim basis.
Sending a portion of the workforce out of VA every year would
only exacerbate this situation. If VA can afford to lose those
personnel for even a year, then we believe the VA may not need
those positions to be filled.
The American Legion would rather see the VA fill the
positions and ensure there is a full workforce available to
treat the needs of veterans, therefore, for this reason, The
American Legion opposes Section 7, which would create within
VA, an executive management fellowship program.
There are plenty of other sections of this legislation that
offers improvements to VA health care. Section 3 offers a fix
to a problem The American Legion has long sought a solution to,
adjusting Federal work guidelines to fix the unusual hours
necessary to staff emergency rooms.
Other sections address fixes to how VA determines market
values to stay competitive for health care and hiring, how VA
evaluates which portions are needed, and attempt to further
refine the accountability process for VA employees. Any of
these measures should contribute immeasurably toward improving
VA and these are measures that should move forward with the
passage of this legislation.
Again, on behalf of our national commander, Dale Barnett,
and the millions of dedicated veterans that comprise the
Nation's largest veterans' service organization, we thank you
for having the opportunity to speak today. I would be happy to
answer any of the Committee's questions, and, again, thank you.
Mr. Benishek. Thank you very much, Mr. Butler.
[The prepared statement of Roscoe G. Butler appears in the
Appendix]
Mr. Benishek. Mr. Fuentes, you are now recognized for five
minutes.
STATEMENT OF CARLOS FUENTES
Mr. Fuentes. On behalf of the men and women of the VFW and
our auxiliaries, I would like to thank you for the opportunity
to present our views on ways VA can improve retirement--I'm
sorry--recruitment, retention of high-quality health care
professionals and other employees.
The VFW thanks you for recognizing that VA's ability to
hire and retain high-quality employees is equally as important
as its ability to fire and demote employees who put veterans at
risk. The VFW agrees with many of the ideas included in the
draft legislation being discussed today, however, we would like
to share an idea that we hope the Subcommittees will consider.
During our site visits of VA medical facilities, the VFW
has noticed one constant struggle: hiring and retaining entry-
level clerks who help with answering phones, greeting patients,
scheduling appointments, and other administrative tasks. During
our visits, we often hear from providers and facility
leadership say that the lack of administrative support limits
their ability to deliver health care to veterans. This issue
must be addressed, authorizing VA to quickly fill high-turnover
positions at VA medical facilities.
Similar to VA medical facilities, the VA Canteen Service
relies on entry-level employees to operate and maintain its
services; however, the Canteen Service is exempt from certain
Title V competitive service requirements to ensure high
turnover does not impact its ability to operate retail stores,
cafes, and other quality-of-life programs in VA medical
facilities around the country. The VFW urges Congress to
consider extending these authorities to VHA to quickly fill
high-turnover vacancies.
The VFW supports most sections of the discussion draft
being considered today, which takes a multifaceted approach
towards expanding VA's authorities to hire and retain high-
quality employees.
In the interest of time, I would like to comment on two
sections we believe can be improved. The VFW opposes Section 4,
which would expand VA's Yellow Ribbon Program to require VA to
help veterans cover the costs of advanced degrees in mental
health. The VFW supports efforts to provide additional
assistance for veterans who choose to advance their careers and
assist their fellow veterans by obtaining advanced degrees in
mental health; however, we do not believe that amending the
Yellow Ribbon Program is the best option to do so.
The Yellow Ribbon Program was established to supplement the
Post-9/11 G.I. Bill by authorizing VA to enter into agreements
with educational institutions to cover up to 50 percent of the
gap between the costs of tuition and fees associated with
degree programs and the statutory caps.
The VFW is concerned that this legislation fails to ensure
veterans have enough Post-9/11 G.I. Bill eligibility to
complete their advanced degrees in mental health. For example,
veterans who use their Post-9/11 G.I. Bill to obtain a
bachelor's degree and would like to participate in this
program, are unlikely to have enough eligibility remaining to
complete an advanced degree in mental health. The VFW is a
strong proponent of public-private partnerships, but believes
that the program would be better suited under VA's Health
Professionals Education Assistance Program.
Section 9 would require VA to comply with certain Title V
competitive service requirements when hiring SES employees.
While the VFW supports applying Veterans' Preference when
hiring VA SES employees, we feel that Congress must streamline,
not impede, VA's ability to hire qualified executives. That is
why we recommend that the Subcommittees exempt VA SES
employment process from Title V competitive service
requirements.
To ensure VA hires qualified veteran senior executives,
Congress should require VA to properly consider veterans when
considering SES employees, regardless of which authority or
hiring authority they use.
Mr. Chairman, this concludes my testimony. I would be happy
to answer any questions you may have.
Mr. Benishek. Thank you, Mr. Fuentes.
[The prepared statement of Carlos Fuentes appears in the
Appendix]
Mr. Benishek. Dr. Clancy, you may proceed with your
testimony.
STATEMENT OF CAROLYN CLANCY, M.D.
Dr. Clancy. Good afternoon, Chairman Benishek, Chairman
Wenstrup, Ranking Member Brownley, Ranking Member Takano, and
Members of the Committee. Thank you for inviting us here today
to present our views on the draft bill to improve the authority
of the secretary of veterans affairs to hire and retain
physicians and other employees.
Joining me today is Elias Hernandez, the Chief Officer for
Workforce Management and Consulting; Tia Butler, who is sitting
behind me, the Executive Director of the Corporate Senior
Executive Management Office; and Kimberly McLeod, Associate
Chief Counsel.
First, we want to thank the Subcommittees for including
three of our legislative proposals in the draft legislation.
These will give us the necessary resources to meet the
department's obligation to meet--to provide timely quality
health care and benefits to our veterans. We are happy to
support several sections of the proposed bill, including
Section 2, which matches a proposal put forward last year in
VA's 2017 budget submission.
VA believes that there are primary factors that warrant a
separate compensation system for medical center directors and
VISN or network directors, which are detailed in the written
testimony. VA requests, however, that the section stating that
medical center director and network directors be a qualified
doctor of any kind, be removed from the bill.
It is already difficult to recruit for these positions and
this additional restriction would make it nearly impossible for
recruit in some areas; moreover, running a hospital is an
inherently complex skill set requiring a diverse background,
including skills needed to manage from multimillion-dollar
budget facility and staffing operations and so forth.
Physicians may or may not have these skills and there are other
graduate programs that do give people this kind of training; in
fact, we have a fellowship program for people who graduate from
master's of health administration programs.
Section 3 of the proposed bill would allow VA to arrange
flexible physician and physician assistant work schedules to
allow for the hiring and full implementation of a hospitalist
physician system and to accommodate the unusual work schedule
requirements for emergency medicine physicians--thank you, Dr.
Ruiz--VA supports this increased flexibility for critical
medical personnel.
Hospitalists and emergency medicine physicians specialize
in the care of patients in the hospital, often working
irregular work schedules to accommodate the need for efficient
hospital care. And we believe that increased scheduling
flexibility would align our practices with the private sectors,
which would facilitate the recruitment and retention of
emergency physicians as well as the operation of the
hospitalist physician system at all VA medical centers.
Section 4 of the bill would amend Title 38 to prohibit the
use of transferred entitlement under the public-private
contributions. VA supports legislation that would provide
training and employment opportunities for veterans, however,
the department has some concerns with this section of the bill.
VA is not certain a change in the way VA and institutions of
higher learning share contributions for specific degrees and
programs would be beneficial.
Under its current structure, the Yellow Ribbon Program is a
remarkably successful program with nearly 2,000 participating
institutions. For VA to support this bill, each of the
professions listed that has educational and licensure
requirements would need to have a corresponding provision that
would state that the program meets the educational requirements
defined by VA's qualification standards.
As for the report required in Section 5, we defer to the
Office of Inspector General on how they would process this
report.
VA supports Section 6, which would eliminate the
compensation panel recommendation process. This section is also
similar to another proposal put forward in February 2016 in
VA's 2017 budget submission. The compensation panel process is
time-consuming and adds little value as medical center
directors and other approving officials already have the final
authority to approve the rate of pay. This process also
contributes to a delay in hiring, which is probably our
greatest concern. It would be more cost-effective and efficient
to allow a selecting official and to recommend the appropriate
salary for prospective employees and eliminate this
compensation panel process.
We very much look forward to working with the Committees
and our agency partners to finalize language on these
provisions. The remaining sections will be discussed in a
follow-up views letter that is currently being drafted and we
will forward these remaining views and costs to you
expeditiously.
Thank you, Mr. Chairman for this opportunity to present our
views on this draft bill, and my colleagues and I are happy to
respond to any questions that you or other Members might have.
Mr. Benishek. Thank you, Dr. Clancy. I really appreciate
your answers there.
[The prepared statement of Carolyn Clancy, M.D. appears in
the Appendix]
Mr. Benishek. I yield myself five minutes for questions.
And, frankly, I was kind of excited to have this hearing
because it is a lot of important issues. I think the roundtable
really got us a lot of input and this is basically the next
step.
Dr. Clancy, I agree with you that this compensation panel
doesn't make a lot of sense to me because, a physician who is
about to be hired is going to surely shop around to see what
other people are offering and that doesn't make sense--but what
I would like to know is, what else can we do besides this, to
speed up the process? I have heard that it takes up to a year
to hire somebody, physicians in particular, at the VA, so
besides a central database for finding people looking for work
and this process here, what other processes could we do? And
maybe Mr. Stier would like to comment on that, too.
So, let's start with Mr. Stier, and I will give you an
opportunity, too, Dr. Clancy. Mr. Stier, what else should we be
doing to make this process quicker?
Mr. Stier. Well, part of it, which you already have in the
bill, is that it is going to be really important to have good
information. My bet is that there is a high degree of
variability across the system as to who is hiring fast and who
is not, and what the experience is like for the potential
applicants to the positions.
And so, collecting information about who is actually doing
hiring well and making data available across the whole network
of VA facilities, I think will help you identify the best
practices that ought to be adopted more generally.
What you are doing here, I think is very important, but I
really do believe it is just the starter's pistol and at the
end of the day, ensuring that these authorities are used
effectively, that the execution of the tasks that you are
trying to facilitate happen effectively, is most important.
Mr. Benishek. To be measured as they go.
Mr. Stier. Correct. They need to be measured and they need
to identify, again, where certain components are doing it well
so that they become the model for best practices across the
whole organization.
I am confident that if you explored, you used a year
figure, you would find organizations within the VA system that
are actually doing it really, really well, best-in-class. The
question is, what are they doing and why isn't everyone else
doing it, and how do you get them to do that?
Mr. Benishek. Dr. Clancy, let me ask you in follow-up of
what Mr. Stier was saying, do people who are interviewed for
positions, are they given an opportunity to comment on the
process? Do you collect that data at all?
Dr. Clancy. We collect exit-interview data when people
leave. I am not sure about the front-end.
Mr. Benishek. But when hiring, do you interview the people
that you are hiring to comment on the process--
Dr. Clancy. Mr. Hernandez?
Mr. Benishek [continued]. --perhaps in an anonymous way, so
that they can give comments on the process?
Mr. Hernandez. Yes, Mr. Chairman, we do collect information
in terms of the interview process, however, that information is
obviously not released to anyone, other than the hiring
official.
But what I would like to say is, I fully agree with
everything that has been said here today, and I would like to
share some information regarding, you know, some of the
improvements we have made in the hiring process, in particular,
for the positions of nurses. And this bill that is being
introduced is also going to help us do even better in the
hiring process.
We do track the hiring process in terms of the speed of
hire, and we have a measure in the organization where all the
hiring actions must occur within 60 days. Eighty percent of
those actions must occur within 60 days.
The recent data that we collected, you know, in fiscal year
2015, and so far this year--
Mr. Benishek. I guess I don't understand though, it is 60
days? You are saying the hiring process is 60 days? That is
contrary to most of the information that I have ever heard.
Most of the time, people tell me it takes months.
Mr. Hernandez. Yes, Mr. Chairman, that is what I--you know,
if I may, that is what I am trying to convey, that we still
have issues, and I will tell you what those issues are shortly.
So we collect the data and we measure the hiring process
and the different stages of the process, and right now, we are
about 78 percent of all the hires that have taken place in
fiscal year 2015 have been met within 60 days; however, that
measure only measures from the beginning of the process to a
tentative job offer, okay.
What happens after the tentative job offer is the
information that we are really keying in, as an example, the
physicians, we can give them a tentative job offer based on the
data that we collected within 96 days; however, it takes an
additional 32 days to bring them onboard.
So there are a lot of factors associated with that in terms
of, you know, the scope of practice, them being able to kind of
close their scope of practice in the previous organization
going into the new organization, and also the credentialing
process, which, by the way, VHA has made major improvements to
that area where we are right now averaging about 35 days for
some of those credentialing processes, which is a whole lot
better than what it is in the private sector of 45 days.
The challenges that we have--
Mr. Benishek. I guess that sounds like really great
numbers, but that is just not the way it is from what I have
been talking to people, okay. I talk to people and that is just
not the numbers that you submit here; 60 days and 90 days is
not it.
But I am out of time and I am going to yield to Dr.
Wenstrup.
Mr. Wenstrup. Thank you, Mr. Chairman.
Mr. Butler, the American Legion's written statement
mentioned some of the challenges the VA faces attempting to
recruit and retain medical staff in rural areas, and I know
that is difficult in parts of my district as well.
But do you believe that this bill that we are considering
could improve the recruitment and retention in rural areas? And
if it is not able to, what would you suggest maybe that we add
to the bill to try and improve that?
Mr. Butler. Well, I think there are good components,
excellent components within the bill that will enhance VA's
existing hiring authority and give facility leadership the
ability to hire employees more quickly.
I was out on a recent visit in Reno, Nevada and, in
response to the Chairman's question, what I heard, there are
certain hard-to-fill positions, audiologists, and it is taking
years to fill those positions, not necessarily because--well,
because they don't have the locations and the disciplines, the
teaching facilities, they don't have the source where people
are interested in coming to like Nevada for those positions,
and then they are competing with private industry.
So I think that you have to build a program that is on the
same level that the private industry program is, and it has the
same or similar metrics, so that it is more attractive to
outside providers when they are considering the VA. If they
look at the outside community hospital versus the VA, it is
much easier for them, higher pay and other things that drive
them, that they will choose the community hospital over the VA.
And I think from what we are seeing, that it takes a
special breed of doctor to work for the VA. They really have to
be committed, and have to care, have that mentality of caring
for veterans and not all doctors, I would say, have that same
mentality. Some people's drivers is the money that they would
make, but I think the doctors that really choose to work for
the VA choose it for different reasons other than money.
And so I think that you have to take all of those factors
into consideration and then build a program that is much more
competitive with the private community.
Mr. Wenstrup. Thank you.
Dr. Clancy, on that same vein, are there barriers that
Congress could break down to make it easier in the rural
communities for recruitment and retention?
Dr. Clancy. So I appreciate my colleague's comments very
much from the American Legion. I will say, I think all of U.S.
health care is struggling with how do you get people to come to
rural areas. In fact, I saw something recently, I didn't see
the backup detail, you know, that claimed that physicians with
higher educated specialties were harder to recruit to rural
areas.
If there is one area where our system would have a bit of a
barrier and I am at a loss for how you all could help, although
I would be happy to be surprised, a private sector hospital
could actually be helping for the spouse to get a position,
other opportunities and so forth, and that we are hiring for
that one position, right? So that is about the only thing I can
think that would be helpful.
It is very clear to us that expanding our footprint in
telehealth and other kinds of virtual care is going to be
hugely important to our efforts in rural areas, but happy to
work with you on other ideas.
Mr. Wenstrup. Well, one thought that I have in that vein
is, you know, you are talking about small communities are
having the same problem, same problem that VA is having. I
mean, if both entities are looking for one type of specialist,
there should be ways to start thinking about collaborating--
Dr. Clancy. I think that is a great idea.
Mr. Wenstrup. --to bring a specialty to the area.
With that, I yield back.
Mr. Benishek. Ms. Brownley, you are recognized.
Ms. Brownley. Thank you, Mr. Chairman.
I think just following up a little bit on this line of
questioning, I just had a general question and would appreciate
a short answer, if it is possible. But if we get to the
consolidation of non-VA care and that program, how would that
affect really the number of employees needed for veterans'
health care within the VA, if that makes sense?
Dr. Clancy. It makes perfect sense. I am very optimistic
that we will indeed, with your help, get to consolidation of
all paths to community care. And I think the answer to your
question is going to depend on the part of the country that you
are talking about, and the issue is going to be less about
numbers of VA physicians, and more about the distribution by
specialty. But I don't believe that we have got a very clear-
cut analysis, but we would be happy to get back to you with
more information.
Ms. Brownley. Do you intend on doing some kind of analysis?
Because I think it would be helpful in terms of what we are
looking at here, I think it would also be helpful in terms of
moving forward, in terms of good selling points, if you will,
towards consolidation of these programs, which I think is
important.
Dr. Clancy. I don't know actually if it is on the list yet,
but it is now.
Ms. Brownley. Okay.
Dr. Clancy. And obviously making that consolidation and
integration happen is going to be key, but I am happy to take
that back.
Ms. Brownley. Okay. You know, we have just kind of gone
through really, as I mentioned in my opening remarks, a two-
year space of time where we haven't had a permanent director of
the West L.A. Medical Center. We finally do now, we are very
happy that we do--
Dr. Clancy. We are too.
Ms. Brownley [continued]. --but it is--has been a long
road.
And so I just wanted you to comment a little bit on
succession plans and how they are being conducted at the VA,
and are they being conducted, you know, across services and
across the country?
Dr. Clancy. It is a standing practice that our facilities
and our networks actually have a regular cycle of succession
planning. As Mr. Stier alluded to earlier, I am quite confident
that there is some variability. I haven't taken a very close
eye on all of those, but that has long been a standard practice
for all of our facilities.
Ms. Brownley. You are sure that it is a standard practice
across the country--
Dr. Clancy. Yes.
Ms. Brownley [continued]. --across centers?
Dr. Clancy. No, the extent to which the crisis and many of
our vacancies have, you know, cut that off or interrupted it in
the recent past year or two, I don't know, but I would be happy
to have someone take a look at that and get back to you.
But I will tell you, people take this very, very seriously.
Ms. Brownley. Thank you very much.
And in terms of Mr. Stier's opening comments too, with
regards to demographics within the VA population, I mean, what
are the challenges that you are facing in attracting
particularly younger employees?
Dr. Clancy. Well, understand that except for truly
exceptional people attracting doctors is going to be getting to
the upper ends by the time you finish training of the category
that Mr. Stier was referring to.
My understanding is that over recent years there has been a
little bit of a downturn in interest among younger people in
working for Government writ large. Whether that affects VA more
than other departments I don't have good information about.
I will say our Assistant Secretary for HR&A is constantly
talking about the Pathways initiative and some parts of the
department use that quite a bit. We can certainly take it back
to see if the Veterans Health System might be using it more
vigorously.
Ms. Brownley. I mean, are we tracking that information--
Dr. Clancy. Oh, yes.
Ms. Brownley [continued]. --so we understand where the
problems and challenges are?
Dr. Clancy. Yes.
Ms. Brownley. In terms of this proposed legislation, do you
have a timeframe when we might hear written views on the
sections that aren't included in the testimony today?
Dr. Clancy. I can assure you that literally people are
working on this right now and we will get it to you as quickly
as we can.
Ms. Brownley. Okay. And last and finally on the area on
Section 9, that again I understand that you weren't able to
provide your views on Section 9 today, which would expand the
eligibility for Veterans' Preference in the Federal hiring
process to both National Guards and Reservists who serve 180
cumulative days on active duty as opposed to 180 consecutive
days, and I think as a Federal agency, VA would clearly benefit
from hiring more Guards and Reservists. Is there a concern that
expanding eligibility would dilute the Veterans' Preference to
the point of requiring veterans to compete against each other
for Federal jobs?
Dr. Clancy. I am going to ask my colleague Mr. Butler if he
has more information on that.
Ms. Brownley. No, it looks like I have run out of time,
so--
Dr. Clancy. We will follow-up.
Ms. Brownley. Okay.
Dr. Clancy. Can we take that for the record?
Ms. Brownley. Thank you.
I yield back.
Mr. Benishek. Mr. Takano, you are recognized.
Mr. Takano. Yeah, that is a question on which I am
interested in hearing the VA's answer. So I will take that
question up, Ms. Brownley.
Go ahead.
Dr. Clancy. All right. Elias, do you want to take that?
Mr. Hernandez. My humble opinion in that particular section
is that, you know, our organization strive for hiring veterans.
You know, we have hiring initiatives in our organization to
hire more veterans. It is something that we probably have to
kind of look at it a little bit more closely in terms of the
impact. Like I say, my personal opinion is that, you know, the
more veterans that are eligible for our jobs, the greater the
opportunities for our organization to be able to hire them.
Mr. Takano. Well, I will just give you this input. I
represent an Air Reserve base where we have both Reservists and
Guardsmen, and it is always difficult for them to find a
flexible-enough employer who will enable them to do their
reservist duties.
And so I appreciate that you are going to review the impact
it would have on the VA and whether or not it would be good or
bad, but I understand the VFW has some concerns about this.
And, Mr. Fuentes, would you care to comment on what your
concerns are about this provision?
Mr. Fuentes. And just to clarify our position, we support
the change from cumulative--the change for Guard and Reserve--
we support that section.
Mr. Takano. Oh, good.
Mr. Fuentes. What we have concerns with is the change that
would require VA to comply with certain Title V competitive
service legislation or law.
Mr. Takano. Okay.
Mr. Fuentes. And that was done because the intent of the
legislation, my understanding is, so that Veterans' Preference
is opened up to retired veterans, retirees--most are retirees.
So these are the folks, the officers who served 20 years, who
would make great executives, who aren't extended Veterans'
Preference at the moment.
But it is not that we believe that they shouldn't have
Veterans' Preference, it is that we feel that by trying to do
something good, I think you are actually impeding VA's ability
to hire more expeditiously because you are now requiring them
to comply with Title V restrictions.
I don't know if that makes sense.
Mr. Takano. I do not quite understand. We will explore this
a little further, but I am glad to hear that you have clarified
the 180-day consecutive service. So you are not opposing that,
you are saying that you don't have an objection to that?
Mr. Fuentes. Not at all. Our written testimony goes into
how we believe that with our all-volunteer military and the way
we have been fighting in the last two wars in Iraq and
Afghanistan, it makes sense that we make this change, that we
support this change.
Mr. Takano. Our Reservists and members of the Guard I think
would feel that this would treat them with respect that we also
give them a hiring preference.
Mr. Fuentes. Congressman, if I may, I am a Reservist,
former Reservist and Afghanistan veteran, so I completely
understand how this would impact my fellow veterans.
Mr. Takano. It would have a great impact, I think, on our
ability to help our Guardsmen find employment that works.
On the retiree issue, please help me understand this a
little better. Because I thought that maybe your objection
might be that we have people who haven't reached the 20-year
retiree level. I mean, I am thinking that military retirees may
be in a better place than our veterans with shorter service,
that being younger, it puts them at a disadvantage.
Mr. Fuentes. We completely agree, I think that military
retirees and officers who have served 20 years or more make
excellent candidates for executives at VA. I think it is the
vehicle that is utilized to make that happen that we have
concerns about.
Mr. Takano. All right. Let's try to talk a little bit more
about that offline to understand. It seems a little more
subtle. So I didn't hear the Title V complications. But I am
glad to hear about your support of the 180-day non-consecutive.
But just to be clear, the 180-days cumulative versus
consecutive you are in favor of or you support?
Mr. Fuentes. Yes, we support that aspect of the section.
The section has a number of provisions and that one is one that
we support.
Mr. Takano. Okay. Well, great. Thank you for your
testimony.
Mr. Benishek. Dr. Roe, you are recognized.
Mr. Roe. Thank you, Dr. Benishek. And thank you, all
panelists, for being here today. It has been a good discussion,
I think, and one that needs to be had.
First of all, I want to just say for the record that, to
me, a veteran is a veteran. If I didn't know if you served in
the Reserves, could care less, or the Guard. I was active duty;
to me, it doesn't matter, you served. But I tell everybody, the
military ain't Club Med. They send you where they send you and
where they need you. So whether it is 180 consecutive days, 14
days in the summer and you never get deployed, you put yourself
out there to be deployed if you need to be and, to me, that is
service.
So I wanted to get that on the record and want you to know
that I am going to support that type of legislation or whatever
going forward. I feel like you are a brother just like I am.
Now, a couple things, I guess, Dr. Clancy, that we were
looking at. I am concerned about the VA's request to remove the
VISN or Medical Center directors to be doctors or I would say
other medical providers on the ground. It is already difficult
to recruit for these positions and this additional restriction
will make it nearly impossible in some areas.
And then, what data do you have to back up the assertion
that you think that medical expertise is unnecessary when
recruiting a professional to lead a hospital or a group of
hospitals?
Let me give you an example. I don't have an MBA from
Harvard in business, but I have an MBA from paying bills for 30
years and running a practice, and managing people and helping
manage a very large organization. So when you look at that, you
are just like in the Reservists and Guard, they had that
military experience, but they also have a civilian experience.
It is very valuable when they go in the military. They may be
accountants, they may be mechanics, they may be managers of a
Walmart, whatever. They bring those skills with them and those
are valuable leadership skills.
And it is just like I don't have a Master's in public
health somewhere, but I have decades of real world experience
that would be valuable in running a hospital, because I can
promise you, I know exactly how an OR works, I know exactly how
a medical floor works, I know exactly how the laundry works and
especially when it doesn't work, and especially when you don't
get your instruments sterilized and so on, that a person that
has never walked in those shoes wouldn't know.
So how many of our directors at the VISN or otherwise are
Medical Center directors are medically trained people? Nurse,
nurse practitioner, doctor, pharmacist, whatever.
Dr. Clancy. I would have to take that for the record. And I
take your comment very, very seriously. Some of our best
Medical Center and network directors have been physicians, some
of them are now.
Mr. Roe. Yeah, and it doesn't mean you wouldn't be.
Dr. Clancy. My only point was, just as you have an MBA in
paying bills, I am going to guess that you had colleagues who
probably failed that course or who struggled much more to run
the business that running a practice requires.
My only point was that there is expertise in other areas
that is quite important.
Mr. Roe. No question. I totally agree with you there. It is
not because you do practice doesn't mean you ran one and I
think that is exactly right. But I think you should look.
I do think that those providers have a different set of
lenses that they look through and the reason they do, I think,
is they will always look through it, as you will, Dr. Clancy,
through the eyes of how everything I do affects a patient and
the care they get every day. Does it make it better and easier
for the people that's providing the care, if you have been down
there actually doing it yourself and you do understand it. So I
would leave it with that.
I wonder if the staffing and the other question I have is,
do you know what the demographics are of the 340-something-
thousand slots that you have or the employees you have at the
VA, what their ages are? Because if you are like a lot of them,
I know Eastman Chemicals, a large company in my district, I
think in the next five years 25 percent of their labor force
can retire and they don't know what they are going to do. I
mean, they are trying to train--people are now working longer,
thank goodness they are. And one of the reasons I think that
there is not a very, as you pointed out just a minute ago, the
very young, Mr. Stier, is that it does take us a while to get
them trained up. You know, I tried as fast as I could to learn
it, but it is just a lot to learn and it takes you a lot of
years to do it, and I think that is one of the thing.
And the other thing I think is, I wonder if this is
generational. You see people, younger people tend to turn what
they are doing over a lot more frequently than people in my
generation who got a job at the plant, worked there for 40
years and retired. I wonder if it is that also. It is a
challenge for everybody, not just the VA, is my point.
Dr. Clancy. I will simply say, we would be happy to give
you specific numbers on what the age breakdown is. The issue of
how many people are retirement-eligible is something that we
watch a lot. As you say, many people for a variety of reasons
have deferred that decision or in contrast to previous years,
but it is something we keep a close eye on, and I am going to
guess Mr. Stier and his colleagues do as well.
Mr. Roe. Yeah, we know that 10,000 people turned 65 today.
Dr. Clancy. Yes.
Mr. Roe. I mean, that is just a fact.
Mr. Stier. I mean, there is no question that the retirement
issue is a very prominent one, and I think it is really
important to look at the mission-critical pieces at VA and not
just the whole thing. But in general, VA struggles not just
with the medical directors, but in bringing in young people. It
is not the medical directors or the doctors themselves, VA is
not hiring young people in any real number.
Some of that has to do, again, just on the Pathways side,
that VA is not doing what any other professional organization
does, and this is true across government, of taking people in
as student interns, seeing if they actually work out, and then
converting them to full-time employees if they do well. That is
not a model that is used in government more generally or at VA
in particular, and it is a big mistake, because you can look at
time to hire, which is the question we were discussing, but you
really want to look at quality of hire, you want to look at the
assessment, and there is no substitute for having an
opportunity to work with somebody.
So, again, government and VA in particular are not doing
the most basic thing of seeing student interns as the primary
hiring entry point, and that is something that could be done.
You are going to improve the situation with a bill, but
fundamentally that is going to be a management exercise on the
part of the VA.
Mr. Roe. I am sorry, I didn't mean to go over. But I agree
with you a hundred percent that four of the seven members of my
staff here in Washington, D.C. came in basically as interns,
entry-level jobs, and they are great.
Mr. Stier. And you hired the ones that made sense.
Mr. Benishek. Thanks, Dr. Roe.
Mr. O'Rourke, you are recognized.
Mr. O'Rourke. Thank you, Mr. Chairman. I want to thank you
and Chairman Wenstrup for your work and the work of other
Committee Members on this draft legislation, and the work of
your staffs and the minority staff as well. This is, I think,
one of the most critical issues for us to be working on, and I
appreciate the feedback from the VSOs and Mr. Stier and the VA
on this. Whatever imperfections or improvements that can be
made, let's get to them as quickly as possible. And I hope that
the VA, and it sounds like from some of your comments, Dr.
Clancy, you are, I hope the VA will run with the spirit of this
and whatever you can do administratively now, do it. You don't
need to wait for legislation from Congress to do so.
Last summer we learned that there were 41,500 medical
positions authorized, appropriated for, but unfilled at the VA.
What is that number today?
Mr. Hernandez. Congressman O'Rourke, we do have a number of
requirements, they have been initiated in WebHR. We don't have
a precise number of vacancies, due to the fact that we don't
have a position management system in the organization, but the
number is currently 43,000 positions, and out of those, 37,176
are actually on the active recruitment phase.
Mr. O'Rourke. Okay. So I will just take from your answer,
if we were at 41,500, we are now at 43. Okay.
So we are having a really hard time not even treading
water, but just not sinking all together.
How many of those 43,000 are behavioral or mental health
positions?
Mr. Hernandez. I have the numbers here, let me just find it
real quickly. There are 3,497 physicians, close to 9,000
nurses. I have some specific numbers related to mental health,
you know, there are psychiatric, there are about 3200 of those
positions--well, let me rephrase that back. There are 3216 on
board psychiatric, there are 275 actions in the WebHR system
being recruited.
Mr. O'Rourke. How many psychiatrists are you short?
Mr. Hernandez. I don't have that specific data in front of
me, Congressman O'Rourke.
Mr. O'Rourke. So this is a request I have made of the
Secretary already, and I will make it again through you, Dr.
Clancy. I know the Secretary has a 12-point program to turn
around the VA, I will again submit it should be a 13-point
program and point number one should be reduce veteran suicide.
If we do that, we are going to make decisions, including hiring
decisions and decisions on where we prioritize accordingly. And
we will know how many psychiatrists and psychologists and
social workers short we are, and I think we will make some
decisions about how we prioritize their hiring.
I shared with you, Dr. Clancy, that we are at 89 FTEs,
full-time equivalents, in El Paso for mental health today with
116 authorized and appropriated for, and we are at a two or
three-year low for mental health providers. And we know that
care delayed becomes care denied and results in some tragic
outcomes, including veteran suicide. So I want to use this
forum again to ask that we prioritize that.
Within this bill, I am encouraged to see provisions for
market pay. My only concern related to that is that perhaps in
El Paso, which is not a rural area, but an under-served area,
and then you have rural under-served areas, we may need to go
far above market pay to get the number of psychiatrists,
psychologists, behavioral health providers that we need. And so
that would be a change that I would ask for. Pay whatever it
costs to get the appropriate person. Understanding that
American medicine generally is having a hard time producing
psychiatrists and psychologists and mental health specialists,
but, you know, there are people in Manhattan who are able to go
see a psychiatrist about, you know, their dog urinating on the
carpet, there should be veterans suffering from PTSD who are
able to see somebody immediately without any question. We just
need to do whatever it takes.
And, Mr. Stier, I just have to tell you I really appreciate
your comments about this being perhaps the starter pistol, and
what is really needed ultimately is accountability and
oversight. And for the record, I would love for you to tell us
what you specifically recommend for that to ensure that we are
following up on this. Because it can't just be, look, this
stuff is hard, we can't hire these people, it is hard in
American medicine, there have to be consequences if there are
new authorities and resources given to get the job done and to
prevent veteran suicide and provide greater access for mental
health.
So sorry to make a speech and not ask as many questions,
but I would like the direct answers to those questions I asked
of you, Mr. Hernandez and Dr. Clancy.
Dr. Clancy. We will get you that information expeditiously.
I am going to presume, just to clarify, that getting the
full spectrum of professionals who provide mental health care
is what you would like, the social workers, psychologists,
psychiatrists.
Mr. O'Rourke. Nurse practitioners.
Dr. Clancy. Yes.
Mr. O'Rourke. Everyone involved in the provision of that
care, so that we can connect veterans who need it, who aren't
receiving it today, that is what I am looking for.
Dr. Clancy. We will get that to you expeditiously.
I will also just insert for one moment that we are
exercising all of the incentives that, thanks to the Congress,
were provided in the Clay-Hunt bill as well, because we agree
with you, whatever it takes; this is an imperative.
And one other thing. One of the Secretary's 12
breakthroughs actually does include a component on suicide. It
is not explicit about the hiring piece, but to do it right, we
have got to have the hiring piece as well. So that message has
been heard.
Mr. O'Rourke. Thank you.
Mr. Benishek. Dr. Abraham.
Mr. Abraham. Thank you, Mr. Chairman. And thank you for
this hearing, it is a great hearing.
I am going to pick up where Mr. O'Rourke left off, I
thought his line of questioning was great.
Mr. Hernandez, you said there was a 60-day period from when
that applicant hits to when it is a job offer. What percentage
of job offers that the VA extends are actually taken? What
percentage of those physicians or nurses that come into the VA?
Is it a 50 percent, is it a 25? So if you offer a hundred
positions, how many are taken by the applicants?
Mr. Hernandez. If I understand the question correctly, out
of the job offers that we made, you want to know what
percentage of those--
Mr. Abraham. Accepted the offer, yes.
Mr. Hernandez [continued]. --accepted the job offer?
Mr. Abraham. Yes.
Mr. Hernandez. I don't have that data with me.
Mr. Abraham. Okay. If you could, I would appreciate that. I
think that is important.
Do you know, in 2015, let's go to DOs and MDs, just
physicians themselves, how many hires were made by the VA, do
you have that answer?
Mr. Hernandez. How many overall hires we did?
Mr. Abraham. Yes, sir. If you put MDs and DOs together, how
many hires? Do you have that particular answer?
And the reason I ask the question, I mean, you said with
Mr. O'Rourke's question that we had 43,000 open slots, I just
wanted to see how many are being filled. And you can get back
to me, that is fine.
Mr. Hernandez. Yes, I will get back with you.
Mr. Abraham. I didn't mean to put you on the spot, that is
not my intent here. My intent is just to get something I can
wrap my head around and get an answer.
Mr. Hernandez. Yes, sir.
Mr. Abraham. Dr. Clancy, I know with the credentialing
board that the VA has, is there any difference in standards
between the MDs, the DOs, the DPMs, all the MPs and PAs, is it
pretty much standard operating procedure across the board as to
how they are graded before they are offered that job offer?
Dr. Clancy. Yes. What takes time here is, like many
institutions, we do primary source verification.
Mr. Abraham. Right.
Dr. Clancy. So we are not sort of taking someone's word for
it, but yes.
Mr. Abraham. Okay. Mr. Stier, the figures that you have, do
they agree with Dr. Hernandez as far as that 60-day? I am like
Dr. Benishek, you know, I am out in the district and I am
talking to my docs that are trying to get into the VA system
and they say, you know, it has been over a year. So I just want
to make sure we are all on the same page here.
Do your figures go with what the VA is telling us here?
Mr. Stier. So two things. The first is that I don't have
access to their direct hire information, so I have no
independent sourcing. But I would say that what we have heard
so far is a general number as opposed to the mission-critical
positions that you are focused on, as I understand it, the
doctors.
So I think one of the interesting requests would be, can we
get information about time to hire for, you know, MDs or DOs,
so that you have the specific population you are interested in.
And then I just would like to add again that time to hire
is relevant, but at the end of the day, you can hire fast or
slow, if you don't hire well, you have not done the job.
Mr. Abraham. I totally agree with that.
Mr. Stier. And I think one of the things that this bill is
important about is that it is going to also require some
critical information around applicant satisfaction, hiring
manager satisfaction. So asking both the population that is
applying for the job, what was the experience like, and then
the people who actually need the hires, did you get the talent
that you actually wanted and relative to, you know, what you
have been doing in the past. So those things are very
important.
I think you heard one other thing that was really critical
here is the technology. You don't have an integrated HR system
across the whole agency, so it is very hard to do the kind of
work that you actually need to do in terms of comparing the
information and holding folks accountable if you don't have
that. So that would be another place where I think further
exploration would help, you know, understand how you can
improve the situation.
We don't have, and again VA is not alone, we don't have
integrated HR platforms, it is a big mistake. Any other large
organization that is well run in the private sector would have
it. And it is a big problem in the government and it is not the
agencies, there is lots of room for blame around. So to fix it,
I think this is a place that Congress could help.
Mr. Abraham. Okay.
Mr. Fuentes. Congressman, if I may--
Mr. Abraham. Yes, sir, Mr. Fuentes.
Mr. Fuentes [continued]. --just one quick suggestion.
Mr. Abraham. Yes, sir.
Mr. Fuentes. In order to identify the bottlenecks, I think
one of the things that can be done is really take a look at the
different segments and their hiring process.
One of my biggest, I would say, complaints of how VA
measures things is they select the start date or they select
the time in which they start measuring. And I think what is
needed is to really take a look at every single segment of the
hiring process, from the time that someone has left, or that
vacancy was created, until the time that we get someone to fill
that vacancy.
Mr. Abraham. I understand, good point.
I yield back, Mr. Chairman. Thank you so much.
Mr. Benishek. Ms. Titus, you are recognized.
Ms. Titus. Thank you very much, Mr. Chairman.
As we have had meetings over the last several years, you
have heard me say many times that we need to not only focus on
making it easier for the VA to discipline and dismiss
employees, but also to recruit and retain the best employees.
So I want to thank Dr. Benishek and also Dr. Wenstrup and your
staff for bringing this legislation forward, and for including
me and my staff in the process as you have drafted it, we very
much appreciate that.
I hope also as we continue working on the bill, that we
will include in it legislation that Mr. Takano and I have
worked on to kind of continue something we started when we were
doing the Choice Act, which was to increase the number of GMEs.
We had that for five years, I hope we can extend that to ten
years, because we have often heard that where you go to school
and do your residency is where you stay and practice. And so
that might also be something that helps with this problem.
Mr. Stier, your testimony presents some very compelling
statistics that are pretty upsetting in terms of the retirement
and the number of people who are going to be retiring, and the
number of people who think it is not a great place to work and,
you know, that seems to be a real challenge. But I think it
also presents us an opportunity, because with this many
vacancies, it kind of dovetails with the Secretary's position
of recreating the VA as my VA and making it more veteran-
centric as opposed to agency-centric.
And so I hope that we take advantage of the opportunity to
broaden the kind of people we hire. You mentioned that we don't
have enough young people coming into the program and yet the
number of young veterans is increasing in my district, it is
almost as equal to Vietnam veterans at this point, and I think
that number will overtake the previous war veterans. Also, more
women are now coming into the VA, LGBT issues are coming in.
So I wonder if you are doing anything specifically to
recruit these kinds of employees or if there is anything we can
do to help you kind of broaden the base of people who are
coming to work for the VA who can better serve the special
needs of our new and younger veterans.
I don't know, we can start with anybody.
Dr. Clancy. So I will say we have a center for the
department, and also an Office of Health Equity within VHA that
reports directly to me that keeps a very close look on this,
not just to count numbers, which is one step, but actually to
identify outreach opportunities and opportunities where we can
encourage a very broad applicant pool. So I did want you to be
aware of that.
Obviously, as our affiliates in medical schools and so
forth themselves become more diverse, that becomes a terrific
fertile recruiting ground and one that we take very seriously.
The Secretary has been in more medical schools than I think he
ever thought possible, but he never misses an opportunity to go
out on recruiting opportunity for that.
Ms. Titus. Well, I am glad to hear that, because women
veterans often tell me they would prefer to see a woman doctor,
but that there aren't many available. Some transgender veterans
say there aren't many who kind of understand their special
issues or can talk to them or relate to them. So I think the
more diversity you have in your recruiting, the better.
I didn't mean to cut you off, I'm sorry.
Dr. Clancy. No, I was going to say that we are making a
change in the very near future. All of our facilities, and I
bet Dr. Benishek would know this, have an our doctors Web site,
but right now you click off by the alphabet. So if I knew that
I was looking for Benishek, I would click on B, right? We are
going to make it much easier for veterans to find information
about physicians that they would be interested in. For example,
if I want to see a woman physician, I can actually see a photo
and things like that, and it will be a lot more contemporary
than our current sites.
Ms. Titus. Mr. Stier, do you want to add to that?
Mr. Stier. The one thing that I hope you will find germane
is that there are a lot of good things that the VA is doing
right now in terms of on the execution side, but we are coming
up obviously to an election year, and one of the big challenges
in government agencies is good work gets started and then it
gets interrupted because of the change in the leadership.
And so I think that is an area that this Committee could
actually assist on in terms of trying to ensure at least two
things, one of which is, you know, making sure that when there
is an interruption of political leadership that the agency
actually has plans to carry forward the good things that are
going on, and that this Committee holds the next team
accountable to carrying on the good work. So if there is some
number of priorities that you want to see occurring, you get at
them at the very front end.
And, you know, we heard some discussion about the
qualifications for Medical Centers and I would ask whether this
Committee will push on qualifications for leading the VA as
well, but obviously it is a huge job, it is a huge
transformation effort, and the kinds of folks that you get into
those positions and the speed in which you get them there will
be very important.
So I am kind of using your question for a little more and I
hope that is okay.
Ms. Titus. That is fine, I appreciate that.
Just real briefly. When we talk about recruiting in under-
served areas, we tend to focus on the rural areas, but also
some of our inner cities are also under-served. I know I
represent the heart of Las Vegas. So let's keep that in mind as
we move forward, those areas can be under-served as well.
Thank you, Mr. Chairman.
Mr. Benishek. Dr. Ruiz, you are recognized.
Mr. Ruiz. Thank you. I would also like to start by saying
thanks to the leadership of both the Health and Economic
Opportunity Subcommittees for holding this hearing, and for
continuing to include my legislation, H.R. 4150, and Section 3
of the discussion draft.
The inclusion of other medical professionals other than
emergency physicians will only continue to ensure veterans
receive the efficient, effective and continuous care that they
deserve. By allowing schedulers and managers more flexibility,
physicians and other care providers will be able to work
schedules that are more beneficial to the patient and promote
continuity of that care.
However, I disagree with the VA's suggestion that the
language of this section be amended to say, quote, ``is not
less than,'' unquote, as opposed to, quote, ``does not
exceed,'' quote. I am concerned that requiring ``is not less
than'' would likely lead to confusion and potential abuse
within the department, and ultimately deter medical
professionals from seeking employment within the VA.
The point is to match scheduling and work practices with
the private sector in the emergency department and other shift-
like work like hospitalists who sometimes work a light-shift
week for maybe one or two weeks and then resume with a very
heavy-shift work week for one or two weeks that could be more
or less than a specified number. So the idea is flexibility,
not to create a rigid, concrete amount as the change in
language would signify.
So I urge my colleagues to keep this in mind as we continue
to develop this discussion draft into legislation. And I look
forward to continuing the discussion around Section 3 and the
discussion draft as a whole.
Let me ask you a question, Dr. Clancy. Does the VA have a
physician shortage that mimics the general population physician
shortage?
Dr. Clancy. Yes.
Mr. Ruiz. Okay.
Dr. Clancy. Particularly primary care and mental health. I
mean, those are tough for us. We got ahead of the curve briefly
for mental health for the whole system, but because so few
students are choosing those career paths, that becomes a rate
limiter, and with mental health parity for the rest of the
population.
Mr. Ruiz. And how do you measure that? You know, in the
United States we have the medically recommended number of one
physician for 2,000, and to be medically under-served it is one
to 3,500. What is the recommendation for physicians within the
VA and how do you measure it? Is it per population? Is it per
attachment area population of veterans? How many physicians per
veteran population is your goal?
Dr. Clancy. I don't think that we have a physicians-per-
veteran-population for the goal, which would be a bit tricky
because--
Mr. Ruiz. Do you think we should have one?
Dr. Clancy. We would be happy to explore that with you
further. The issues are--that not all veterans in a particular
area are enrolled in our system and some who are enrolled use
our system for some services, but not all.
Mr. Ruiz. So how do you determine need and how do you
determine physician-shortage need within specific visits within
specific VA health care systems?
Dr. Clancy. We determine that by how easy it is for
veterans to get their needs met, that is literally veterans who
report that they usually always can get the care that they need
or want in a timely way, literally. And we actually look very
closely, as Dr. Wenstrup knows, I am sorry he is not here
because we have been over this with him a lot, in terms of
physician productivity, and are we providing the right
infrastructure support so that they can be as productive as
possible.
So it is a very dynamic--
Mr. Ruiz. So where do you recruit these physicians where
you have these unfilled vacancies and this physician-shortage
needs, where is your best place to recruit them? And is the
military a fruitful place for you to recruit not only
physicians or residents or maybe perhaps even pre-meds from the
medic community into the medical school, and then into your
residency programs and ultimately into your VA?
Dr. Clancy. I don't know if we have statistics on that, I
will ask Mr. Hernandez in a second. I want to assure you that
there is absolutely no source that we don't turn to, whether
that is the military. Our affiliates and the students who
rotate through our facilities are a very good source.
Mr. Ruiz. My specialty, as you know, is emergency medicine
and I do have public health background and public policy
background with my educational training, but my on-the-ground
effort has been to address a physician shortage crisis and how
to create pipeline programs from very difficult, under-served,
hard-to-reach communities where you lack physicians, take
students from those communities into medical schools, into
residencies, back into those communities.
So I want to be able to better define the problems that you
are having using some real analytical tools rather than
qualitative tools or maybe inaccurate tools of wait times, so
that we can better match the need with the source, or maybe
even create a pipeline program from pre-med medics into medical
schools that feed the VA residency programs and into ultimately
staying in the VA health care system.
Dr. Clancy. We would be delighted to work with you on that.
Mr. Ruiz. Let's work on that.
Dr. Clancy. Great.
Mr. Ruiz. Thank you.
Mr. Benishek. Thank you, Dr. Ruiz.
Well, that is pretty much it for the questions, but I just
want to make one more comment that I have been thinking about
through the whole hearing here. And it is something that since
I worked within the VA, and I speak to a lot of VA physicians,
and it is not something that we really addressed here in this
legislation or the hearing, but my feeling is that with
speaking to many physicians, that they do not have enough input
in the way the processes that the VA does where they feel as if
they are doing things as well as they could.
And some of the comments Dr. Wenstrup touched on a little
bit, but my experience is that physicians feel as if they are
not being as efficient as possible because they don't have
enough input in the way things are done. The nursing department
decides how the clinics are run and the physicians may not have
enough input there.
And in order to make it a competitive place to recruit
physicians, they need to have the input to feel as if they are
doing a good job, because I know things are changing in
medicine where more and more physicians end up working for a
big organization because you can't do it.
But you have to compete with the private sector and I think
that you really need to work on that issue, because many of the
physicians are very frustrated with it in the VA. And that the
whole culture there needs to have physician leadership and
communication with the medical director and the physicians on
staff, and a visit to VA is an important part of that. So I
want to encourage you to make that happen a little easier.
So thank you all for being here again today. Does anyone
have any other questions?
The panel is now excused.
I ask unanimous consent that all Members have five
legislative days to revise and extend their remarks and include
extraneous material.
Without objection, so ordered.
This hearing is now adjourned.
[Whereupon, at 3:25 p.m., Subcommittees were adjourned.]
A P P E N D I X
----------
Prepared Statement of Max Stier
Chairman Benishek, Chairman Wenstrup, Ranking Member Brownley,
Ranking Member Takano, members of the Subcommittee on Health and
Subcommittee on Economic Opportunity, thank you very much for the
opportunity to share the Partnership's views of the Subcommittees'
draft legislation to improve the authority of the Secretary of Veterans
Affairs to hire and retain physicians and other employees.
I am Max Stier, President and CEO of the Partnership for Public
Service, a nonpartisan nonprofit organization that works to revitalize
our federal government by inspiring a new generation to serve and
transforming the way government works.
Background
On May 15, 2015, the Partnership submitted a statement to the
Subcommittee on Health addressing how the Department could overcome
barriers to efficient and effective staffing of medical and non-medical
personnel \1\. In our statement, we discussed how VA employees are
deeply committed to the Department's mission, but the agency as a whole
struggles with declining morale and an inefficient hiring process. We
recommended three ways VA could improve its talent acquisition
processes: reforming the hiring process, standardizing onboarding
across the organization, and placing renewed focus on employee
engagement efforts. The Partnership reinforced those recommendations at
the Subcommittees' December 2, 2015 Roundtable on Veterans Affairs
Hiring. I am pleased to note that the legislation being discussed today
would address each of these recommendations in a substantive and
meaningful way, and would, I believe, improve the Department's ability
to recruit, hire and retain the top-quality talent our Nation's
veterans deserve.
---------------------------------------------------------------------------
\1\ Statement of Max Stier, President and CEO of the Partnership
for Public Service - Prepared for The House Committee on Veterans'
Affairs Subcommittee on Health Hearing Entitled, ``Overcoming Barriers
to More Efficient and Effective VA Staffing'', 114th Cong. (2015)
(testimony of Max Stier). Print.
---------------------------------------------------------------------------
VA Must Do More to Bring in Young Talent
The ability of the Department of Veterans Affairs to care for and
support America's veterans depends on how well it can recruit, hire and
retain highly qualified and engaged employees, particularly in the
medical field. Unfortunately, the Department has struggled to bring in
and hold on to top talent, with some reports showing nearly 41,000
vacancies at the Veterans Health Administration alone. \2\ VA employees
recognize these challenges as well. According to a Partnership for
Public Service analysis of the Office of Personnel Management's (OPM)
2015 Federal Employee Viewpoint Survey, fewer than half of VA's
employees responded positively to the statement, ``My work unit is able
to recruit people with the right skills'' (43.2%), while a bare
majority of VA employees (51%) believe ``the skill level of my work
unit has improved over the past year.''
---------------------------------------------------------------------------
\2\ Hoyer, Megan. ``Half of Critical Positions Open at Some VA
Hospitals.'' USA Today. 4 Sept. 2015. Web. 1 Mar. 2016.
---------------------------------------------------------------------------
Recruitment and retention issues are exacerbated by an aging
workforce which is becoming eligible for retirement in increasing
numbers. For example, GAO found that by FY 2019 one in five VA nurses
will be able to retire 1A\3\, while 42% of VHA's overall senior
leadership, including medical professionals, was retirement eligible in
2015. 1A\4\ In order to create a balanced workforce and meet both
short- and long-term talent needs, VA must do more to recruit and hire
students and recent graduates, and millennials more generally. Focusing
efforts to bring in young talent now has the additional benefit of
allowing new employees to learn from thousands of talented, dedicated
and experienced medical professionals, benefits administrators, and
mission-support staff before they leave the organization.
---------------------------------------------------------------------------
\3\ 1AUnited States of America. Government Accountability Office.
VA Health Care: Oversight Improvements Needed for Nurse Recruitment and
Retention Initiatives. Washington, D.C., 2015. Page 9. Print.
\4\ 1AIbid. 21.
---------------------------------------------------------------------------
The Department's own 2014 Interim Workforce and Succession
Strategic Plan noted that by the end of the decade the U.S. workforce
will be approximately 50% millennials. 1A\5\ The Department of Veterans
Affairs cannot be left behind. However, to date VA has struggled to
build pipelines of young talent. In 2015, just 0.68% of VA's workforce
was under the age of 25 and 5.35% were under the age of 30. In terms of
hiring, 15.7% of new VA hires were under the age of 30, while the
comparable government-wide figure was 25.2%, according to OPM's
Fedscope database. In 2014 millennials made up 11.3% of the Veterans
Health Administration workforce, where the bulk of the Department's
employees reside. 1A\6\ Exacerbating this problem is low satisfaction
among younger employees. The latest Best Places to Work in the Federal
Government Rankings, published by the Partnership for Public Service
and Deloitte, found that VA ranked second-to-last among large agencies
in satisfaction among employees under the age of 40.
---------------------------------------------------------------------------
\5\ 1AUnited States of America. Veterans Health Administration.
Healthcare Talent Management, Workforce Management & Consulting Office.
2014 VHA Interim Workforce and Succession Strategic Plan. Page 13. Web.
\6\ 1AIbid. 24.
Partnership Views of the Draft Legislation to Improve VA's Authority to
---------------------------------------------------------------------------
Hire and Retain Physicians and Other Employees
Because several sections of the proposed legislation are outside of
the Partnership's areas of expertise, I will focus my remarks on those
provisions on which we are best equipped to comment. My remarks below
address each relevant section individually.
Section 2. Appointment and Pay for Directors of Medical Centers and
Veterans Integrated Services Networks
The Partnership supports greater use of market pay as a mechanism
for attracting and rewarding top talent in government, though we do not
have a specific view as to the qualifications standards for medical
center and Veterans Integrated Service Network directors. The
Partnership's 2014 report with Booz Allen Hamilton, Building the
Enterprise: A New Civil Service Framework, states that the current
federal pay system undermines government's ability to attract and
retain high-quality professional and administrative personnel and
proposes a market pay system that recognizes distinctions between job
types, compensation, and performance common in the private sector. We
are pleased to see the Subcommittees expanding this concept to these
critical, high-visibility positions.
Section 7. Executive Management Fellowship Program
The Partnership has long supported efforts to expand the mobility
of government employees and senior executives across agencies and
between government and the private sector. For that reason, we strongly
support the draft legislation's Executive Management Fellowship
Program, which would provide a one-year fellowship to eligible
employees to work in private sector organizations engaged in the
administration and delivery of health care or other benefits. In 2012
the Partnership and McKinsey and Company issued a report titled,
Mission-Driven Mobility: Strengthening Our Government through a Mobile
Leadership Corps, examining how the SES could meet its promise of
serving as a mobile, enterprise-wide leadership team as originally
envisioned by the Civil Service Reform Act of 1978. Our report
describes the powerful positive impacts of mobility in building
executive managerial skills, strategically filling vacancies, and
infusing new thinking into an organization. Senior career employees at
VA will benefit from access to diverse perspectives, a breadth of
experience, and a deeper understanding of the private sector's
processes, technologies, and operational framework. The Executive
Management Fellowship Program, aimed at SES and aspiring senior
executives, if well-executed, offers to bring significant benefits to
VA's senior executive corps.
We recommend the Subcommittees consider two changes to the
Executive Management Fellowship Program as currently constructed.
First, we suggest increasing the program's cap of 30 participants, for
example by initially implementing the Fellowship as a pilot program
with a participant cap to determine its effectiveness, and then opening
it up to a larger number of participants if warranted. To ensure that
only the best employees are able to participate, the Subcommittees
should also consider requiring eligible employees to have at least two
consecutive outstanding ratings. The combined workforce of VHA and VBA
is nearly 293,000, and there are more than 7,000 eligible participants.
Cost concerns aside, the vast size of this workforce means that a cap
of 30 participants will severely limit the program's potential impact.
The Partnership believes mobility is a worthwhile investment, and would
demonstrate to senior VA employees that their agency values them and is
willing to invest in their development. Our second recommendation is to
look at ways in which the Fellowship program could be made into a two-
way exchange, in which individuals from the private sector come to VA
to share cutting-edge operational techniques and best practices.
Section 8. Accountability of Leaders for Managing the Department of
Veterans Affairs
The Partnership strongly supports the draft legislation's provision
requiring political appointees at the Department to undergo a
performance planning and appraisal process similar to that of the
Department's career senior executives. We additionally recommend that
the Subcommittees look into how VA could create connectivity between
the performance expectations for political appointees and career
executives. Though political appointees and career executives face
different demands and operate at different levels of the organization,
aligning performance expectations in this way can help needed reforms
and accountability cascade throughout the organization.
As the highest level of leadership in the Department of Veterans
Affairs, political appointees play a crucial role in providing
leadership and setting priorities for the organization. Appointees
should be held accountable for their performance and contributions like
every other employee. Data from the Partnership's analysis of the
latest OPM Federal Employee Viewpoint Survey demonstrates why this
provision is so important: in 2015, just 32.7% of VA employees
responded positively to the statement, ``In my organization, senior
leaders generate high levels of motivation and commitment in the
workforce'', and only slightly more, 38.5%, positively responded to the
statement ``My organization's senior leaders maintain high standards of
honesty and integrity.'' Appraising and holding accountable political
leaders for setting priorities and expectations, and developing an
empowering and engaged culture throughout the organization, will help
to restore trust in senior leadership.
We are particularly pleased that the performance plans will address
the accountability of leaders for promoting good practices and
supporting efforts to recruit, select and retain well-qualified
individuals, engage and motivate employees, train and develop future
leaders in the Department, and hold managers accountable for addressing
performance issues. Each plays a critical role in building a high-
performing workforce, and will further drive leadership attention to
the pressing workforce issues within the Department. However, engaging
and motivating employees may be one of the most immediate and impactful
ways by which senior political appointees at VA can make an impact. As
noted above, fewer than four in ten VA employees feel that their senior
leaders are motivating them. The Partnership's Best Places to Work in
the Federal Government Rankings put VA employee satisfaction with
senior leaders at 18 out of 19 large agencies. GAO has also found that
employee dissatisfaction negatively impacts the ability of VHA to
retain employees in mission-critical occupations. 1A\7\
---------------------------------------------------------------------------
\7\ 1AUnited States of America. Government Accountability Office.
VA Health Care: Oversight Improvements Needed for Nurse Recruitment and
Retention Initiatives. Washington, D.C., 2015. Page 17. Print.
---------------------------------------------------------------------------
Section 9. Modification of Veterans Preference
While the Partnership supports the goal of a diverse federal
workforce, including the continued recruitment and hiring of veterans,
we have concerns over the proposed legislation's expansion of veterans'
preference to the Senior Executive Service. The Senior Executive
Service is, by law, excluded from the application of veterans'
preference, and applying such preference specifically to VA would put
the Department at a disadvantage when competing for executive talent
with other agencies and the private sector. Requiring, as the proposed
legislation does, that VA should select candidates for senior executive
positions ``in the same manner and under the same conditions required
for the competitive service'' may further hinder the VA's ability to
recruit diverse talent with the skills the Department badly needs, such
as in hospital administration and critical mission-support functions
such as human resources, information technology, and financial
management.
We ask the Subcommittees to consider other ways to increase the
number of veterans in senior executive positions that do not
unnecessarily restrict the Department's ability to bring in the
executive talent needed to complete its transformation process.
Concerns about a relative paucity of veterans in top leadership
positions is a valid concern, and there are substantive ways in which
the Subcommittees and VA can work together to address it. For example,
while VA does not have specific leadership development programs aimed
at employees who are veterans, the Department can increase its efforts
to encourage veteran employees to participate in its two primary
leadership development programs, LeadershipVA and the Senior Executive
Service Candidate Development Program, which prepare employees for
senior leadership positions. VA could also enhance its outreach to the
broader veterans' community to recruit external veteran candidates for
SES jobs at the Department. Such an approach would require VA to work
with these candidates to help them navigate the SES application
process, though we believe it is well worth the effort.
Section 10. Reemployment of Former Employees
The Partnership enthusiastically supports granting VA authority to
noncompetitively appoint qualified former employees of VA to any
competitive or excepted service position at the agency - an issue the
Partnership discussed in our report, Building the Enterprise: a New
Civil Service Framework. As the report notes, current law allows a
former employee who has held a career or career-conditional position to
be noncompetitively reinstated only at a grade level at or below that
which they held before leaving government. This change, provided for in
the draft legislation being discussed today, will give VA greater
flexibility in bringing back employees who have gained valuable
training and work experience in their time away from the Department,
and would provide an additional incentive to employees who are
considering a return to VA.
We suggest, however, that the Subcommittees consider going further.
Specifically, we would recommend removing the one grade level limit and
opening the opportunity for noncompetitive reemployment to all federal
employees, rather than just those previously employed at the
Department. By removing this limitation, VA would offer further
enticement to those former employees who are more advanced in their
careers, providing the Department with an additional method by which it
could recruit mid-career and senior-level talent. Opening the
noncompetitive reemployment opportunity to all federal employees would
give VA a leg up in recruiting talent from other agencies with similar
workforces (e.g., HHS, NIH, DOD, etc.) and recognize the enterprise-
wide nature of the challenges that agencies like VA face in hiring top
talent. We understand and appreciate the concern over the potential of
this flexibility to be used improperly, but believe this could be
easily addressed by requiring the VA Inspector General or the
Government Accountability Office to audit the use of this hiring
authority within a specific timeframe to ensure that it is being used
as intended. VA could also report on the use of this authority as part
of the hiring effectiveness measures in Section 15.
Section 11. Recruiting Database
The Partnership supports the draft bill's requirement for the
Department of Veterans Affairs to create a Department-wide database for
vacant mission-critical and hard-to-fill positions, particularly those
that have been vacant for a prolonged period of time. VA's
decentralized hiring processes have led to many facilities competing
for similar talent, and has prevented the Department from addressing
critical shortages where they exist. The recruiting database will help
VA move closer to an enterprise-wide hiring system that can effectively
address recruitment, hiring and retention challenges where and when
they occur, rather than simply hoping candidates for VA jobs find their
way to the facilities where they are needed most. We recommend that VA
consider how it can combine the recruiting database authorized by this
legislation with the recently-enacted Competitive Service Act, which
allows agencies to hire off each other's certification list for a
position. The Partnership believes the Act has the potential to greatly
facilitate the filling of mission-critical positions both government-
wide and within the VA, and we encourage VA to work with the Office of
Personnel Management to make the best possible use of this new
authority.
Section 12. Human Resources Academy
The Partnership supports all efforts to strengthen the federal
human resources workforce. Our May 15, 2015 statement for the
Subcommittee noted that VA HR staff tend to ``post and pray'' when
hiring for key positions and receive limited training in workforce and
succession planning. A September 2015 GAO report on the recruitment and
retention of nurses also found that a lack of sufficient administrative
support from HR departments at individual VHA facilities limited the
extent to which those facilities could take advantage of recruitment
and retention tools, though this report cited a lack of resources for
HR teams as having just as big an impact as training. 1A\8\ The
decentralized nature of VA's hiring system also tends to mean that
recruiting and hiring is not done strategically and special hiring
authorities and flexibilities are not used to the extent that they
could be.
---------------------------------------------------------------------------
\8\ 1AIbid. 17.
---------------------------------------------------------------------------
The Department currently operates a ``VA HR Academy'', which
provides access to training, career pathing tools like MyCareer@VA, and
an HR competency model for VA HR employees to use as part of their
professional development 1A\9\, but it has been underfunded in recent
years. This legislation provides an opportunity to bring greater
prominence and renewed focus to this underutilized resource.
Specifically, the goals of the legislation to provide more training on
best practices in recruiting and hiring mission-critical talent should
be integrated into a strengthened HR Academy. The Subcommittees should
request more information from VA on the current status of the HR
Academy, and on ways the Academy's offerings can best be tailored to
meet the intent of this legislation and the Department's most pressing
current talent needs. Reviving the VA HR Academy has the potential to
address the challenges this draft legislation seeks to take on, and
could even help increase engagement among VA's HR workforce. The
Partnership's 2015 Best Places to Work in the Federal Government
Rankings showed the cohort of human resources employees at VA ranked 10
out of 18 large agencies in overall satisfaction.
---------------------------------------------------------------------------
\9\ 1A``VA HR Academy.'' Home. Department of Veterans Affairs, 17
Nov. 2014. Web. 09 Mar. 2016.
---------------------------------------------------------------------------
In 2012, the Partnership's Vice President of Policy John Palguta
testified before the Senate Homeland Security and Governmental Affairs
Subcommittee on the Oversight of Government Management, the Federal
Workforce and the District of Columbia on building and maintaining an
effective federal human resource workforce 1A\10\. His testimony
emphasized the important role HR plays in acting as a strategic advisor
and business partner supporting the mission side of the organization
and advocated for directing more resources to the federal HR workforce.
Not only can better training for HR staff improve the quality of talent
coming into VA, but has huge potential to improve morale and
engagement, increase retention, and reduce turnover costs.
---------------------------------------------------------------------------
\10\ 1AStatement of John Palguta, Vice President of Policy,
Partnership for Public Service - Prepared for The Senate Homeland
Security and Governmental Affairs Subcommittee on Oversight of
Government Management, the Federal Workforce, and the District of
Columbia titled ``Building and Maintaining and Effective Human Resource
Workforce in the Federal Government'', 112th Cong. (2012) (testimony of
John Palguta). Print.
---------------------------------------------------------------------------
Finally, we recommend both to the Subcommittees and to VA that the
training provided by the VA HR Academy also include best practices for
HR staff in effectively engaging with hiring managers to maximize the
success of the hiring process and satisfaction with new hires, and to
think more holistically about how other aspects of VA's HR processes
impact its ability to use the tools, flexibilities and authorities
available. Another recommendation to the Subcommittees would be to
expand the availability of training beyond just human resources staff
to all VA employees who are engaged in recruitment activities. We hope
the Subcommittees will consider other ways by which more attention and
resources can be directed to VA's human resources offices and staff,
for example by specifically authorizing money for non-medical, mission-
support training at the Department that will be protected from use for
other administrative or personnel activities. HR plays a crucial role
in ensuring that VA has the talent it needs to serve veterans, and we
appreciate the Subcommittees substantive action in this area.
Section 13. Promotional Opportunities for Technical Experts
The Partnership is highly supportive of the draft legislation's
provision requiring the Secretary of Veterans Affairs to establish a
promotional track system for employees of the Department who are
technical experts. The rigid structure of the GS system requires
employees to move into supervisory and management roles, even in cases
where the employee may not be an effective manager but must take on
such duties in order to advance in their career. This is especially
true for employees who possess valuable technical expertise but are not
suited for supervisory duties. Such employees may include medical
professionals or experts in veterans' benefits law who possess valuable
expertise in complex subjects.
However, we believe this provision can be further strengthened by
making explicit that the Department should evaluate candidates for
managerial or supervisory roles based on their executive and people
skills as well as their technical expertise, and give candidates the
opportunity to develop these skills. Like most other federal agencies,
VA does not have a standard criteria for promoting managers. As noted
above, managers are often promoted based on the technical expertise
relevant to their particular organization (e.g., VBA will look for
managers with strong knowledge of claims administration). We recommend
the Subcommittee consider language requiring aspiring supervisors and
managers to demonstrate leadership skills either through their day-to-
day work or through an educational requirement. This educational
requirement could take the form of online or in-person classes
developed and advertised through VA Learning University (VALU).
Employees would not be able to advance into supervisory or managerial
positions without being certified as having taken such a course. This
would be a high-impact and light lift for the Department. Not only
would it guarantee that every new manager understands the basic tenets
of effective leadership, but would allow those individuals who are not
fit for management to realize it before they take on a supervisory
role. Only those employees who have the competencies necessary to be
successful would become supervisors.
Section 14. Comptroller General Report on Succession Planning
The Partnership supports the requirement included in this draft
legislation requiring the Comptroller General to report on succession
planning efforts at the Department of Veterans' Affairs. According to
Secretary McDonald's statement before the House Committee on Veterans'
Affairs on February 10, 2016 1A\11\ the Veterans Health Administration
hired over 41,000 employees in 2015, though that hiring resulted in a
net employment gain of about 14,000 staff. This, combined with the
figures on retirements cited earlier, suggests a high level of turnover
at the Department, and a need for a robust succession management
process. The Partnership believes this report would be useful in
helping the Department better understand the quality of succession
planning going on throughout the organization and in developing a more
consistent succession planning strategy. While VHA currently conducts
strategic planning across its network of facilities 1A\12\, the GAO's
report would give Congress better visibility into the extent and
usefulness of workforce and succession planning activities at these
individual facilities, as well as at other facilities across the VA. As
the Partnership's 2011 report with Booz Allen Hamilton, Preparing the
People Pipeline: A Federal Succession Planning Primer noted, succession
planning is an effective tool for dealing not only with departures but
also with retention by helping managers determine the critical skills
that exist within their teams and how to develop and keep needed
talent. The Partnership encourages VA to use this report to further
refine and strengthen its internal succession planning processes,
ensure that such processes are consistent across the organization, and
tie them to the measures of hiring effectiveness required to be
collected under Section 15.
---------------------------------------------------------------------------
\11\ 1AStatement of the Honorable Robert A. McDonald, Secretary of
Veterans Affairs, For Presentation Before the House Committee on
Veterans' Affairs, ``Budget Request for Fiscal Year 2017'', 114th Cong.
(February 10, 2016). Print.
\12\ 1AUnited States of America. Veterans Health Administration.
Healthcare Talent Management, Workforce Management & Consulting Office.
2014 VHA Interim Workforce and Succession Strategic Plan. Page 5. Web.
---------------------------------------------------------------------------
Section 15. Information on Hiring Effectiveness
The Partnership applauds the Subcommittee's decision to include in
its proposed legislation a mandate for VA to measure and report on the
effectiveness of its hiring process, and we believe this requirement
can be further strengthened. As I noted at the Roundtable on VA hiring
hosted by the Subcommittees in December, you cannot manage what you
cannot measure. VA must have actionable data in order to properly
understand and address persistent hiring challenges. Yet the Department
appears to lack a comprehensive understanding of the strengths and
weaknesses of its hiring process. The language proposed here would
require VA to collect and publically report on the effectiveness of its
recruitment programs and hiring authorities, the quality of new hires,
time-to-hire, applicant and employee satisfaction with the hiring
process, and new hire satisfaction with onboarding, among other things.
These data should allow VA to construct a fuller picture of its hiring
process, including specific points where the process bogs down.
Developing a fuller understanding of the use of special hiring tools,
authorities and flexibilities is especially critical, as Congress has
authorized a number of programs and tools at VA to promote hiring,
particularly of medical professionals, such as the Education Debt
Reduction Program, the Employee Incentive Scholarship Program, and
various recruitment, retention and relocation incentives.
To make this report even more valuable both to VA and to Congress,
the Subcommittees should look at including a measure of ``customer
satisfaction'' of hiring managers and new employees with VA's human
resources offices, for example by asking their views of the information
and support they received from their HR offices. It is worth noting
that VA has collected this data in the past. Such a measure, if
included, should also specify that data should be taken from HR offices
across the VA enterprise, where the vast majority of hiring and other
personnel actions take place. We encourage the Subcommittees to look
into the administration's and VA's work to benchmark costs and best
practices across agency mission-support functions and how these efforts
can be further encouraged, a process that involves analyzing customer
satisfaction in each function. VA is currently tasked with benchmarking
administrative spending and identifying performance improvements
opportunities in the areas of real property and financial management
1A\13\. An expansion of the benchmarking effort to VA's HR by the
administration would go a long way towards fixing the organization's
talent issues. We also recommend that, as part of the Department's
requirement to share this information to Congress, it be asked to
report on the biggest pain points in or barriers to effective hiring.
We believe this is an effective way for the Subcommittees to engage
with VA on any additional reforms necessary to improve its hiring
process.
---------------------------------------------------------------------------
\13\ 1AUnited States of America. Office of Management and Budget. M
0914 0912: Memorandum for the Heads of Executive Departments and
Agencies: Management Agenda Priorities for the FY 2016 Budget. By Brian
C. Deese. July 18, 2014. Web.
---------------------------------------------------------------------------
It is, however, important to understand that VA's HR systems, as
currently constructed, are not built to collect and centralize this
information. In fact, this problem is not unique to VA - nearly every
agency lacks such a system. While VA is currently developing an
integrated human resources information system, it is still in its early
stages and rudimentary. Personnel databases are scattered across the
organization and within each of the Department's individual
subcomponents, and each subcomponent owns its own data. The bill as
written requires VA to fully commit to constructing a centralized
information system. This is a very worthy goal, and something we
encourage the Department to pursue. It is important to understand,
though, that it will take time. However, the Subcommittees' draft
legislation can serve as a useful focusing mechanism for the Department
and prompt quicker development of this system.
Section 16. Employment of Students and Recent Graduates
The Partnership is highly supportive of the draft legislation's
provision codifying the Department's authority to convert Pathways
program participants to full-time entry-level positions. At the
Subcommittees' December roundtable on VA hiring, I emphasized how
student interns and recent graduates provide the best way for the
Department to assess and hire top young talent into the organization.
Increasing the number of young people in an organization can provide
fresh ideas, reinvigorate the workforce, and provide a pipeline of
future leaders. This is true even at VHA, which could take advantage of
students and recent graduates to fill nursing, physician assistant and
mission-support roles. Increasing the number of students and recent
graduates in VA's workforce is critical given the overall dearth of
young talent at VA which I noted earlier. The private sector makes
significant use of student interns as a talent pipeline for entry level
positions, but government squanders the opportunity to make use of this
talent pool. Government as a whole, and the Department of Veterans
Affairs in particular, needs to normalize the way interns are utilized.
While the administration's 2010 hiring reform, which included the
Pathways internship programs, has made some progress, we do not believe
it has been enough. The Partnership is very pleased that the
Subcommittees have included this provision, which would codify VA's
existing authority under the Pathways programs to make excepted service
appointments of student interns, volunteers with substantive duties,
and interns contracted through third-party organizations. This change
would demonstrate Congress' support for Pathways and push VA to expand
its use of the programs, which VA has already committed to implementing
in its 2014 Interim Workforce and Succession Strategic Plan. 1A\14\
Ultimately, we believe this provision will increase the pool of proven,
high quality entry-level talent available to VA.
---------------------------------------------------------------------------
\14\ 1AUnited States of America. Veterans Health Administration.
Health are Talent Management, Workforce Management & Consulting Office.
2014 VHA Interim Workforce and Succession Strategic Plan. Page 64. Web.
---------------------------------------------------------------------------
Section 17. Exit Surveys
The Partnership supports mandating in statute an exit survey for
employees who voluntarily separate from the agency, and we are
particularly pleased that the Subcommittees have included a reporting
requirement that will ensure that the Department is using the survey
data to improve retention of VA employees, especially those in mission-
critical occupations. VA Directive 5006 currently requires the
Department to conduct a voluntary exit survey of employees separating
from the organization, but we believe the survey is underutilized and
that this provision will strengthen the survey and bring it renewed
focus. Holding on to mission-critical talent requires understanding the
reasons employees are leaving in the first place, and so VA's ability
to continue to strengthen its hiring process requires that the
Department can measure its success and hold itself accountable for its
improvement. We would encourage the Department of Veterans Affairs to
use this mandate from Congress to make its current exit surveys more
robust, participation more widespread and data more widely available to
key stakeholders inside and outside of the organization. To this end,
the Subcommittees should consider requiring the Department to
publically report aggregate exit survey data. VA must make special
efforts to ensure that these data, in combination with the other hiring
and workforce planning information required to be collected by this
legislation, is available to all human resources offices and hiring
managers, and is actually being used to develop a comprehensive
strategy for bringing in and holding on to the talent the Department
needs. Data from the 2014 VHA Interim Workforce and Succession
Strategic Plan proves the need for this effort - the report showed that
only 25.8% of VA employees exiting the organization had their manager
or supervisor talk to them about changing their mind 1A\15\. Keeping
all of this in mind, we encourage the Subcommittees to continue to
conduct meaningful oversight of VA's hiring processes and workforce
management.
---------------------------------------------------------------------------
\15\ 1AIbid. 22
---------------------------------------------------------------------------
Enablers of Effective Implementation
The Partnership believes this legislation has tremendous potential
to improve the Department's recruitment, hiring and retention of
dedicated professionals to serve our Nation's veterans. However, if the
proposals offered here are to be meaningfully implemented, the
Subcommittees must pay special attention to certain key enablers of
that implementation. Legislation does not exist in a vacuum; it must be
executed within an organization with unique strengths, weaknesses and
challenges. If the Department's leadership is not committed, or not
supported in making these changes happen, the odds of success become
much longer. Should this legislation pass, its execution will deserve,
and require, the Subcommittees' sustained attention. Below I identify
several key enabling factors that will impact the potential of this
legislation to bring about significant, positive change to how the
Department manages its talent:
Support from Congress for VA employees - Congress has an
important constitutional duty to ensure that VA serves veterans
efficiently, effectively and with the respect they have earned. The
Department's employees are ultimately accountable to Congress, but
Congress is also accountable to employees as the steward of the VA's
resources and priorities. We urge the Committee to work constructively
with VA to address challenges facing its workforce, and to recognize
the vast majority of VA's employees who are hard-working, patriotic
public servants who have dedicated their professional lives to serving
America's veterans. The public image of VA, which Congress has a hand
in shaping, plays as important a role in supporting recruitment and
retention as any single initiative of the Department.
Recognizing the impact of recent proposals on VA's senior
executive workforce - The Secretary's recent proposal to place the
Department's senior executive corps under Title 38 grants greater
flexibility to VA in hiring, paying and, if necessary, disciplining
executives. However, the proposal will complicate the leadership and
morale picture at VA. If that proposal moves forward, the Subcommittees
should conduct rigorous oversight to ensure that it complements the
intent of this legislation and furthers the goal of bringing top
executive talent into the organization.
Clear accountability for implementation - As written, the
bill does not provide for specific individuals to be responsible for
implementing the various programs, flexibilities and reporting
requirements this legislation creates. It is critically important to
keep in mind that there is no one human resources office at VA. Day-to-
day program and policy implementation is handled by the human resources
offices of the Department's subcomponents, and truly effective
implementation will require the Subcommittees to, within the bill
itself, delegate specific responsibilities or allow the Secretary to
delegate specific responsibilities to those individuals best situated
to make these improvements happen.
Development of a centralized, integrated VA human
resources information system (HRIS) - VA, like nearly all federal
agencies, lacks a single repository of personnel data. Instead, data
critical to understanding the state of VA's workforce and hiring
processes is scattered throughout the organization. While the
Department is developing a HRIS, it should not be assumed that VA's
central HR office can pull this data together easily. The Subcommittees
should sufficiently resource and conduct meaningful oversight of VA's
efforts to build an accurate, usable and fully integrated personnel
information system.
Sufficient resources for training and development -
Training is one of the most effective means by which VA can retain the
best and brightest employees, improve morale, and reduce turnover
costs. However, funding available for non-medical training at the
Department has declined in recent years and has hurt its ability to
provide quality developmental opportunities to employees, particularly
those in mission-support functions such as human resources, who are at
the front lines of the VA's efforts to recruit top talent. Further
complicating this picture is that such funds can be lumped in with
other personnel costs and used for purposes other than staff
development. The Subcommittees, as well as the Appropriations
Subcommittee on Veterans Affairs, Military Construction, and Related
Agencies, should ensure sufficient, dedicated funding for quality,
recurring training for the mission-support services that enable the
Department's work.
Maintaining momentum through the transition - There are
roughly ten months left in the current administration, and many of the
Department's key leaders will soon be gone. The commitment of current
leadership to executing on this legislation will, potentially, be
limited by an unwillingness to take on bold and time- and resource-
intensive new initiatives. The Subcommittees provide important
continuity across administrations, and so we urge you to sustain your
commitment to building a strong, engaged and effective VA workforce.
Conclusion
Chairman Benishek, Chairman Wenstrup, Ranking Member Brownley,
Ranking Member Takano and members of the Subcommittees on Health and
Economic Opportunity, thank you for the opportunity to give the
Partnership's views of this legislation. The draft bill we are
discussing today will make a meaningful and positive impact on the
ability of the Department of Veterans Affairs to recruit, hire and
retain the talent it needs to achieve its mission, and we are pleased
to support it. I look forward to continuing to work with your
Subcommittees to advance this legislation. Thank you, and I am happy to
answer any questions you may have.
Prepared Statement of Roscoe G. Butler
As far back as 1998, The American Legion expressed concerns
regarding VA physicians and medical specialists staffing shortages
within the Veterans Health Administration (VHA). This was accomplished
by monitoring the progress in establishing patient centered primary
care within each Veterans Integrated Service Network (VISN), including
both rural and urban localities as well as ensuring that the model of
care features both the quality and efficient combination of medical
professionals that are tailored to the needs of the local veteran's
population. 1A\1\
---------------------------------------------------------------------------
\1\ 1AResolution 311: The American Legion Policy on VA Physicians
and Medical Specialists Staffing Guidelines
---------------------------------------------------------------------------
Chairmen Benishek, Wenstrup, Ranking Members Brownley, Takano and
distinguished members of the Subcommittees on Health and Economic
Opportunity on behalf of National Commander Dale Barnett and The
American Legion; the country's largest patriotic wartime service
organization for veterans, comprising over 2 million members and
serving every man and woman who has worn the uniform for this country;
we thank you for the opportunity to testify regarding the draft
legislation regarding ``Improving the authority for the Secretary of
Veterans Affairs (VA) to hire and retain physicians and other employees
of the Department of Veterans Affairs''.
From the inception of The American Legion's System Worth Saving
(SWS) Program in 2003, The American Legion has tracked and reported
staffing shortages at every VA medical facility across the country and
submitted those to Congress, VA Central Office (VACO), and to the
President of the United States. Through numerous SWS hospital site
visits, The American Legion has dedicated considerable resources to
monitoring the Veterans Health Administration (VHA) healthcare system.
Unfortunately, there are no easy solutions for VA when it comes to
effectively and efficiently recruiting and retaining medical staff to
treat the growing number of veterans that are entering the VA
healthcare system. The American Legion believes that access to basic
health care services offered by qualified primary care providers should
be available locally as often as possible. VHA is still currently
struggling to achieve the appropriate balance of primary care and
medical specialists across the country.
In 2004, The American Legion urged the VA to develop an aggressive
strategy to recruit, train, and retain advanced practice nurses
(APN's), registered nurses (RN's), licensed practical nurses (LPN's),
and nursing assistants (NA's) to meet the inpatient and outpatient
health care needs of veterans. The Legion fully supports VA's
education-assistance programs for APNs, RNs, LPNs, and NA's. We also
urged VA to provide equitable and competitive wages for Advanced
Practice Nurses (APNs), Registered Nurses (RNs), Licensed Practical
Nurses (LPNs), and nursing assistants. 1A\2\
---------------------------------------------------------------------------
\2\ 1AResolution No. 237: The American Legion Policy on VA Nurse
Recruitment and Retention
---------------------------------------------------------------------------
Due to the fact that one out of every three veterans treated by the
VA lives in a rural area, The American Legion remains concerned with
the problems rural veterans face due to a lack of access to qualified
health care. As the number of veterans residing in rural communities
increases, veterans will continue to struggle to find timely and
quality VA health care that meets their individual health care needs.
VA medical centers in rural areas have often expressed concerns in
recruiting and retaining qualified medical and clinical providers due
to their inability to compete with medical centers in large
metropolitan areas. In The American Legion's 2012 System Worth Savings
(SWS) Report on Rural Healthcare, The American Legion found that:
``[Department of Veteran Affairs Medical Centers (VAMCs)] in rural
America, recruitment and retention of primary and specialty care
providers has been a constant challenge. Some clinicians prefer to
practice in more urban settings with more research opportunities and
quality of life that urban settings provide.'' 1A\3\
---------------------------------------------------------------------------
\3\ 1AThe American Legion: 2012 System Worth Saving Report on Rural
Health Care
---------------------------------------------------------------------------
In 2014, The American Legion published a SWS report titled ``Past,
Present, and Future of VA Healthcare'', which noted several challenges
VA still faced regarding recruiting and retention such as:
Several VAMCs continue to struggle to fill critical
leadership positions across multiple departments.
These gaps have caused communication breakdowns between
medical center leadership and staff that work within these departments.
During our 2013 site visit to the Huntington VA Medical Center in
Huntington, West Virginia, we recommended that, ``VHA conduct a rural
analysis for hard to recruit areas and look into different options to
support VAMCs in getting talent they need to better serve veterans.''
VHA needs to ensure that veteran health care is consistent across each
Veterans Integrated Service Network (VISN).
In 2015, during our SWS site visit to the VA Medical Center in St.
Cloud, Minnesota, providers expressed concerns about the number of
physician vacancies, and how the additional workload is impacting
morale at the medical centers. During the same visit, one veteran
expressed concern noting ``every time [I] visit the medical center, [I
am] assigned a new primary care provider because [my] last provider
either quit or transfer to another VA.''
There have been numerous reports citing VA's staffing issues, for
example in January 2015, the VA's Office of Inspector General (VAOIG)
released their determination of the ``Veterans Health Administration's
Occupational Staffing Shortages,'' as required by Section 301, of the
``Veterans Access, Choice and Accountability Act (VACAA) of 2014''.
With this report, VAOIG determined that the five occupations with the
largest staffing shortages were Medical Officers, Nurses, Physician
Assistants, Physical Therapists, and Psychologists. The OIG recommended
that the ``Interim Under Secretary for Health continue to develop and
implement staffing models for critical need occupations.'' Ultimately,
if the VA continues to struggle with retention and recruitment, the
trend of closures (or continued closures) for multiple departments
within VAMCs nationwide will continue.
As The American Legion continues to conduct System Worth Saving
Site visits across the VA health care system, we see VA staffing
shortages getting worse rather than improving.
Draft Legislation to Improve Hiring Practices at the Department of
Veterans Affairs:
This draft bill aims to improve the authority for the VA Secretary
to hire and retain physicians and other employees of the VA. Below is a
section by section analysis of the draft bill as presented:
Section 2: Appointment and Pay for Directors of Medical Centers and
Veterans Integrated
Services Network (VISN)
Currently, Paragraph (4) of section 7306(a) of Title 38, United
States Code (U.S.C.) states that the Office of the Under Secretary for
Health shall consist of such Medical Directors as may be appointed to
suit the needs of the Department, who shall be either a qualified
doctor of medicine or a qualified doctor of dental surgery or dental
medicine 1A\4\. Subsection (a) of this bill would add ``or other
qualified medical professionals.''
---------------------------------------------------------------------------
\4\ 1A38 U.S. Code Sec. 7306 : Office of the Under Secretary for
Health
---------------------------------------------------------------------------
This subsection includes a new section in Title 38 U.S.C. Chapter
74, Subchapter IV ``Pay for Nurses and Other Health-Care Personnel.''
The new section, titled ``Medical Directors and directors of Veterans
Integrated Service Networks (VISN),'' discusses elements of pay, base
pay, market pay, requirements and limitations on total pay, treatment
of pay, and ancillary effects of decreases in pay.
The American Legion supports legislation addressing the recruitment
and retention challenges that the VA has regarding pay disparities
among those physicians and medical specialists who are providing direct
health care to our Nation's veterans 1A\5\.
---------------------------------------------------------------------------
\5\ 1AAmerican Legion Resolution No. 101: Department of Veterans
Affairs Recruitment & Retention-Sept. 2015
---------------------------------------------------------------------------
The American Legion supports this section.
Section 3: Adjustment of Hours Authorized for Certain Full-Time
Employees of Veterans Health Administration
Currently, Section 7423(a) of Title 38, U.S.C., sets the hours of
employment of Full Time Employees (FTEEs) to not less than 80 hours in
a biweekly pay period 1A\6\. This section is a legislative request by
the VA which would allow the Secretary to modify the hours that
employees work within the Veterans Health Administration by changing
the regulation to ``be more or less than 80 hours in a biweekly pay
period if the total hours of employment for such an employee does not
exceed 2,080 hours per calendar year.''
---------------------------------------------------------------------------
\6\ 1A38 U.S. Code Sec. 7423: Personnel Administration; Full-Time
Employees-2011
---------------------------------------------------------------------------
The American Legion encourages and supports VA in providing
extended hours and weekend appointments for both primary and specialty
care at all VA medical facilities in addition to their regular hours of
operation 1A\7\.
---------------------------------------------------------------------------
\7\ 1AResolution No. 251: Extended Hours and Weekends for Veterans'
Health Care-Aug 2014
---------------------------------------------------------------------------
The American Legion supports this section.
Section 4: Public-Private Contributions for Additional Educational
Assistance for
Graduate Degrees Relating to Mental Health
This section allows the Secretary to pay 66 percent for the Yellow
Ribbon Program under the Post-9/11 GI Bill for a graduate degree in the
mental health field instead of ``up to 50 percent'' as is currently the
case. The schools would then only be required to pay the remaining 34
percent as opposed to ``an equal percentage.''
This increase is not going to apply to all people using the GI.
Bill, as there are several particular requirements to qualify. In order
to qualify the veteran would be required to already have a bachelor's
degree; be eligible for the Post-9/11 GI Bill and eligible for the
Yellow Ribbon Program; and pursuing the degree with the intention of
being a mental health professional for VA.
The Yellow Ribbon Program allows institutions of higher learning
(i.e., colleges, universities, and other degree-granting schools) in
the U.S. to voluntarily enter into an agreement with VA to fund tuition
and fee expenses that exceed the tuition and fee amounts payable under
the Post-9/11 GI Bill. It is well documented and understood that
present and future labor shortages are in the healthcare field. It's
important to note - as the aging U.S. population causes the number of
working-age adults to shrink - the demand for medical workers will
certainly increase. Consequently, paired with the often high education
and experience requirements needed to enter the job market - it has
been a factor in the shortage in healthcare workers.
Based upon VA's report, they've determined that the five
occupations with the largest staffing shortages' were Medical Officer,
Nurse, Physician Assistant, Physical Therapist, and Psychologist.
Without question there is a tremendous need for healthcare
professionals, and something has to be done to deal with this shortage.
This increase in payment just might provide the right incentive for
more schools to participate in the Yellow Ribbon Program and more
student-veterans to potentially pursue employment within the healthcare
field, which would lead to a greater percentage of potential employees
in the healthcare industry. The healthcare industry is an attractive
and high growth industry (includes good pay, benefits and mobility)--
it's a win-win for all of them and the VA.
The American Legion seeks and supports any legislative or
administrative proposal that improves, but not limited to the GI bill,
Department of Defense Tuition Assistance (TA), Higher Education Title
IV funding (i.e., Pell Grants, Student Loans, etc) and education
benefits so servicemembers, veterans, and their families can maximize
its usage. 1A\8\
---------------------------------------------------------------------------
\8\ 1AResolution 312: Ensuring the Quality of Servicemember and
Veteran Student's Education at Institutions of Higher Learning- Aug.
2014
---------------------------------------------------------------------------
The American Legion supports this section.
Section 5: Modification to Annual Determination of Staffing
Shortages in Veterans Health Administration
Currently, subsection (a) of section 7412 of title 38 U.S.C.
requires the Secretary to publish in the Federal Register, the five
occupations of personnel of this title of the Department covered under
section 7401 of this title for which there are the largest staffing
shortages throughout the Department as calculated over the five-year
period preceding the determination 1A\9\. This section would modify the
Veterans Access, Choice and Accountability Act, (VACAA) which required
the VA Office of Inspector General (VAOIG) on an annual basis to
determine the five occupations that have the highest staffing
shortages. The VAOIG would now be required to conduct a review to
evaluate staffing shortages within five clinical and nonclinical fields
within each Veterans Service Integrated Networks (VISNs).
---------------------------------------------------------------------------
\9\ 1A38 U.S. code Sec. 7412: Annual determination of staffing
shortages; recruitment and appointment for needed occupations-March
2016
---------------------------------------------------------------------------
The American Legion encourages and supports the VHA leadership to
conduct an internal review and develop an action plan to address VISN
management, staffing and its current geographic boundaries/catchment
areas for the purpose of providing veterans better and timely access to
quality health care. 1A\10\
---------------------------------------------------------------------------
\10\ 1AResolution 114: Department of Veterans Affairs Veteran
Integrated Service Networks-Aug. 2014
---------------------------------------------------------------------------
The American Legion supports this section.
Section 6: Repeal of Compensation Panels to Determine Market Pay
for Physicians
and Dentists
This section would replace subsection (c) paragraph (4) of Section
7431, Title 38 U.S.C. Paragraph (4) which determines the amount of
market pay for physicians or dentists, with a system that would require
the Secretary consult two or more national surveys of pay for
physicians or dentists, as applicable, whether prepared by private,
public, or quasi-public entities in order to make a general assessment
of the range of pays payable to physicians or dentists. It also
requires the Secretary to consult with and consider the recommendations
of an appropriate panel or board composed of physicians or dentists.
The American Legion currently does not have a position on Section
6.
Section 7: Executive Management Fellowship Program
This would require the Secretary to select, each year, at least 18
but not more than 30 eligible Veterans Benefits Administration (VBA)
and Veterans Health Administration (VHA) employees to participate in a
one year fellowship with a private sector company or entity.
As it currently stands, VA has over half of their critical
leadership positions either unfilled or filled in an interim role.
Sending a portion of the workforce out of VA every year would only
exacerbate this situation. If VA can afford to lose these personnel for
an entire year then they don't need that position. The American Legion
would rather see VA fill the positions they have and ensure there is a
full workforce available to treat the needs of veterans.
The American Legion opposes this section.
Section 8: Accountability of Leaders for Managing the Department of
Veterans Affairs
The VA has come under scrutiny by Congress, Veterans Service
Organizations (VSOs), media, veterans, and the American public for
their failures in leadership performance and accountability which
resulted in numerous quality and patient safety issues, as well as
patient deaths.
This section would add a new section following Chapter 7 of title
38, U.S.C.'s section 709 pertaining to Employment Restrictions. The new
section, ``Annual Performance Plan for Political Appointees,'' requires
the Secretary to conduct an annual performance plan for each political
appointee of the Department that is similar to the annual performance
plan conducted for an employee of the Department who is appointed as a
career appointee within the Senior Executive Service at the Department.
This assessment would ensure the employee is meeting their goals with
recruiting, engaging and motivating employees, training employees, and
holding each employee accountable for performance issues.
The American Legion urges Congress to enact legislation that
provides the VA Secretary the authority to remove any individual from
the Senior Executive Service (SES) due to performance and transfer
those individuals to a General Schedule (GS) position without any
increased monetary benefit. 1A\11\
---------------------------------------------------------------------------
\11\ 1AResolution No. 30: Department of Veterans Affairs
Accountability- May 2015
---------------------------------------------------------------------------
The American Legion supports this section.
Section 9: Modification to Veterans Preference
Veterans' preference is authorized by the Veterans' Preference Act
(VPA) of 1944; it only applies to federal government employment. It
provides that most veterans are to receive an extra five points (ten
points for disabled veterans) in receiving and keeping federal jobs.
The Veterans' Employment Opportunity Act (VEOA) of 1998 extended
certain rights and remedies to recently separated veterans. A grateful
nation created veterans' preference to ensure fair treatment for those
citizens who served this country in the Armed Forces. The following
recommendations are:
c IChange the service requirements to receive veterans' preference
for Reservists and Guardsmen from 180 days of consecutive active-duty
service to 180 days of cumulative active-duty service.
Based upon the high percentage of Reservists and Guardsmen that
have honorably served as well as been deployed multiple times in the
war against terror - their days of service should merit inclusion
within veterans' preference criteria for 180 days of cumulative
service.
c IExpand those to be considered ``preference eligible'' to include
all retired service members, including those who retire above the rank
of major or its equivalent.
In addition, approximately 250,000 service members leave the Armed
Forces every year, of which 6.4 percent are Officers O 094 and above
(6.4 percent equates to roughly 16,000 Officers O 094 and above).
America shouldn't overlook the minority of high ranking officers who
are ready to start a second career in public service. The lessons
learned in the Armed Forces allow these individuals to provide a
quality level of professionalism, expertise and patriotism within the
structure of a federal agency who's seeking that kind of talent.
c IExpand veterans' preference to also apply to hiring individuals
for the Senior Executive Service at VA.
The attributes that define a veteran employee, which include a
strong work ethic, adaptability, organizational skills, team player,
self-confidence, preparedness - are all things a leader needs to have
in abundance. It only seems fitting that veterans applying for a Senior
Executive Service position would receive veterans' preference.
Lastly, veterans' preference should play a large role in employing
veterans and their spouses. Federal agencies need to make sure that
their Human Resource personnel are properly trained to effectively
implement veterans' preference. The federal government has scores of
employment opportunities that educated, well-trained, and motivated
veterans can fill given a fair and equitable chance to compete. Working
together, all federal agencies should identify those vocational fields,
especially those with high turnover rates, for transitioning veterans
who are trying to continue their service within the federal government.
The American Legion restates its commitment to ensure that veteran
preference is consistently and accurately applied in federal civilian
recruitment, application, and hiring 1A\12\.
---------------------------------------------------------------------------
\12\ 1AResolution 301- Enforcing Veterans' Preference Hiring
Practices in Federal Civil Service: Aug 2014
---------------------------------------------------------------------------
The American Legion supports this section.
Section 10: Reemployment of Former Employees
This section would allow the Secretary to noncompetitively
reappoint a qualified former employee to any position within the VA as
long as the position is not more than one grade higher than what they
received in their former position and as long as if they employee left
VA voluntarily within the prior two years and has kept all licensures
and credentials up to date.
The American Legion currently has no position on Section 10.
Section 11: Recruiting Database
This section would require the Secretary of VA to establish a
single centralized database that lists all critical vacancies that are
difficult to fill within VA. This database would contain information on
qualified individuals who have applied previously for other positions
within VA in which they have not been selected however, would be
qualified for another position within VA. The Secretary would be
required to use this database to consider qualified applicants who have
already applied for other positions within VA to fill prolonged
vacancies.
The American Legion urges the VHA to continue to develop and
implement staffing models for critical need occupations. 1A\13\
---------------------------------------------------------------------------
\13\ 1AResolution 101- Department of Veterans Affairs Recruitment
and Retention: Sept. 2015
---------------------------------------------------------------------------
The American Legion supports this section.
Section 12: Human Resources Academy
This section would require Human Resources (HR) professionals
within VA be trained in hiring Title 38 employees within VHA. These
professionals will be adequately trained on how to best recruit and
retain employees in VHA.
The American Legion currently has no position on Section 12.
Section 13: Promotional Opportunities for Technical Expert
This section would require the Secretary to establish a promotional
track system for employees of the VA for technical experts without
requiring them to take managerial positions if they choose to stay
employed at VA.
The American Legion currently has no position on Section 13.
Section 14: Comptroller General Study on Succession Planning
This section would require the VA Comptroller General to conduct a
succession planning study at each VA Medical Center (VAMC), Regional
Office (RO), and National Cemetery (NCA). While The American Legion
supports studies on VHA staffing, we currently do not have a position
on staffing at the VARO's or at NCA.
The American Legion encourages and supports the VHA leadership to
conduct an internal review and develop an action plan to address VISN
management, staffing and its current geographic boundaries/catchment
areas for the purpose of providing veterans better and timely access to
quality health care. 1A\14\
---------------------------------------------------------------------------
\14\ 1AResolution 114: Department of Veterans Affairs Veteran
Integrated Service Networks- Aug. 2014
---------------------------------------------------------------------------
The American Legion supports this section.
Section 15: Information on Hiring Effectiveness
This section requires VA to measure and collect certain information
regarding hiring effectiveness. The American Legion continues to be
concerned VA's hiring process is cumbersome and negatively affects
VHA's ability to recruit and retain effective staffing levels in order
to meet veteran's overall health care needs.
The American Legion urges the VHA continue to develop and implement
staffing models for critical need occupations and that VA work more
comprehensively with community partners when struggling to fill
shortages within VA's ranks. 1A\15\
---------------------------------------------------------------------------
\15\ 1AResolution 101:Department of Veterans Affairs Recruitment
and Retention- Sept. 2015
---------------------------------------------------------------------------
The American Legion supports this section.
Section 16: Employment of Students and Recent Graduates
This section requires VA to promulgate regulations to allow for
excepted service appointments of students and recent graduates leading
to conversion to career or career conditional employment of a student
or recent graduate.
The American Legion has no position on Section 16.
Section 17: Exit Surveys
This section requires VA to request that employees voluntarily
leaving VA service complete standardized exit surveys.
The American Legion has no position on this section.
Conclusion
The American Legion understands that filling highly skilled
vacancies at premiere VA hospitals around the country is challenging.
We also expect VA to do whatever legally permissible to ensure that
veterans have access to the quality healthcare they have come to expect
from VA. VA leadership needs to do more to work with community members
and stakeholders.
Except as noted above, on balance there is a large amount of this
proposed legislation which would have a positive effect on transforming
VA to a more effective healthcare delivery system.
As always, The American Legion thanks the Subcommittees on Health
and Economic Opportunity for the opportunity to explain the position of
the over 2 million veteran members of this organization.
For additional information regarding this testimony, please contact
Mr. Warren J. Goldstein at The American Legion's Legislative Division
at (202) 861 092700 or [email protected]
Prepared Statement of Carlos Fuentes
Chairmen Benishek and Wenstrup, Ranking Members Brownley and Takano
and members of the Subcommittees, on behalf of the men and women of the
Veterans of Foreign Wars of the United States (VFW) and our
Auxiliaries, I want to thank you for the opportunity to present the
VFW's views on ways the Department of Veterans Affairs (VA) can improve
recruitment and retention of high quality health care professionals and
other employees.
The VFW thanks you for recognizing that VA's ability to hire and
retain high quality employees is equality as important as its ability
to fire or demote employees who put veterans' lives at risk. The VFW
agrees with many of the ideas included in the draft legislation being
discussed today. However, we would like to share an idea that we hope
the Subcommittees will consider.
Expedited Authority to Hire Frontline Health Care Staff
During our site visits of VA medical facilities, the VFW has
noticed one constant struggle facilities face--hiring and retaining
entry level clerks who help with answering phones, greeting patients,
scheduling appointments, and other administrative tasks. During our
visits, we often hear providers and facility leadership say that the
lack of administrative support staff limits their ability to deliver
health care to veterans, particularly when operating in a patient
aligned care team (PACT) where team members are often left to backfill
the duties of vacant positions. This contributes to attrition of
existing employees who are overworked and underpaid because of
vacancies that take too long to fill. Non-clinical VA employees,
including frontline staff, are typically hired under title 5, United
States Code (U.S.C.) authorities. Unfortunately, such authorities
preclude VA from expeditiously hiring qualified candidates to fill
vacancies.
Under section 7802 of title 38, U.S.C., the VA Canteen Service is
exempted from title 5, U.S.C., competitive service, general schedule
pay rates and classification requirements to ensure it is able to
provide veterans reasonably priced merchandise and services essential
to their comfort and well-being. Similar to VA medical facilities, the
Canteen Service relies on entry level employees to operate and maintain
its services. However, without the exemptions from competitive service
requirements, the VA Canteen Service would not be able to operate its
retail stores, cafes, and quality of life programs in VA medical
facilities around the country.
The VA Canteen Service has the authority to bypass the USA Jobs
process and hire employees through referral and traditional job search
engines such as Monster, Indeed, and Career Builder. When it finds
qualified candidates, the VA Canteen Service hires employees as
contractors while they undergo the 30 0960 day process to become a
federal employee. This process provides the VA Canteen Service the
latitude it needs to ensure its retail stores remain fully staffed
despite high turnover rates. The VFW urges Congress to provide the
Veterans Health Administration (VHA) similar authorities to quickly
hire into high turnover positions at VA medical facilities.
Discussion Draft to improve the authority of the Secretary of Veterans
Affairs to hire and retain physicians and other employees.
The VFW strongly supports efforts to expand VA's authorities to
hire and retain high quality employees. This legislation takes a
multifaceted approach towards achieving that goal. The VFW supports
sections 2, 3, 5, 7, 8, 12, 14, 15, 16 and 17; does not oppose sections
6, 10, 11 and 13; has concerns with section 9; and opposes section 4.
Section 2 would ensure VA has the authority to properly compensate
medical center directors. The VFW generally supports this section and
has two recommendations to improve it. Director positions are hard to
fill positions because they are responsible for overseeing hundreds of
employees delivering care and services to thousands of beneficiaries.
Such a charge requires proper incentives, such as market-based
compensation, which this legislation would address.
However, VA must also have the leeway to quickly hire a qualified
candidate when one is identified. The best qualified person for a
medical center position may not be searching for a job on USA Jobs, and
if VA identifies a qualified candidate it should not be required to
have that candidate apply for an opening through USA Jobs. This
legislation would also preclude directors from appealing a decrease in
pay resulting from an involuntary reassignment in connection with a
disciplinary action. While the VFW fully supports the reduction in pay
of VA employees who have committed malfeasants, we believe such
individuals have the right to due process. For that reason, we suggest
the Subcommittees clarify that the reduction in pay is final after the
employee has been offered the opportunity to appeal the disciplinary
action.
The VFW supports section 3, which would grant VA health care
providers the ability to have flexible working hours that best suit the
demand for health care by the veterans they serve. In response to the
access crisis, VA has made a full-fledged effort to increase access for
veterans who rely on VA for their health care needs. In the past year,
VHA has increased clinic production by 10 percent, adopted best
practices from the private sector, and increased the number of health
care employees by more than 14,000. Yet, VA continues to face numerous
challenges in meeting the growing demand on its health care system. One
of those challenges is the statutory 40-hour work week limitation for
title 38, U.S.C., employees. The VFW supports efforts to eliminate this
access barrier and improve VA's ability to recruit and retain high
quality health care professionals.
The VFW opposes section 4, which would amend the Yellow Ribbon
Program to require VA to cover up to 66 percent of the full cost of an
advanced degree in mental health care. The VFW is a strong advocate and
proponent of the Yellow Ribbon Program and the Post-9/11 Educational
Assistance Act, commonly referred to as the Post-9/11 G.I. Bill. The
VFW also supports efforts to provide additional assistance for veterans
who choose to advance their careers by obtaining a graduate or doctoral
degree in mental health care. However, the VFW does not believe
amending the Yellow Ribbon Program is the best option to do so.
The Yellow Ribbon Program was established to address the gap
between the cost of tuition and fees associated with approved degree
programs and the amount VA is statutorily able to cover under the Post-
9/11 G.I. Bill. To supplement the Post-9/11 G.I. Bill, VA is authorized
to enter into an agreement with educational institutions to cover up to
fifty percent of such gaps, which may be up to tens of thousands of
dollars. While the VFW agrees that increasing the percentage VA is
statutorily authorized to cover under the Yellow Ribbon Program would
incentivize educational institutions to establish Yellow Ribbon
agreements with VA, it does not provide much incentive for veterans to
obtain degrees in mental health care.
Furthermore, the discussion draft fails to ensure veterans have
enough Post-9/11 G.I. Bill eligibility to complete their degree
program. This is a particular concern for veterans who use their Post-
9/11 G.I. Bill benefits to obtain a bachelor's degree and would like to
participate in this program. Given that the Post-9/11 G.I. Bill is
limited to 36 months of eligibility, it is unlikely that these veterans
would have enough eligibility remaining to complete an advanced degree
in mental health.
The VFW is a proponent of public-private partnerships, but believes
this program would be better suited under VA's Health Professionals
Educational Assistance Program (HPEAP). VA operates six different
educational assistance programs under its HPEAP authorities, including
a debt reduction program and several employee scholarships. One of
those programs is the Visual Impairment Education Assistance Program,
which was created by Public Law 111 09163, the Caregivers and Veterans
Omnibus Health Services Act of 2010, to increase the supply of
qualified blind rehabilitation specialists for the department and the
nation.
This program authorizes VA to provide any person enrolled in a
degree or certificate program in visual impairment or orientation and
mobility up to $45,000 to complete their educational program if they
agree to serve as a full time VA employee after completing such
program. The VFW urges Congress to consider a similar program that
would authorize VA to cover the cost of a veteran's advanced mental
health care degree, up to the post-9/11 G.I. Bill rate, for veterans
who agree to serve as a VA mental health care professional.
Section 9 would amend veterans preference to ensure veterans who
served in the Guard and Reserves are afforded the same hiring
preferences as their active duty counterparts. Currently, veterans who
served after September 11, 2001, are required to have served at least
180 consecutive days on active duty. Due to our all-volunteer military
and the nature of the wars in Iraq and Afghanistan, the Guard and
Reserves have been utilized much more than they have during past
conflicts. However, not all Guard and Reserves service members receive
active duty orders for more than 180 days. Thus, many veterans that
deployed into harm's way in support of the wars in Iraq and Afghanistan
are not eligible for veterans hiring preferences. The VFW supports
correcting this inequity.
Section 9 would require VA to comply with title 5 competitive
service requirements when hiring Senior Executive Service (SES)
employees. While the VFW supports applying veterans preference to the
employment process for VA SES employees, we feel that Congress must
streamline, not impede, VA's ability to hire qualified executives. That
is why we recommend that the Subcommittees amend this section to exempt
VA's SES employment process from title 5 competitive service
requirement. To ensure VA hires qualified veterans as senior
executives, Congress should amend title 38 to ensure VA properly
considers veterans when hiring SES employees.
Mr. Chairman, this concludes my testimony and I will be happy to
answer any questions you or the Subcommittee members may have.
Information Required by Rule XI2(g)(4) of the House of Representatives
Pursuant to Rule XI2(g)(4) of the House of Representatives, the VFW
has not received any federal grants in Fiscal Year 2016, nor has it
received any federal grants in the two previous Fiscal Years.
The VFW has not received payments or contracts from any foreign
governments in the current year or preceding two calendar years.
Prepared Statement of Carolyn Clancy, M.D.
Good morning Chairman Benishek, Chairman Wenstrup, Ranking Member
Brownley, Ranking Member Takano, and Members of the Committee. Thank
you for inviting us here today to present our views on the draft bill
to improve the authority of the Secretary of Veterans Affairs to hire
and retain physicians and other employees of the Department of Veterans
Affairs, and for other purposes. Joining me today is Elias Hernandez,
Chief Officer, Workforce Management and Consulting; Tia N. Butler,
Executive Director, Corporate Senior Executive Management Office; and
Kimberly P. McLeod, Associate Chief Counsel.
We are pleased to see the Committee include in the draft
legislation, three of our legislative proposals which will give us the
necessary resources to meet the Department of Veterans Affairs' (VA)
obligation to provide timely, quality health care and benefits to
Veterans. Due to the timing of the hearing, the VA is unable to provide
views for sections 7, 9, 10, 11, 12, 15, 16, 17 as well as costs for
section 4. These are currently being drafted and we will forward the
remaining views and costs to you as soon as they are available.
Section 2, Appointment and pay for directors of medical centers and
Veterans Integrated Services Networks
VA supports section 2 as the provision matches a proposal put
forward in February 2016 in VA's Fiscal Year 2017 budget submission. VA
believes that there are three primary factors that warrant a separate
compensation system for Medical Directors and VISN Directors. First,
existing pay compression within the current Senior Executive Service
(SES) pay system and the closely proximate rates of pay for direct
reports to Medical Center Directors and VISN Directors have resulted in
declining Director applicant pools. Second, a high number of existing
(an estimated 84 percent by FY 2018) Directors are or will soon be
eligible for retirement. Third, private sector pay for health care
leadership positions is highly competitive.
In addition, there are limited pay incentives for experienced
Medical Center Directors and VISN Directors to voluntarily move to fill
more demanding positions. Due to the SES pay compression between
experienced Medical Center Directors and VISN Directors, the small pay
raise, if any, that VHA is able to offer in a reassignment may cause
the candidate to be disadvantaged financially. The most significant
cost disparities occur due to housing costs and in some cases, higher
tax rates (e.g., New York, California). With current executive pay
authorities, a move for the good of the organization most of the time
means a move to the financial detriment of Directors and their
families. On average, it has taken over 6 months to fill Medical Center
Director and VISN Director positions, with many being re-announced
multiple times for positions in both rural and major metropolitan
areas. The reluctance on the part of these senior leaders to relocate
is understandable. It is imperative that VHA have the ability to
implement pay to retain eligible leaders, reward mobility, and ensure
knowledge transfer to the next generation of Medical Center Directors
and VISN Directors. VA would request, however, that the section stating
that the Medical Director and VISN Directors be a qualified doctor of
any kind be removed from the bill. It is already difficult to recruit
for these positions. This additional restriction would make it nearly
impossible in some areas. VA estimates that enactment of section 2
would cost $8.8 million in FY 2017, $46 million over 5 years, and $93.2
million over 10 years.
Section 3, Adjustment of hours authorized for certain full-time
employees of Veterans Health Administration
Section 3 would allow VA to arrange flexible physician and
physician assistant work schedules to allow for the hiring and full
implementation of a hospitalist physician system and to accommodate the
unusual work schedule requirements for Emergency Medicine (EM)
Physicians.
VA supports increased flexibility for critical medical personnel.
Hospitalist physicians and EM physicians specialize in the care of
patients in the hospital, often working irregular work schedules to
accommodate the need for continuity of efficient hospital care. VA
believes that increased scheduling flexibility would align VA practice
with the private sector, facilitating the recruitment, retention of
emergency physicians and the recruitment, retention and operation of a
hospitalist physician system at VA medical centers (VAMC). We
understand that the Office of Personnel Management has some concerns
with respect to certain of the bill's provisions. The Administration
looks forward to working with the Congress and our agency partners to
finalize language on these provisions. VA would request the language in
section 3 (2) include the language of, ``is not less than'' in place of
``does not exceed''.
VA believes section 3 would be cost neutral in terms of impact on
salaries as it merely authorizes flexibility in physician and physician
assistant work schedules to allow for the hiring and full
implementation of a hospitalist physician system and improvements in EM
physician coverage and enhanced ability to recruit EM trained and
experienced physicians.
LRD
Section 4, Public-private contributions for additional educational
assistance for graduate degrees relating to mental health
Section 4 of the bill would also amend current section 3319 of
title 38 to prohibit the use of transferred entitlement under the new
program. If enacted, the amendments made by section 4 would apply to a
quarter, semester, or term that begins on or after July 1, 2017.
VA supports legislation that would provide training and employment
opportunities for Veterans; however, the Department has some concerns
with this section of the bill. VA is not certain a change in the way VA
and IHLs share contributions for specific degrees and programs would be
beneficial. Under its current structure, the Yellow Ribbon Program is a
remarkably successful program with nearly 2,000 participating
institutions. During FY 2015, 49,905 students were beneficiaries of the
program.
In order to implement section 4, VA would have to identify Post-9/
11 GI Bill Veterans who are currently pursuing an advanced degree in
mental health, determine their eligibility for the new program, and
verify that each Veteran intends to seek employment with VA. This would
create a significant administrative burden as the Long Term Solution
(LTS), the system used to process Post-9/11 GI Bill payments, does not
have the capability to issue varying Yellow Ribbon payments based on
the type of program being pursued. Subject to the availability of
funding, VA would need one year from the date of enactment to make
programming changes to the LTS to support implementation of this
section. In addition to LTS changes, the amendments made by section 4
would also require changes to the Comparison Tool, VA Online
Certification of Enrollment (VA ONCE), and Web Enabled Approval
Management (WEAMS) computer systems. Otherwise, manual processes would
be required, which would result in a decrease in timeliness and
accuracy for processing GI Bill claims.
Further, the amendments made by section 4 would authorize VA to
establish residencies and internships at VA medical facilities for
Veterans participating in the program. VHA has already established
training programs in mental health disciplines in many locations. These
programs lead to a degree, licensure, certification, or registration.
The process to develop training programs requires relationships with
accredited educational sponsors and suitable infrastructure for the
training program, including space, qualified faculty preceptors,
information technology (IT) equipment, staff support, and a sufficient
number of patients to satisfy the needs of the educational program.
Therefore, establishing residencies and internships must occur in
settings with appropriate infrastructure and collaborative educational
partnerships.
This bill also does not address the unique qualification standards
of each of the professions that are listed in the bill. Each of the 14
professions/disciplines listed has unique qualification standards which
must be met to be eligible for VA employment. For some of these
professions (e.g. psychologist, social worker, mental health nurse,
marriage and family therapist), the qualification standards include
both educational accreditation as well as licensure requirements. Other
professions listed (e.g. addiction therapist, vocational rehabilitation
therapist) do not have educational or licensure requirements.
The Yellow Ribbon Education program allows for Veterans to attend
mental health programs that do not meet the accreditation standards
required in the VA qualification standards. Thus, if an individual
obtained a degree in those programs, that individual would not be
eligible for VA employment.
For VA to support this bill, each of the professions listed that
has educational/licensure requirements would need to have a provision
that would state that the program meets the educational requirements
defined by the VA qualification standards. Additionally, for some of
the professions listed, even with such a provision, it may not be
possible to guarantee VA employment (even if the educational
requirements of the profession are met). For example, the Psychology
Qualification Standards require that an individual have graduated from
a program accredited by the American Psychological Association (APA) as
well as have completed an internship accredited by APA. While the bill
suggests that the Secretary may establish residencies and internships
at medical facilities of the Department, the Secretary is not able to
accredit these internships.
VA is still determining costs associated with this provision.
Section 5, Modification to annual determination of staffing shortages
in Veterans Health Administration
Section 5, would amend 38 USC Sec. 7412 (a) to require the
Inspector General of the Department of Veterans Affairs (VAOIG) to
determine and the Secretary of Veterans Affair to publish in the
Federal Register, the five clinical occupations and the five
nonclinical occupations of personnel of the Department covered under
section 7401 for which there are the largest staffing shortages with
respect to each Veterans Integrated Services Network (VISN) as
calculated over the five-year period preceding the determination.
The VA defers to VAOIG on how they would process this report.
Section 6, Repeal of compensation panels to determine market pay for
physicians and dentists
Section 6 would modify 38 USC Sec. 7431 to eliminate the
compensation panel recommendation process required under 38 USC
Sec. 7431(c)(4)(B).
VA supports this section as it is similar to another proposal put
forward in February 2016 in VA's Fiscal Year 2017 budget submission.
The ``Department of Veterans Affairs Health Care Personnel Enhancement
Act of 2004'' (Public Law 108 09445, dated December 3, 2004)
established the current pay system for Veterans Health Administration
(VHA) physicians and dentists. A requirement of the pay system that has
proven to be of little or no value is the compensation panel process.
The current statute requires that the recommendations of a panel
composed of physicians or dentists be considered when determining the
amount of market pay for a physician or dentist. To the extent
practicable, the panel must consist of physicians or dentists (as
applicable) who are practicing clinicians and who do not hold
management positions at the medical facility at which the physician or
dentist subject to the consultation is employed. In most circumstances,
this requires physicians or dentists to take time away from providing
direct patient care in order to perform the unnecessary administrative
function of recommending the amount of pay for prospective employees.
The compensation panel process is time consuming and adds no value
as Medical Center Directors and/or other approving officials have the
authority to approve (decide) the final rate of pay. Currently there
are three separate reviews being conducted for VHA physicians and
dentists prior to their appointment, to include: (1) a Professional
Standards Board reviews the qualifications standards and makes a
recommendation to appoint an individual tentatively selected for a
position; (2) the compensation panel recommends market pay and annual
salary for the provider; and (3) the Medical Staff credentialing and
privileging committee reviews the provider's credentials and recommends
medical staff clinical privileges.
As an example, a compensation panel may be required to convene to
make a salary recommendation for two prospective physician candidates.
At a minimum, three physicians would be required to meet to review a
recommendation made by the selecting official or Chief of Staff, and
complete the Compensation Panel review form. Using an average salary
for a VA physician of $218,237 (or $104.92 per hour) in manpower hours
it would cost $52.46 per 30 minutes x 3 physicians, or approximately
$157 per compensation panel.
This may seem like a trivial amount but if you consider the number
of times each medical center convenes a compensation panel, multiplied
by the number of VA facilities across the country, the manpower cost of
this administrative function is much more significant. In VA facilities
with numerous physician and dentist vacancies, compensation panel
members may be required to spend many hours a week meeting to
deliberate and recommend salary for prospective employees. Market pay
criteria and documentation on the Compensation Panel Recommendation and
Approval form, VA Form 10 090432a, is time consuming and continues to
be a challenge for clinicians.
This arduous process also contributes to a delay in hiring. A VA
facility is often unable to convene a Compensation Panel on a timely
basis because its members are unable to quickly meet due to patient
care responsibilities. Physicians and dentists typically will not
accept employment or give notice without a firm salary offer, and in
cases where Compensation Panels are delayed, it pushes back the
starting dates of new providers which also negatively impacts patient
care.
It would be more cost effective and time efficient to allow a
selecting official and/or Chief of Staff to recommend to the facility
director the appropriate salary for prospective employees and eliminate
the compensation panel process.
The VA believes this proposal to be cost neutral. Physicians and
dentists will continue to be paid rates approved by the appointing
official. This proposal will benefit VA by streamlining the appointment
process.
Section 8, Accountability of leaders for managing the Department of
Veterans Affairs
Section 8 would amend chapter 7 of Title 38 by adding in a new
section 709A, which would require the Secretary to annually assess the
performance of political appointees in a manner similar to the
assessment of career Senior Executive Service employees.
Section 13, Promotional opportunities for technical experts
Section 13 would require VA to develop a promotional track, which
does not involve a transition to a management position, for employees
who are considered technical experts. VA is committed to ensuring that
its employees are allowed to advance in their careers, regardless of
whether the employee wants to be a manager. Consequently, VA supports
this section.
Section 14, Comptroller General study on succession planning
Section 14 would require the Comptroller General to conduct a study
on the succession planning at each medical facility of the Department
of Veterans Affairs, the Veterans Benefits Administration and the
National Cemetery Administration and submit it to the House and Senate
Veterans' Affairs Committees not later than one year after the date of
enactment of this Act.
The study would include: a determination of the mission-critical
positions within the entity and the vacancy risk of such positions; an
analysis of the future needs for mission-critical positions and gaps
within the existing talent poll of the entity; a description of
strategies to close skill gaps through the use of training for existing
staff, targeted recruitment, and hiring; a plan to regularly evaluate
progress of staff and update existing succession plans using clear and
measureable metrics and benchmarks; a demonstration of the capacity of
the entity to execute succession plans with successful succession
management strategies; and any other matters Comptroller General
determines appropriate.
VA defers to GAO.
Mr. Chairman, this concludes my statement. Thank you for the
opportunity to appear before you today. We would be pleased to respond
to questions you or other members may have.
Statements For The Record
AMERICAN FEDERATION OF GOVERNMENT EMPLOYEES
Overview: AFGE strongly objects to Section 6 of this draft bill. It
would destroy the critical market pay process established through
strong bipartisan support twelve years ago when Congress enacted P.L.
108 09445 to ensure that VA provider pay would be competitive with
other health care systems. More specifically, this bill would devastate
the Department's ability to recruit and retain physicians and dentists
through:
u IElimination of the requirement that the Secretary consult two
pay surveys;
u IElimination of the requirement that the Secretary consider the
recommendations of a panel of peers; and,
u IReturn of all market pay determinations to full Secretary
discretion.
The VA desperately needs stronger market pay requirements, not a
market pay process completely subject to Secretary discretion.
Currently, the VA is losing large numbers of physicians and dentists
because of broken pay policies, including: managers who pay new hires
$20,000 or more than incumbents; managers who make pay promises to new
hires that they break once the provider is on board; management's
refusal to convene market pay panels every two years; and improper pay
panel composition.
This provision would vastly increase the use of arbitrary pay
policies against front-line providers in order to further management
cronyism, discrimination against older physicians and other targeted
groups and retaliation against vocal providers. The mean-spirited and
arbitrary nature of this provision makes even less sense given that it
appears to eliminate an important right for one group of providers
while giving that identical right to VA directors!
Analysis of other sections:
Section 2(a): This subsection would expand eligibility for medical
center director (MC) and Veterans Integrated Service Networks (VISN)
director appointments to all qualified medical professionals. AFGE
supports.
Section 2(b):
u IThis subsection would extend part of the existing market pay
process to MC and VISN directors. AFGE supports consideration of
recruitment and retention needs for setting market pay for these
positions and the requirement to adjust pay every two years. However,
AFGE strongly recommends greater transparency in all market pay-setting
processes (directors, and management and non-management physicians and
dentists). More specifically, all employees and their representatives
should have the same rights to request copies of survey data as was
afforded to registered nurses by Section 601(j) of the Caregiver Act.
u ISimilarly, all employees whose market pay is set by pay panels
(which does not apply to directors under this bill) should have the
right to request information about the composition of their panels.
u IFrequency of market pay adjustments: Noncompliance with the
current requirement to make market pay adjustments at least every two
years is rampant. Directors are far more likely to get timely
adjustments under this bill than front-line healthcare providers.
Therefore, AFGE strongly urges the Committee to ensure that managers be
held accountable for delays in convening market pay panels and
implementing pay adjustments through performance measures and new
requirements to report market pay adjustments to Congress. In addition,
physicians and dentists deserve equal bargaining rights so they can
challenge unfair and illegal pay practices. Therefore, AFGE urges the
Committee to approve H.R. 2193, introduced by Representative Mark
Takano (D 09CA). H.R. 2193 is a valuable recruitment and retention bill
because it also equalizes rights to bargain over indirect patient care
matters such as scheduling and assignments.
u IPay decreases: This provision would deny directors all rights to
appeal pay decreases. AFGE strongly opposes this provision. Such broad
Secretary discretion will encourage abuse of discretion by officials
seeking to harass, discriminate and conduct de facto terminations.
Under current law, management and non-management physicians and
dentists are protected to some extent against arbitrary market pay
decreases as long as they stay in the same position. However, as
already noted, non-management physicians and dentists have very little
actual ability to challenge unfair and illegal pay actions because of
unequal bargaining rights.
Section 3: This provision would provide flexible work schedules for
most ``pure Title 38'' personnel. AFGE supports this provision. AFGE
again urges passage of H.R. 2193 to ensure that every VA employee has
an equal right to challenge unfair management practices related to
schedules, assignment and other routine workplace matters.
Section 4: No comment.
Section 5: This provision would expand the annual staffing shortage
determinations to include nonclinical occupations. AFGE supports.
Section 7: This provision would place Veterans Health
Administration (VHA) and Veterans Benefits Administration (VBA)
employees in private-sector executive management fellow programs. AFGE
strongly opposes this provision. This is likely to be a costly program
of little value. The skills required to be effective in the VBA and VHA
workplace must be learned in-house using strong in-house mentors with
sufficient time and skills, not private sector managers who have no
experience with the VA's unique population, or its unique health care
system and benefits programs.
Section 8: This provision would establish an annual performance
plan for political appointees. AFGE supports.
Section 9: This provision makes it easier for reservists to earn
veterans' preference by counting cumulative service. AFGE supports.
Section 10: This provision allows for noncompetitive appointments
with significant pay increases for returning employees, subject to full
Secretary discretion. AFGE strongly opposes this provision. Upper
management is very likely to abuse this hiring authority to hire their
own friends and pass over other qualified applicants using the
competitive process. In addition, it will be very easy for managers and
employees they favor to game the system by leaving the VA in order to
return at a higher grade. VA managers already engage in far too much
cronyism in both the hiring and pay processes.
Section 11: This provision would establish a single database of
vacant positions. AFGE generally supports this concept but is concerned
that veterans working in VHA will be harmed by any increase in
Secretary hiring discretion. More specifically, Congress should more
closely monitor the VA hiring process to ensure that all applicants
have a fair chance to be considered under this single database.
Congress should also enact legislation to close the harmful loophole in
the Veterans Employment Opportunities Act that deprives Title 38
appointees of equal veterans' preference rights, allowing managers to
pass them over for non-veterans in the hiring process. (Language to
close this loophole was included in H.R. 2275 in the 113th Congress).
Section 12: This provision would establish a VHA training academy
to improve human resources (HR) training. AFGE supports improved
training for HR personnel who appear to lack critical skills in areas
such as coding personnel actions, applying shift differential pay rules
and determining the cope of Title 38 bargaining rights. However, as we
have seen from the VBA academy training program, on-the-job training
under strong mentors is also a critical component of any training
process.
Section 13: This provision establishes a technical expert
promotional track. AFGE supports.
Section 14: This provisions mandates a GAO study of succession
planning. AFGE supports with the provision that researchers adequately
consider the input of front line employees and their representatives
who have unique insights into training, recruitment and hiring.
Section 15: This provision requires the Secretary to collect
information on hiring effectiveness. AFGE generally supports more data
collection but urges the Secretary to adequately consider the input of
front line employees and their representatives who have unique insights
into hiring. AFGE strongly opposes any increase in the use of special
hiring authorities that adversely impact veterans' employment.
Section 16: This provision would increase the use of excepted
service appointments for students and recent graduates. AFGE strongly
opposes this as it is likely to adversely impact veterans' employment.
Section 17: This provision would improve and expand the
Department's use of exit surveys. AFGE supports the use of exit surveys
but will only support this provision if: (1) the Secretary adequately
considers the input of front line employees and their representatives;
and (2) the Secretary is required to share the survey results with
employees and their representatives, veterans' groups and other
stakeholders.
NATIONAL ASSOCIATION OF VA PHYSICIANS AND DENTISTS
Chairmen Benishek and Wenstrup, thank you for the opportunity to
comment on your proposed legislation ``To improve the authority of the
Secretary of Veterans Affairs to hire and retain physicians and other
employees of the Department of Veterans Affairs and for other
purposes.''
I am a practicing physician with more than 4 decades with the VA
and the President of the National Association of Veteran Administration
Physicians and Dentists usually referred to as NAVAPD.
I might add that I too am a veteran, having served for two years on
active duty in the US Public Health Service.
The National Association of VA Physicians and Dentists (NAVAPD) is
a 501(c)(6) nonprofit organization and is dedicated to improving the
quality of patient care in the VA health care system and ensuring the
doctor-patient relationship is maintained and strengthened.
NAVAPD believes that a key means of enhancing the care of the
Veterans is by employing the best physicians and dentists. NAVAPD
believes it is essential for health care providers to be involved in
decisions regarding delivery and quality of care.
In the late 1960s and 1970s nearly all of the VA Medical Centers
were led by Directors who were physicians and your draft legislation
says Veterans Affairs Medical Center and Veterans Integrated Service
Networks directors ``may be appointed to suit the needs of the
department, who, to the extent practicable, shall be a qualified doctor
of medicine or a qualified dental surgeon or other qualified medical
professional''. I strongly support this provision and suggest you
consider eliminating ``who, to the extent practicable''.
Currently, in the VA, the single greatest impediment to recruiting
and retaining physicians and dentists is the disenfranchisement and
marginalization that many of the current physicians and dentists
experience daily. Today, most VA physicians and dentists feel like
their opinions are neither helpful nor requested. In many facilities,
their suggestions are summarily rebuffed as inconsequential. At many
centers, physicians and dentists are no longer even considered
professionals but referred to as simply the ``workers''. These
observations do not just come from NAVAPD leadership, but directly from
our members, VA docs and dentists. Men and women who want to help
improve ``the system.''
The proposed revisions to legislation regarding physician work
hours would at least theoretically permit VA medical center leaders to
unilaterally and dramatically alter a physician's tour indefinitely,
and without any stated reason. Specifically, the provision which states
``The Secretary may modify the hours of employment for employees in a
position specified in any of paragraphs (1) through (6) of section
7421(b) of this title to be more or less than 80 hours in a biweekly
pay period if the total hours of employment for such an employee does
not exceed 2,080 hours per calendar year.'' appears to make it possible
for physicians to be told they must work every weekend, or move to
night or evening shifts, or have frequently changing tours. While all
physicians recognize that in a medical emergency they must do whatever
they can to protect patients and treat immediate medical problems, any
involuntary change in their negotiated tour should be motivated by a
bona fide emergency that demands the attention of a physician. It
stands to reason that these circumstances should have defined endpoints
in time and clearly articulated goals, and should include a general
staffing shortfall (where the services needed could be provided by non-
physicians). The authority proposed by this revision should be
qualified by these stipulations.
Recommend the legislation clarify the 24/7 rule's original intent
that it go into effect only if a national or state emergency is
declared by either a Governor or the President. Currently the 24/7 rule
is used as a threat by hospital directors and it should not be used to
intimidate the physicians and dentists. It also appears to be used as a
no-cost method of solving staffing shortages or operational problems.
This is an inappropriate abuse of privilege to solve the consequences
of poor management.
The following are - apart from the important matter of momentary
compensation - key factors that are widely reported as undercutting
physicians' performance and satisfaction.
1. Denigration of CME. It is quite apparent that the VA has little
regard for the continuing professional education of its physicians.
Despite the fact that the Physician Pay Law of 2004 stipulates
financial support of CME, it is regularly reported that the process for
a physician to make use of the $1000 allocated for CME is so
cumbersome, untimely and burdensome that many simply forego the
education itself or in some cases pay out of pocket. Furthermore, the
allocation is paltry in relation to actual, current CME costs. The
Physician Pay Law uses the language ``up to $1000'' to indicate that
the maximum funding is $1000 instead of the total cost of a much larger
cost. Instead, hospital Directors have used this language to argue that
they can provide any amount below $1000. This is the opposite intent of
the law, and further frustrates physicians.
One would think that the VA would see, as obvious, that the
ultimate beneficiary of CME is the veteran-patient. Instead, the VA
treats CME as an indulgence. The damage done is to the capability and
morale of physicians as well as to patients. In, comparison with what
the physician would have available in the private sector, it's hardly a
recruiting tool; it is a disincentive to join or remain in the VA.
2. Ignoring the Federal Physician Pay Law/Ghost pay. The VA often
acts as if there is no legal foundation of physician pay. There is.
Physician Pay has three legally defined components: Base Pay, Market
Pay, and Performance Pay.
In the Pay Law, performance pay is authorized up to $15,000 per
physician and appropriated for incentivizing physicians, but no one
seems to know where it goes, and some do not even seem to know that it
exists. Local Directors arbitrarily restrict performance pay to any
level they wish. How? Funds are allotted to VISNs and then to
facilities for performance pay, but only smaller amounts are dispersed.
Where are the remaining funds?
Stipulated bi-annual market surveys and adjustments are skipped or
ignored, market adjustments seem to go to ``favored'' staff members.
Pay panels are assembled with pre-conceived performance pay outcomes.
VA leaders at all levels (local, VISN, Central Office) need to be
pressured to bring pay management into conformance with the Pay Law.
The Pay Law is law, not a suggestion.
Upper echelon VA management seems to think that continuing
obscurity is the best way to handle this issue. In fact, however, what
gets perpetuated is distrust and the sense that superiors are specially
helping themselves and their friends with these funds. Transparency and
behavior that is CONSISTENT with the Physician Pay Law are sorely
needed.
3. Disrespect Disparity. In a private sector organization, no one
would expect a staff person to treat a physician as just another
``worker'' nor expect that a physician would be without remedy when
support personnel regularly fail to perform at a satisfactory levels.
At VA facilities, a supporting employee - tech, secretary, etc. - sees
his or her supervisor as the individual to be pleased, not the
physician involved in patient care. Reports of this phenomenon are
legion.
This will not be remedied unless personnel come to see that
properly supporting the physician is of paramount importance - and this
will not occur unless there is a system whereby the physicians can
anonymously rate personnel, including their supervisors. A department
head should be held to explain why any such ratings within the
department are low.
Relatedly, there are many reports by physicians complaining that
their time is taken up by basic secretarial work - a problem that would
be much alleviated by making support staff concretely responsible to
physicians rather than living in a parallel merit system controlled by
a reigning supervisor. The VA has systematically shifted physician-
roles to non-physicians while simultaneously encumbering physicians
with more non-physician duties, such as filing reports. This disrespect
for physician skills and roles starts are the tops and filters down to
all layers of the organization.
4. The HR problem. HR has too wide a variety of responsibilities
and some basic conflicts of interest - which cannot be remedied within
HR.
A key responsibility is to locate and intake needed personnel,
particularly physicians. It is generally reported that the process is
so slow and cumbersome that good recruits are routinely lost to other
jobs. The draft bill proposes to offer education to HR personnel, but
it does nothing to eliminate or streamline the requirements of the
recruiting process that are the heart of the problem. The bill also
needs to add accountability to the education. Lots of money is spent by
the VA on educating HR personnel, but performance has not improved.
This must change if VA is to turn its image around.
Another key responsibility is to process and resolve employee
(including physician) complaints about their working conditions or
treatment by co-workers or superiors, but HR is hopelessly conflicted.
HR works for management, not the employees. It naturally sees its
function as one of employee pacification, not employee support and
assistance. Given the numerous employee-biased programs within the
government, HR fears retaliation for assertive corrective action and
thus is reluctant to challenge problematic employees.
Although the VA regularly issues declarations purporting to support
employees' rights to challenge possible wrongdoing and inefficiencies,
such declarations are toothless and largely ignored. There is a need to
create a separate system - an ombudsman system, similar to the IG
system where the ultimate authority lies outside the department - to
process such employee grievances. There really is no other solution.
Furthermore, this would free up HR to concentrate on other important
functions, including recruiting.
5. Shedding Stupid Rules. There are numerous physician complaints
about time being misused by VA requirements for TMS testing -
essentially unrelated to their duties of patient care. There are also
rules that obstructively interfere with the flexible management of
physician time. For example, if a physicians needs to make arrangement
to be away for several hours in an afternoon to take care of a non-VA
problem he or she must take off the entire day as personal time - a
rule that serves little purpose but to irritate. If the VA has a
serious interest in retaining physicians by creating a benign working,
atmosphere, someone should be put in charge of weeding out noxious
over-regulation.
NAVAPD supports:
modification to annual determination of staffing
shortages;
reemployment of former employees;
recruiting database;
Comptroller General study on succession planning VA-wide
(although don't know why you don't ask GAO to do it now rather than
wait for enactment)
promotional opportunities for technical experts;
information on hiring effectiveness; and
exit surveys.
While NAVAPD is largely focused on physician and dentist related
issues, we cannot ignore issues that impact recruitment and retention
of other critical professionals in the VA facilities. VA's ability to
fully serve Veterans is also predicated upon sufficient levels of these
personnel. Nursing is represented by its own unions and organizations,
but other key professionals are not, and they are also critical to
effective patient care. Many do not receive appropriate consideration
of attractive pay and benefits to assure their recruitment and
retention. We believe that arbitrary segmentation is counter to the
need to attract and keep skilled staff. We believe that the Hybrid
designation for many professionals (such as Respiratory Therapists)
should be eliminated and these professions should be made full Title 38
employees with the obligations and benefits of that designation.
We applaud the intent of the Human Resources Academy but would
recommend a review of the responsibilities of HR professionals and what
could be consolidated/centralized so valuable time could be spent on
recruitment/retention. The Department of Commerce is implementing a
``shared service for HR processing department-wide'' and leaving
policy, professional training, hiring decision-making at operational
unit level. NASA has a similar operational model.
Many of your provisions could be undertaken administratively by
Veterans Affairs management if they had the political will. I am also
including my recent statement before the Congressionally mandated
Commission on Care in January.
Thank you again for inviting NAVAPD to provide our comments
regarding your important draft legislation.
VETERANS AFFAIRS PHYSICAN ASSISTANT ASSOCIATION'
Chairman Benishek, Chairman Wenstrup, Ranking members;
Congresswoman Brownley, Congressman Takano and other members of the
House Veterans Affairs Subcommittees on Health and Economic
Opportunity, on behalf of the entire membership of the Veterans Affairs
Physician Assistant Association (VAPAA) we appreciate the invitation to
submit this testimony for the record. We thank bipartisan members of
this committee for critical legislation for Physician Assistant (PA)
Workforce issues before you today in the VA System with sponsoring
`Grow Our Own Directive: Physician Assistant Employment and Education
Act of 2015.'' (S.2134) and (H.R. 3974) and we thank Congresswoman Ann
Kuster for her leadership on this bill.
The Physician Assistant (PA) profession has a special unique
relationship with veterans. The very first classes of physician
assistants to graduate from PA educational programs were all former
Navy corpsmen and Army medics who served in the Vietnam War and wanted
to apply their knowledge and experience in a civilian role in 1967.
Today, there are 199 accredited PA educational university programs
across the United States and approximately 2,020 PAs are employed by
the Department of Veterans Affairs (VA), making the VA the largest
single federal employer of PAs. These PAs provide high quality, cost
effective quality health care working in hundreds of VA medical centers
and outpatient clinics, providing medical care to thousands of veterans
each year in their clinics. Physician Assistants work in both
ambulatory care clinics, emergency medicine, CBOC's in rural health,
and in a wide variety of other medical and surgical subspecialties.
1A\1\ 1A\2\ In the VA system about a quarter of all primary care
patients treated are seen by a PA 1A\3\. Approximately 32% of PAs today
employed by VHA are veterans, retired military, or currently serving in
the National Guard and Reserves.
---------------------------------------------------------------------------
\1\ 1AWilliam Fenn, PhD, PA, Vice President, American Academy of
Physician Assistants, Testimony before the United States Senate
Committee on Veterans Affairs, Hearing on S. 1155, a bill to elevate
the VA's PA Advisor to a full-time director of PA services in VA
central office, (October 21, 2009)
\2\ 1APhysician Assistant Education Association, Letter to Senate
Majority Leader Harry Reid and Speaker of the House Nancy Pelosi
(January 15, 2010) http://www.paeaonline.org/index.php?ht=a/
GetDocumentAction/i/99520
\3\ 1AAmerican Academy of Physician Assistants, Press Release
(March 5, 2011) http://www.aapa.org/news--and--publications/pa--pro--
now/item.aspx?id=1917
---------------------------------------------------------------------------
The Veterans Affairs Physician Assistant Association (VAPAA)
maintains that Physician Assistants are a critical component of
improving VA health-care delivery, and have consistently recommended
that VHA include them in all health-care national strategy staffing
policy plans. Since our testimony last May, the VA has identified that
both in VA OIG Reports, and VHA Succession Planning Committee that the
PA occupation is in top five critical healthcare occupations with high
retention and vacancy problems. However, since January 1993 when VA
added the Title 38 GS 0913, Chief Grade more than 22 years ago, little
else has been done for this critical workforce and hope that as these
committees review changes to improve access to care for veterans and
oversight on VHA strategy for its healthcare workforce that changes
will be included to address these PA problems.
Civilian Growth Physician Assistant Profession
Forbes, US News & World Report, and New York Times articles all
again named Physician Assistant occupation the single best master's
degree for the third year in a row, citing the profession's favorable
outlook for salary and long-term employment. The PA field was listed as
one of the 50 best careers in 2014 due to increasing demand for health-
care services, the impending retirement of baby boomers, and broader
efforts to limit health-care costs. 1A\2\According to the US Bureau of
Labor Statistics the PA profession is expected to grow by 30% from 2012
-2022
---------------------------------------------------------------------------
\2\ 1A[2] US News and World Report, Best Careers 2011: Physician
Assistant (December 6, 2010) http://money.usnews.com/money/careers/
articles/2010/12/06/best-careers-2011-physician-assistant
---------------------------------------------------------------------------
In early February, VA Secretary Bob McDonald and USH Dr. Shulkin
testified about the challenges facing VHA in hiring employees.
Secretary McDonald told the House Veterans Affairs Committee that he
has personally visited dozens of colleges to recruit medical students,
but that the people he talked to had the perception that the agency was
intent on firing its employees. The VA also struggles to recruit
medical personnel away from the private sector to come to the agency
where they are likely to have a lower salary and be posted to less
desirable, rural locations.
The VA hired 41,000 new employees last year, but that represented a
net increase of only about 14,000 staff, or 4.7 percent of the Veterans
Health Administration payroll, according to Secretary McDonald's
prepared statement for the House VA Committee. The department said in
an emailed statement early February that the VA has about a 9 percent
turnover rate - which it said is better than an 18 percent turnover
rate in the private sector.
VA officials said the current staffing shortage mirrors national
trends in health care, where a study by the Association of American
Medical Colleges predicted that the shortage of physicians could range
from 46,000 to 90,000 in the next 10 years. 1A\4\
---------------------------------------------------------------------------
\4\ 1ASecretary VA Budget Testimony February 2016 before House VA
Committee on VA Budget
---------------------------------------------------------------------------
VHA Recruitment and Retention of Physician Assistants; Problems
Continue to rise
Physician Assistants provide health care access for millions of
veterans each year, VHA has not developed any strategic national plans
to address the chronic 10% to 14% total loss rate, which is one of the
highest of any profession in VHA - top five hard to recruit
occupations. With the existing reported disparity in pay between PAs
employed by the VA and the private sector market this problem continues
to grow. For several years, The Independent Budget veterans service
organizations (IBVSOs) along with American Academy Physician Assistants
(AAPA), and Veterans Affairs Physician Assistant Association (VAPAA),
have all recommended that Congress ensure the retention and recruitment
problems for PA's be immediately rectified with new national targeted
policy and programs for this critical occupation.
The VA Office of Inspector General (OIG) Report #15 0900430 09103,
January 30, 2015; conducted a determination of Veterans Health
Administration (VHA) occupations with the largest staffing shortages as
required by Section 301 of the Veterans Access, Choice, and
Accountability Act of 2014. VAOIG determined Physician Assistant, were
3rd compared to all other VHA occupations with the largest staffing
shortages. 1A\5\ In addition to the VAOIG report the National Workforce
Succession Planning 2015 - the data demonstrates the scope of the
problems.
---------------------------------------------------------------------------
\5\ 1AVAOIG Report #15 0900430 09103, January 30, 2015 VA Health
Care Critical Occupations Staffing
---------------------------------------------------------------------------
Data VHA National Workforce Succession Planning 2015
In 2016 37% of VHA PA is eligible to retire. That is
approximate loss of 600 Physician Assistants. By 2021 48% of VHA PA's
are eligible to retire.
2014 - PA's had the highest Total Loss Rate of 10%; of the
other top ten occupations.
2014 - 14.28 % VHA PAs left the VA due to Compensation
(salary and benefits).
The PA workforce has grown far less than other physician extend
positions within the VHA and little is being done about it; therefore,
what should be a warning signal of serious retention and recruiting
problems is being left to local VAMCs to manage. Despite increasing
discrepancy in salary levels, benefits, and education debt reduction
programs between the civilian sector and the VAMCs often tells our
members there is no problem. Currently Physician Assistants remain in
an antiquated pay system with no competitive market survey resulting in
a large pay disparity with the civilian sector. Last May I testified
that the VA utilize the Nurse Locality Pay System surveys (LPS)
allowing for annual market salary surveys aligning these professions
within the VA with the private sector market. Inclusion of Physician
Assistants into the Nurse LPS within Grow Our Own Directive H.R. 3974
will allow for salary adjustments so that the VHA can be competitive.
VAPAA is also concerned that the use of recruitment incentives
within the VA is at the discretion of the hiring facility and is not
standardized across the VA system. During 2012 092013 only 44 Physician
Assistants have received $319,074 in funding to further their education
in comparison to Seven hundred five registered nurses seeking to become
Nurse Practitioners receiving scholarship awards totaling over
$11,842,919 in support of NPs and NP programs. VA should implement
recruitment and retention tools targeting Employee Incentive
Scholarship Program by including PA as a hard to recruit occupation at
the facility level to reflect WSP and OIG findings. Include Employee
Debt Reduction Program funding to include PAs and make it available to
all advertised PA vacancy announcements as EDRP cannot be issued unless
it is advertised in the initial vacancy announcement. VISN and VA
medical center directors must be held accountable for the failure to
utilize these recruiting tools. Evidence of the problem from small
sample of VAMC's reflecting lack of VHA controls on providing
scholarships to PAs.
New Orleans Office the National Healthcare Recruiter, Workforce
Management & Consulting VHA Healthcare Recruitment & Marketing said
they have no Health Professional Scholarship Program (HPSP) funds of
their own, so they are using funds provided by the VACO Office of
Academic Affiliations to provide HPSP to nurses who want to be NPs.
They have stated that these funds are not available to Intermediate
Care Technician (ICTs) combat OIF OEF veterans, seeking to become PAs.
The same office assured senior PA office representatives at the same
time that they have EISP VANEEP/NEEI scholarship funds are available
for VAMCs who request the funds.
Cincinnati VAMC has told their ICTs who asked for VANEEP for PA
education that they have been ``out of'' VANEEP funds for the last 4
years. What exactly does that mean since the funds come from New
Orleans? No VAMC funds the VANEEP locally.
San Diego VAMC told one of our ICT that they have ``suspended'' all
scholarships and no support for PA students will occur.
The VAMC in Spokane told an ICT that PAs were not a critical
occupation in the VA and that therefore she was not eligible for VA
scholarship funds.
PAs then across the country find on USA JOBS web site and in VA
news stories the following: Through its network of academic
affiliations and sponsored programs, VA invests $900 million annually
to provide clinical education and training programs to approximately
120,000 health care trainees. Sixty percent of VA's psychiatrists, 70
percent of its psychologists and 35 percent of its social workers have
previously participated in VA's training programs.
These committees must make certain that opportunities for required
PA continuing medical education and training exist within the VA
education programs. Physician Assistants provide high quality, cost
effective medical care as they are held to the same standards of health
care delivery as their MD/DO VA colleagues who are afforded a yearly
stipend for continuing educations. PAs must maintain CME hours.
Physician Assistants mush recertify by examination every 10 years. In
order to be competitive with the civilian sector, the VA must make
certain that employees gain opportunities for required PA professional
development and continuing education and training in support in
maintaining a high level of professional competence.
Continued Delays in Hiring PA Employees
VAPAA has found since last May's hearing that whenever a PA
employee leaves the VA system, VA acknowledges that it can take still
six months to a year to fill one vacant position-assuming a viable pool
of candidates is interested and available. When VA seeks to replace
health care professionals, VA cannot compete with nimble private health
care systems. The lengthy process VA requires for candidates to receive
employment commitments and boarding continues to hinder the VA ability
to recruit and officially appoint new employees.
Private health care systems can easily fill PA vacancies in a
matter of days or weeks. While PA applicants may have noble intentions
of working for the VA and serving veterans, many will forgo what could
be a 4 to 6 month long waiting period and pursue timely employment
opportunities elsewhere. For these reasons, we ask Congress to
carefully review VA appointment authorities, internal credentialing
processes, and common human-resources practices to identify ways to
streamline the hiring process. If VA takes months to fill its health
care vacancies, VA will continue to fail the delivery of timely,
quality care to our nation's veterans.
Members of HVAC and SVAC both introduced bipartisan legislation
last October, providing for specific plans for Grow Our Own, asking
that VA utilizing VHA provisions (Titles III and VIII of the newly
enacted Veterans Access, Choice, and Accountability Act of 2014) to
include the national VHA plans for expanding recruiting for new FTEE PA
positions and for retaining an optimal PA workforce utilizing our
recommendations below.
Department of Veterans Affairs ``Independent Care Technician''
(ICT) Program, One Solution to Support Transitioning Medics and
Corpsmen OIF OEF OND into ``Grow Our Own'' to Physician Assistant
Occupation
VAPAA points to another solution for meeting the healthcare
workforce challenges in a recent pilot program. On October 26, 2011,
the Administration announced its commitment to providing support to
unemployed Post 9/11 combat veterans and it highlighted the PA
profession as a prominent targeted career path for new returning
veterans who had served as medics and corpsmen with combat medical
skills similar to the history of returning Vietnam War veterans with
these skills within the ICT pilot VA program at 19 VA sites. Under this
initiative, the Administration promoted incentives to create training,
education, and certifications of these veterans needing in transition
to a civilian application of their military medical skills, being hired
to work inside VA emergency departments, and has expanded into primary
care, mental health, and surgery clinic positions. While these ICT
veterans should be provided VANEEP, EDRP, EISP, and HPSP scholarships
for entering accredited PA University programs they are being told by
local facilities they have no funds for them, only for Nursing
Educational programs.
The VA has an excellent opportunity to facilitate and coordinate
``Grow Our Own'' combat medics, Corpsmen, or Air Force paramedics to
transition to the physician assistant occupation. However the (ICT's)
currently in the Grow Our Own VA program are being frustrated by
statements they should not expect scholarships from VA, and there is
lack of VHA policy language directing VAMCs to ensure educational
support of these combat veteran PA program candidates, assisting them
in admission to accredited PA university Master's programs with
targeted scholarships for PA Education. Ten former OIF OEF combat
veterans already enrolled in University PA program in Tennessee are
told they will not be eligible for scholarships.
The VAPAA is concerned over this ICT program started in 2012,
reported to be expanding to more full time ICTs. The continued lack of
use of recruitment educational incentives within VHA and having it left
at the discretion of the local hiring facility is setting up further
frustration across the VA system with the lack of VHA scholarships for
the critical PA occupation. The Office of VA Healthcare Retention and
Recruitment and the VAMC's participating in the pilot ICT program have
no dedicated VHAS support to transition them into PAs in the Employee
Incentive Scholarship Program (EISP) or EDRP. The barriers to PA
recruitment and retention will continue unless congressional members
provide oversight, VHA must ensure that employee incentive programs,
such as the EISP and the VA Employee Debt Reduction Program are made
consistently available to all critical healthcare workforce PA vacancy
announcements and utilized in ICT the program. VISN and VA medical
center directors they must be held accountable for the failure to
utilize these recruiting tools.
The ICT Program establishment and expansion was authorized by the
SEC VA in March 2015. The program expansion will increase ICTs in the
VA from the original 45 by hiring 234 more ICTs. Hiring the additional
234 ICTs has been left to the discretion of the Facility Directors of
individual VAMCs.
Between March 2015 when the ICT expansion was approved and March
2016, less than 6 of the additional 234 ICTs have actually been hired
by the VA. VHA was supposed to develop a national VA veteran employment
program targeting OIF OEF combat medics and corpsmen that is being
managed by local VAMCs with little oversight from VHA or VISN
Directors.
Critical Workforce Occupations:
VA's mission statement for human resources is to recruit, develop,
and retain a competent, committed, and diverse workforce that provides
high quality service to veterans and their families. VA identifies
specific occupations as ``critical occupations'' based on the degree of
need and the difficulty in recruitment and retention. There are 3 types
of primary care clinical providers within the VA that provide direct
patient care - Physicians, Physician Assistants and Nurse
Practitioners. Physicians have mandated yearly market pay survey. Nurse
Practitioners, by virtue of being a nurse, are under the mandated
yearly RN LPS.
PAs in few facilities fall under Special Salary Rates; however,
this is NOT mandated yearly. Some facilities have not performed a
special salary survey for 11 years, resulting in the reporting in the
VISN 2014 0915 Workforce Succession Plan - 12 out of the 21 VISNs (88
VA main facilities) reported the reason that their VISN cannot hire
PA's is because they cannot compete with the private sector pay. Some
VAMCs have refused to pursue steps to solve the current retention
problems for PAs.
Recommendations: We ask that both committees recognize the
advantages to the Recruitment and Retention of Physician Assistant (PA)
Workforce in the VA System by supporting enactment and supported by the
veteran service organizations at the November 18, 2015 hearing on S.
2134 and call attention the VHA witness Dr. Carolyn McCarthy testified
in favor of this legislation `Grow Our Own Directive: Physician
Assistant Employment and Education Act of 2015.'' (S.2134) and (H.R.
3974)
HR 3230 - Veterans Access, Choice, and Accountability Act of 2014
directs the Secretary, under the VA's Health Professionals Education
Assistance program, to give scholarship priority to applicants pursing
education or training towards a career in a health care occupation that
represents one of the five largest staffing shortages.
The measure used under the Choice Act- OIG Top 5, prevents PA
eligibility for EISP scholarship funds, as EISP - VANEEP, NEEI (VHA
handbook 1020) conveniently only recognizes local facility workforce
succession planning and ignores the OIG top five.
To prevent local nursing bias, include PA at all facility level to
reflect WSP and OIG findings as a hard to recruit occupation as this is
the qualifying factor for EISP funding - VANEEP/NEEI
In VHA Handbook 1020 - Employee Incentive Scholarship Program
(EISP) Procedures: includes a priority protocol for nursing only
scholarship funds, (1) applicants enrolled in academic programs which
provide the minimum education for entry level in to the occupation RN
to BSN, (2) RN to Master's degree program (NP), (3) RN to doctorate
(NP), and (4) RN to a degree related to their occupation.
Include PAs in the hierarchy for funding allocations for EISP -
VANEEP, NEEI scholarship funds. Include medicine - Designated Learning
Officer (DLO) a part of the local facility selection committee for
applicants.
Include EDRP in all PA job postings.
Include targeted scholarships for the ICT program OIF OEF Grow Our
Own returning veterans, and mandate VHA shall appoint PA ICT program
director to coordinate the educational assistance necessary and be
liaison with PA university programs.
H.R. 3974 would direct new Physician Assistant director position to
work within the National Healthcare Recruiter, Workforce Management &
Consulting VHA Healthcare Recruitment & Marketing Office. This position
then can develop targeted recruiting plans with 187 PA programs,
working in a way that the local Human Resource Officer (HRO) often will
not due to lack of staffing. The VA employed PA national Healthcare
Recruiter would develop improvements in finding qualified candidate in
a matter of days not months. VHA must incorporate new PA consultant
manager into this National Healthcare Workforce program office.
Conclusion:
Chairman Benishek and Chairman Wenstrup, and Ranking member
Brownley and Takano, other members of HVAC committee as you strive to
ensure that all veterans receive timely access to quality healthcare
and as you build increased capacity for delivery of accessible high
quality health care, and demand more accountability into the VA health
care system, I strongly urge the full Committee to review the important
critical role of the PA profession and ensure legislatively that VHA
takes immediate steps to address these longstanding problems and
continue to work with VAPAA in supporting our nation's veterans.
DISCLOSURE OF FEDERAL GRANTS OR CONTRACTS
Veterans Affairs Physician Assistant Association
The Veterans Affairs Physician Assistant Association (VAPAA) does
not currently receive any money from a federal contract or grants.
During the past six years, VAPAA has not entered into any federal
contracts or grants for any federal services or governmental programs.
VAPAA is a 501c (3) nonprofit membership organization.
NURSES ORGANIZATION OF VETERANS AFFAIRS
STATEMENT OF SHARON JOHNSON, MSN, RN 09BC, PRESIDENT
Chairman Benishek, Chairman Wenstrup, and Members of the
Subcommittees on Health and Economic Opportunity, on behalf of the
nearly 3,000 members of the Nurses Organization of Veterans Affairs
(NOVA), I would like to thank you for the opportunity to submit
testimony on today's draft legislation to Improve the Authority of the
Secretary of VA to Hire and Retain Physicians and other Employees of
the Department of Veterans Affairs.
NOVA is a professional non-profit organization for registered
nurses employed by the VA.
NOVA appreciates the opportunity to provide our input and, as
nurses who make up one third of the VA workforce, we will highlight
areas of concern that are pertinent to our mission.
While overall we appreciate the intent of the bill and support any
activities that will improve how VHA hires, retains and recruits its
workforce, the bill as written, does very little to affect nursing
personnel and the staffing shortages being felt nationwide.
For example, Section 2, paragraph 4 states that the Medical
Director should be a doctor or other qualifying medical professional.
NOVA believes that this minimizes the expertise of those professionals
who are trained in healthcare and administration and limits flexibility
in hiring within these leadership positions.
Section 2 (7) (D) for clarification, mention is made of ``Advanced
Degree in Mental Health'' and line 18 has Nursing Assistant. Nursing
Assistants have no degrees and perhaps this was inserted in error.
Section 3 - Adjustment of Hours Authorized for Certain Full-Time
Employees of VHA implies that any hours can be worked to meet the
biweekly pay period of 80 hours with a cap at 2,080 in a calendar year.
NOVA has concerns that payroll and human resources systems will not be
able to manage this change unless IT software is rebooted and HR staff
is trained to meet this change.
NOVA applauds Section 5, which would clarify staffing shortages and
include clinical as well as non-clinical personnel as needed.
NOVA has no comments on Sections 6 through 9 of the Draft Bill.
Section 10 - Reemployment of Former Employees.
While NOVA appreciates the need to recapture former employees to
help with staffing shortages within VA, for RN appointments, the grade
is based on the Nurse Qualification Standards so the employed
candidates would need to meet those standards. The scope is different
for each grade. A reemployed candidate may not meet the qualifications
for the next higher grade. And while it may be competitive, it could
also be inequitable for those already employed using qualification
standards under the accepted service position.
Section 11- Recruiting Database.
It is unclear to us how a national data base will work and what the
expectation is. Problems often arise with national databases unless
there is a short time period that applicants remain ``active (i.e. 30
or 60 days) within the system and effective management of the database
is provided. Good candidates would be scooped up quickly or will get
other offers outside VA. For positions identified as mission critical,
there should be greater pay flexibility built in to be competitive and
attract candidates to those positions. For example, if an engineer or
HR Specialist is a mission critical occupation and there are no hiring
flexibilities, it will not help if they leave to go to other agencies
or the private sector for more pay or higher grades.
Section 12 - Hiring Academy.
Retention of HR Specialists is of concern to NOVA. While an HR
Academy is a noble idea, unless the workload and ineffective systems
under HR are addressed, a high vacancy rate and ongoing retention
issues will continue to be a concern. We also add that there should be
something more specific that defines the appropriate training milieu
based on the complexity of HR, such as face to face training when
needed, and ensuring funds for travel are appropriated to continue
providing effective training for all HR staff.
Section 13 - Promotional Opportunities for Technical Experts.
NOVA applauds this section and recognizes that technical experts
need to be able to obtain promotions without having to leave their
roles and pursue a managerial position.
Section 14 - Comptroller General Study on Succession Planning. NOVA
has no issues with this section.
Section 15 - Information on Hiring Effectiveness.
We appreciate a system to track use and impact of hiring
authorities and flexibilities. NOVA has already testified that there is
a knowledge gap in hiring authorities and flexibilities within HR. We
also applaud the inclusion of a process for tracking satisfaction and
timeliness of the hiring process.
Section 16 - Employment of Students and recent Graduates.
NOVA supports the allowance of excepted service appointments and
recent graduates. NOVA is an advocate of staff developmental
opportunities such as internships and residency programs.
Finally, Section 17 looks to standardize the process for exit
interview surveys, which is critical in measuring and identifying any
common themes so that action could be taken as well as assisting in
identifying opportunities for improving the workforce environment
within VA.
In summary, NOVA supports all efforts directed towards the
retention, as well as recruitment for the VHA's largest workforce.
Reviewing and enhancing nurse pay to be competitive with community and
private sector standards; removing the cap from nurse pay scales to
enable current employees to apply for critical leadership positions and
increased support with monies for travel and education for nursing
staff would go a long way in enhancing the VA as the employer of choice
for healthcare professionals across the nation.
Staffing methodology should be the accepted and supported mechanism
for all facilities that VACO supports to determine nurse staffing, as
well as having the Chief Nursing Officer at the table when patient care
decisions and planning is made.
Once again, NOVA thanks the Committees for the opportunity to
submit testimony and we would be happy to assist with adding language
in the bill to accommodate and revise any of the issues mentioned in
our testimony.
Statement on Receipt of Grants or Contract Funds: Neither Ms.
Sharon Johnson, nor the organization she represents, the Nurses
Organization of Veterans Affairs (NOVA), has received federal grant or
contract funds relevant to the subject matter of this testimony during
the current or past two fiscal years.
MERRITT HAWKINS
TRAVIS SINGLETON, SENIOR VICE PRESIDENT
Overview:
We would first like to thank Dan Benishek, M.D., Chairman of the
Committee of Veterans' Affairs Subcommittee on Health, and Brad
Wenstrup, Chairman, Subcommittee on Economic Opportunity, for the
opportunity to submit this statement of record concerning draft
legislation to improve the ability of VA healthcare facilities to
effectively recruit and retain qualified physicians and other
employees.
Merritt Hawkins is the largest physician search and consulting firm
in the United States, carrying out over 3,100 physician and advanced
practitioner search assignments annually for healthcare facilities
located in all 50 states. Established in 1987, Merritt Hawkins is a
company of AMN Healthcare (NYSE: AHS), the largest healthcare staffing
organization in the country and the innovator of healthcare workforce
solutions.
Over the course of 27 years of providing physician search services
to the healthcare industry, Merritt Hawkins has worked with VA
healthcare facilities in all regions of the country. Most recently, we
have partnered with VA facilities on physician or advanced practitioner
search assignments at VISN 20, VISN 4, VISN 16, VISN 23, VISN 1, and
VISN 20. We are currently the only permanent placement physician search
firm that has a GSA number and is listed on 738X.
In addition, we have worked with hundreds of other government
sponsored or supported healthcare facilities where the physician
recruiting dynamics are similar to those typically present at VA
facilities. These include numerous Federally Qualified Health Centers
(FQHCs), Indian Health Service (IHS) facilities, and Department of
Defense facilities.
In December, 2015, Merritt Hawkins submitted a Statement of Record
for a roundtable discussion regarding how to improve the ability of the
Department of Veteran's Affairs to efficiently and effectively recruit
and retain high quality physicians and other employees. Based on our
knowledge of physician staffing and physician practice patterns,
Merritt Hawkins' president, Mark Smith, was invited in July, 2012, to
provide testimony before the House Committee on Small Business on the
decline of solo and small physician practices.
In addition to our work with VA and other government sponsored
facilities, Merritt Hawkins has worked with thousands of private sector
healthcare systems, community hospitals, academic centers, medical
groups, urgent care centers, retail clinics, and other facilities. We
therefore have an extensive background from which to draw in comparing
the best physician recruiting practices of government facilities, such
as the VA, to those of a wide range of other facilities in the private
sector.
We will make such comparisons further in this statement but will
first briefly address prevailing conditions in today's physician
recruiting market.
Medical Professional Recruitment: Market Context
In the previous Statement of Record Merritt Hawkins submitted to
the Subcommittees in December, 2015 we outlined prevailing physician
recruiting market conditions in today's rapidly evolving healthcare
system. We will not repeat this entire discussion here, but will state
that both the government and the private healthcare sectors are
challenged by prevailing physician shortages which are projected to
worsen.
The Association of American Medical Colleges (AAMC) projects a
shortage of up to 91,000 physicians by 2025 (see The Complexities of
Physician Supply and Demand, Association of American Medical Colleges,
March 2015). The shortage is being driven by a growing and aging
population, advances in medical technology, and the increased
availability of health insurance through the Affordable Care Act.
Fueling the shortage is the fact that residency training positions for
medical graduates have grown only incrementally over the last 18 years,
as federal funding for physician training was capped by Congress in
1997.
The effect of these shortages is apparent in Merritt Hawkins' 2014
Survey of Physician Appointment Wait Times and Medicaid and Medicare
Acceptance Rates. The survey examines the time needed to schedule a new
patient appointment in five medical specialties in 15 major metro
markets
The chart below shows average wait times to schedule a new patient
appointment with a family physician in the 15 metro markets examined in
the survey:
Wait Time in Days to Schedule a New Patient Appointment With a Family Physicians in 15 Metro Markets
--------------------------------------------------------------------------------------------------------------------------------------------------------
City Shortest Time to Appointment Longest Time to Appointment Average Time to Appointment
--------------------------------------------------------------------------------------------------------------------------------------------------------
Boston, 2014 12 days 152 days 66 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
Boston, 2009 6 days 365 days 63 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
New York, 2014 14 days 38 days 26 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
New York, 2009 6 days 61 days 24 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
Atlanta, 2014 1 day 112 days 24 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
Atlanta, 2009 3 days 21 days 9 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
Seattle, 2014 3 days 129 days 23 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
Seattle, 2009 2 days 14 days 8 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
Philadelphia, 2014 1 day 98 days 21 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
Philadelphia, 2009 3 days 15 days 9 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
Los Angeles, 2014 1 day 126 days 20 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
Los Angeles, 2009 1 day 365 days 59 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
Houston, 2014 1 day 178 days 19 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
Houston, 2009 1 day 29 days 17 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
Denver, 2014 1 day 62 days 16 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
Denver, 2009 1 day 45 days 14 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
Detroit, 2014 1 day 74 days 16 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
Detroit, 2009 3 days 31 days 14 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
Wash., D.C., 2014 1 day 62 days 14 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
Wash., D.C., 2009 3 days 365 days 30 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
Portland, 2014 3 days 45 days 13 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
Portland, 2009 3 days 16 days 8 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
Miami, 2014 1 day 56 days 12 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
Miami, 2009 1 day 25 days 7 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
Minneapolis, 2014 1 day 30 days 10 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
Minneapolis, 2009 2 days 23 days 10 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
San Diego, 2014 1 day 17 days 7 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
San Diego, 2009 1 day 92 days 24 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
Dallas, 2014 1 day 10 days 5 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
Dallas, 2009 1 day 27 days 8 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total, 2014 2.87 days 79.3 days 19.5 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total, 2009 2.47 days 99.6 days 20.3 days
--------------------------------------------------------------------------------------------------------------------------------------------------------
As these numbers indicate, average family physician appointment
wait times exceed 14 days in ten of the markets, and equal or exceed 21
days in five of the markets. In other markets with fewer physicians per
capita, it is likely that wait times may be more protracted. It is
therefore not just VA patients who are experiencing protracted
physician appointment wait times.
Today, a proliferating number of sites of service are competing for
a limited pool of physicians, PAs and NPs, as healthcare delivery
transitions from a hospital based model to an outpatient and
``convenient care'' based model. Thousands of urgent care centers,
ambulatory surgery centers, retail clinics, FQHCs, free-standing
emergency rooms, major employers, and insurance companies are actively
recruiting physicians, along with more traditional types of employers,
including hospitals, hospital systems, academic medical centers, and
government facilities such as the VA.
The type of physicians that VA facilities historically have been
able to recruit, including active military and former military
physicians, are increasingly being contacted and recruited by a wide
range of private sector facilities.
Due to this competitive climate, it is important for healthcare
facilities to have a strategic recruiting plan, to accurately forecast
their needs, to be nimble and responsive, to offer competitive
incentives, an attractive work environment, and, of most importance, to
bring a consistent sense of urgency to the recruiting process.
VA Facility Recruiting Methods and Challenges
In Merritt Hawkins' 2015 Statement of Record referenced above we
outlined various physician recruiting challenges faced by VA
facilities.
To recap, the first and most challenging is the recruiting process
itself, as administrated by the various VA facility human resource
departments. A sense of urgency and the ability to be agile is critical
in today's physician recruiting market.
Physician candidates being sourced by the VA typically also are
receiving job offers from many other organizations. The great majority
of VA facilities with which we work are handicapped by the prolonged
time needed to process candidates who have been selected for VA
employment through security and other bureaucratic requirements.
Processing times at VA facilities to receive clearance on hiring
candidates often can run as long as six months. By contrast,
efficiently run private hospitals typically turnaround the same level
of paperwork in no longer than four weeks. In the private sector, this
process often occurs concurrently with the recruiting process.
These waiting times do not include the process required to approve
candidate interviews before a job offer is made. The process to approve
candidate interviews may be channeled through four or five individuals
who have a variety of duties and may not appreciate the urgency of
approving physician interviews quickly. In Merritt Hawkins' experience,
it may take up to three months to schedule two to three interviews for
the same position. It also may be difficult for candidates to submit
required information, and their applications may be rejected for
lacking certain basic information without the candidate's knowledge.
They simply do not hear back and assume they did not get the job.
In recent physician recruitment efforts in Alaska that Merritt
Hawkins conducted on behalf of the VA, we were successful in placing 10
physicians in the Wasilla, Anchorage and Fairbanks areas. All ten
physicians accepted offers with the VA but the contract approval
process was so protracted and laborious that nine of the ten physicians
withdrew from consideration.
A key part of the problem in Merritt Hawkins' experience is that VA
facilities tend to follow the same recruiting process for all types of
personnel. The same HR systems and processes used to recruit an
administrative support position are used to recruit a neurosurgeon,
though the urgency of recruiting a neurosurgeon may be considerably
greater than the urgency of recruiting other positions. As a third
party, Merritt Hawkins is unable to contact VA HR personnel to help
facilitate interviews or help ensure candidates have the information
they need to make a decision. Moreover, the same person at the VA
managing the recruitment of administrative personnel also may be
managing the recruitment of highly trained medical professionals,
despite the fact that the skill sets required for these two disparate
tasks vary considerably.
Without an efficient, timely method for screening, credentialing
and responding to candidates, the VA is losing well qualified and
motivated physicians and other professionals to employers who do have
such systems in place.
This is particularly unfortunate as the VA offers a style of
practice that is appealing to many of today's physicians. The VA
typically offers set hours, generous vacation times, the security of
government employment, an absence of reimbursement and other practice
management challenges physicians face in the private sector, freedom
from the stress of malpractice, a rewarding sense of mission and
various attractive locations. Many physicians are not aware of this, as
a stigma about VA practice still is prevalent among some doctors, but
these perceptions can be overcome. Indeed, none of the key physician
recruiting challenges facing the VA are related to an inability to
persuade candidates to accept VA employment. The key challenges lie in
candidate sourcing and processing.
Compensation and Incentives
It also may be necessary for the VA to allocate resources to
enhance physician compensation packages. In the private sector, base
salaries for primary care physicians, including family physicians and
internists, average approximately $200,000, not including signing
bonuses, production bonuses, relocation allowances, and benefits. At VA
facilities, compensation for primary care physicians varies, but can be
considerably less than what is common in the private sector. In
addition, due to VA policies, it often is difficult to be clear with
candidates regarding the level of compensation being offered. Primary
care salaries may start with a baseline of $70,000, which immediately
creates a negative impression, then move up base on merits, but
obtaining clarity on compensation often is difficult.
When an offer is made, there are many logistical obstacles in place
before an offer letter or other documentation confirming the offer/
terms can be obtained, which can undermine the process.
While VA physician salaries may never equal those to be found in
the private sector, and it is not necessary that they do so given the
other incentives the VA can offer, it is important that they at least
be competitive in today's evolving physician market. It also is
necessary to communicate effectively to candidates that VA
opportunities have advantages that make them attractive even if
salaries are not always commensurate to those in the private sector.
Statement Regarding the Draft Bill
The draft legislation to improve the authority of the Secretary of
Veterans Affairs to hire and retain physicians and other employees
dated February 26, 2016 includes new language that appears to address
some of the VA's physician recruiting challenges cited above.
In particular, Section 15 (B) ``Information on Hiring
Effectiveness'' includes language that addresses the need for ``special
hiring authorities and flexibilities to recruit most qualified
applicants.'' Though these authorities and flexibilities are not
defined, we take this language to mean appropriate personnel at the VA
will be given the authority to reduce candidate processing times and
needed clearances and possibly reduce the number of individuals who now
currently vet physician candidates. We see increased flexibility in VA
recruiting processes as an essential step in allowing the VA to become
more nimble in response to a market where physicians are receiving
multiple job offers and commonly move on if not communicated within a
timely manner.
We also believe the language in Sec. 15 (G) authorizing the capture
of data regarding ``the length of time between the date on which a
first offer of employment for a position is made and the date on which
a new hire starts in the position'' is constructive. This will allow
the VA to track its relative success in reducing candidate processing
times and increasing process flexibility and effectiveness.
Similarly, Sec. 15 (I) in which the legislation mandates that the
VA track ``the number of offers accepted compared to the number of
offers made for permanent positions'' may have the constructive outcome
of allowing the VA to measure its recruiting success internally and
compared to private sector standards. Tracking this data should help
determine whether the VA is, in fact, becoming more nimble in its
candidate vetting processes and therefore securing a higher percent of
candidates to whom it has made offers.
Further positive new language is included in Sec. 15 (3) in which
the VA is charged with tracking the ``Satisfaction of employment
applicants with the hiring process including.user-friendliness of the
application process, communication regarding status of application, and
timeliness of hiring decision.'' Tracking this data will further allow
the VA to determine if it is streamlining it processes and identify
barriers that may be preventing it from doing so.
New language in Sec. 14 regarding a ``General Study on Succession
Planning'' also may prove useful in requiring VA facilities to be more
proactive in their physician recruiting, anticipating needs and
marshalling the resources needed to address them on the front end. This
strategy has proven effective for many of the private sector healthcare
facilities with which Merritt Hawkins works.
Not currently addressed in the draft legislation is the need to
reassess physician compensation amounts and structures in order to put
VA facilities on a more equal footing with the private sector
facilities with which they compete.
In addition, language may be needed to more clearly define the VA
personnel assigned to the task of physician recruitment and their
required training. In today's market, ``physician recruiter'' is a
specialized position and the great majority of private sector hospitals
(excluding some Critical Access Hospitals) use both in-house physician
recruiting personnel dedicated to that activity and outside resources
such as recruiting firms like Merritt Hawkins. The skill set and
knowledge level needed to recruit physicians, as noted above, is
different from those needed to recruit other types of personnel.
Merritt Hawkins also recommends that the draft legislation (or
implementing regulations) more specifically define how physician
candidates will be processed throughout the recruiting effort,
specifying who the decision makers are (and limiting their number) and
the time frame in which they are required to turnaround candidate
applications.
CONCLUSION
As stated in our December, 2015 Statement of Record, while the
institutional challenges the VA is facing in physician recruitment are
daunting, they are not confined to the VA. Academic medical centers and
increasingly large and consolidated healthcare systems in the private
sector also struggle with implementing streamlined systems for
processing physician candidates. The healthcare facilities that are
able to do so are the most likely to achieve consistent physician
recruiting success, which is attainable even in today's rapidly
evolving healthcare system.
FOR ADDITIONAL INFORMATION, PLEASE CONTACT:
TRAVIS SINGLETON
SENIOR VICE PRESIDENT
459 09524 091630
[email protected]
PARALYZED VETERANS OF AMERICA
Chairmen Benishek and Wenstrup, Ranking Members Brownley and
Takano, and members of the Subcommittees, Paralyzed Veterans of America
(PVA) would like to thank you for the opportunity to present our views
on the pending legislation impacting the Department of Veterans Affairs
(VA) employment authority. No group of veterans understand the full
scope of care provided by the VA better than PVA's members-veterans who
have incurred a spinal cord injury or disease. Most PVA members depend
on VA for 100% of their care and are the most vulnerable when access to
health care, and other challenges, impact quality of care. Elements of
this bill will help ensure that veterans receive timely, quality health
care and benefits services.
In order to accomplish VA's strategic goal, ``to be an employer of
choice in the national labor market,'' VA must be able to recruit and
retain qualified professionals, and administrative, technical and other
staffs, by providing competitive compensation, and opportunities for
professional and technical development. The Association of American
Medical Colleges estimates the United States will have a shortage of
130,600 physicians by 2025. Today, the most vulnerable populations,
including rural communities and veterans with specialty needs are the
first to feel the effects. While VA recruitment efforts are improving,
the inexcusably long process it takes to bring an employee onboard
continue to turn away highly qualified candidates. VA must provide its
human resources management staff with the resources and training
necessary to correct these issues.
Section 2 of the proposed draft bill would eliminate the current
statutory requirements that the Medical Directors of VA Medical Centers
(VAMCs) and directors of Veterans Integrated Service Networks (VISNs)
be a doctor of medicine or dentistry. Rather, it would require they be,
to the ``extent practicable'' a qualified medical professional.
Further, it would allow these directors to receive market pay in
addition to base pay, with the market pay reviewed by the secretary on
a case by case basis. PVA supports any effort intended to recruit and
retain the highest quality health care providers. Our nation's veterans
deserve no less than the very best. Congress should also consider other
incentives, such as child care, flexible scheduling, and continuing
education.
In 2004, Congress passed P.L. 108 09445, the ``Department of
Veterans Affairs Health Care Personnel Enhancement Act.'' The act was
intended to aid VA in recruitment and retention of VA physicians,
especially scarce subspecialty practitioners, by authorizing VA to
offer highly competitive compensation to full-time physicians oriented
to VA careers. VA has fully implemented the act, but PVA suspects the
act may not have been sufficient enough. PVA urges Congress to provide
oversight and to ascertain whether VA has adequately implemented its
intent in enacting P.L. 108 09445.
Section 3 would allow the Secretary to modify the hours of
employment for personnel of VHA so they can have more or less than 80
hours in a biweekly pay period as long as their total hours per
calendar year do not exceed 2,080 hours. PVA supports this
modification. Currently, VA emergency room physicians work inflexible
12-hour shifts within the required 80 hours per pay period that denote
full-time status. This rigidity does not exist in the private sector.
Irregular work schedules are needed to provide high quality patient
care. Additionally, the Veterans Health Administration (VHA) antiquated
system interferes with recruitment and retention efforts.
Section 4 would allow the Secretary to pay for 66 percent of the
Yellow Ribbon Program under the Post-9/11 G.I. Bill for a graduate
degree in the mental health field as opposed to only ``up to 50
percent.'' The applicant would have to be eligible for the Post-9/11
G.I. Bill and eligible for the Yellow Ribbon Program and intend to
become a mental health professional for VA. PVA supports this
provision.
Currently, the Veteran Access Choice and Accountability Act
requires the VA Office of Inspector General (VAOIG) determine annually
the five occupations within VHA that had the highest staff shortages.
Section 5 of this draft would require the VAOIG to evaluate staffing
shortages for five clinical occupations and five nonclinical
occupations within each VISN. PVA supports this provision as it would
add clarity to the staffing capacity where care is directly provided.
Section 6 would repeal the compensation panels to determine market
pay for physicians and dentists. PVA currently has no official position
on this provision.
Section 7 would require the Secretary to select at least 18, but no
more than 30, employees to participate in a one year fellowship with a
private sector company or entity that administers or delivers health
care or other services similar to those provided within VBA and VHA.
PVA generally supports this idea. In the current environment there
could be a benefit to sending VA senior executives into the private
sector to better understand best practices from both sides. At the same
time, sending already limited resources and talent outside of VA could
further undermine the existing training programs within the Department.
Section 8 would require the Secretary to conduct an annual
performance plan of VA's political appointees. The plan would be
similar to those employees who are members of the Senior Executive
Service and would assess recruitment and retention of qualified
employees, engagement and motivation, and performance and
accountability. While surprised there is not already a performance plan
for VA political appointees, PVA considers this a reasonable provision.
Section 9 would expand veterans preference to reservists by
counting their cumulative service rather than consecutive. PVA supports
offering the preference in hiring to those not currently eligible and
hopes such an expansion would allow VA to hire more veterans.
Section 10 would allow the Secretary to noncompetitively reappoint
a former VA employee to any position within the Department as long as
the position is not more than one grade higher than their former
position and as long as the employee left the Department voluntarily
within the prior two years and maintained necessary licensures and
credentials. PVA has concerns about bringing back a former employee to
a higher grade through a noncompetitive process. Such a hiring pathway
allows for personal relationships to dictate placement. While PVA
supports the intent to easily fill critical vacancies, we are not
convinced hiring former employees through a noncompetitive process is
the most appropriate.
Section 11 would require the Secretary to create a single
recruiting database to list any vacant positions the Secretary
determines are critical to the mission of VA, or difficult to fill, or
both. It would keep information on applicants not selected for initial
positions but who are qualified for other positions in the department.
The Secretary would be required to use the database to fill any vacant
positions. PVA does not believe a recruiting database is necessary.
Given the current condition that is VA and its relationship to IT, we
are unsure how the creation of a new apparatus will quicken the
Department's efficiencies. Presumably, the `mission critical' positions
the proposed database would house are currently residing in the
existing system, if not USAJobs.gov. Why these are not suitable means
for discovering their listing we would wish to know before offering a
final opinion.
PVA generally supports Section 12 that would require the Secretary
to provide the proper training for human resources (HR) professionals
for recruiting and hiring Title 38 employees within VHA. Currently,
most HR professionals are primarily trained for hiring under Title 5,
while a majority of VHA's hiring is for Title 38 employees. VA must
reduce the amount of time it takes to bring new employees on board and
provide its HR staff with adequate support through updated hiring
processes and proficiency training. The development and implementation
of defined goals for recruitment and retention (to include promotions,
continuing education, etc.) should be components of HR staff's
performance plans. VA HR management staff are not accountable to direct
service providers. PVA believes they should be held accountable. HR
performance is not measure by the degree to which they meet hiring and
recruitment goals. As a consequence, failure to fill a critical vacancy
in a timely manner carries no adverse effect on the involved HR staff.
PVA thanks the Subcommittees for their work to recruit and retain
excellent employees at VA. However we are unsure how all of the aims of
this draft bill would be meeting the needs of the Department. This
concludes PVA's statement for the record. We would be happy to answer
any questions for the record that the Committee may have.
Information Required by Rule XI 2(g)(4) of the House of Representatives
Pursuant to Rule XI 2(g)(4) of the House of Representatives, the
following information is provided regarding federal grants and
contracts.
Fiscal Year 2016
Department of Veterans Affairs, Office of National Veterans Sports
Programs & Special Events - Grant to support rehabilitation sports
activities - $200,000.
Fiscal Year 2015
Department of Veterans Affairs, Office of National Veterans Sports
Programs & Special Events - Grant to support rehabilitation sports
activities - $425,000.
Fiscal Year 2014
No federal grants or contracts received.
Disclosure of Foreign Payments
Paralyzed Veterans of America is largely supported by donations
from the general public. However, in some very rare cases we receive
direct donations from foreign nationals. In addition, we receive
funding from corporations and foundations which in some cases are U.S.
subsidiaries of non-U.S. companies.
DISABLED AMERICAN VETERANS
ADRIAN M. ATIZADO
Mr. Chairman and Members of the Subcommittees:
Thank you for inviting DAV (Disabled American Veterans) to submit
testimony for the record to discuss our views on draft legislation
aimed at improving the authority of the Secretary of Veterans Affairs
(VA) to hire and retain physicians and other VA employees. As you know,
DAV is a non-profit veterans service organization comprised of nearly
1.3 million wartime service-disabled veterans and is dedicated to a
single purpose: empowering veterans to lead high-quality lives with
respect and dignity.
According to VA, between FY 2013 and FY 2019, nearly 41 percent of
the Veterans Health Administration (VHA) workforce will become eligible
for regular retirement, with over 23 percent projected to actually
retire. Among senior leaders, the rates of retirement eligibility are
staggering, with more than 75 percent of the Senior Executive Service
(SES), Title 38 executives, chiefs of staff, and nurse executives, and
about half of Associate, Assistant, and Deputy Network Directors
eligible for retirement within the next 7 years. 1A\1\ This scenario
highlights the need for this hearing and we applaud the work of both
Subcommittees' to improve the VA Secretary's authority to recruit and
retain VA physicians and other employees.
---------------------------------------------------------------------------
\1\ 1A85.5 percent of SES; 91.2 percent of Title 38 SES; 85.9
percent of Chiefs of Staff; 77.6 percent of Nurse Grade V; 48.3 percent
of Associate, Assistant, and Deputy Directors.
---------------------------------------------------------------------------
Section 2 of this draft bill seeks to address the lack of specific
authority to make appointments or set rates of pay under title 38 for
VA Medical Center Director and Network Directors.
It appears that pay for these directors would be based on the
methodology of a compensation system similar to that which is used for
VHA physicians and dentists (38 U.S.C. Sec. 7431) P.L. 108 09445.
Notably, changes to the VHA physicians and dentists compensation system
is proposed in Section 6 of this bill. We draw the Subcommittees'
attention to our comments and concerns on Section 6 as it applies to
Section 2 of this measure.
Section 3 would align VA practice with the private sector,
facilitating the recruitment and retention of emergency physicians and
the recruitment, retention and operation of a hospitalist physician
system in VA medical centers.
To accommodate the need for continuity of efficient hospital care,
emergency medicine (EM) physicians often work irregular schedules. This
measure would modify the hours of employment for a full-time physician
or physician assistant to more or less than 80 hours in a biweekly pay
period provided the employee's total hours of employment in a calendar
year would not exceed 2,080. Consequently, VA medical centers would
gain the ability to implement flexible physician and physician
assistant work schedules that could accommodate hospitalist and EM
physicians' schedules and practices.
DAV does not have a resolution calling for this specific
legislation; however, because of the measure's beneficial nature, we
would not oppose its favorable consideration.
As part of the ``Yellow Ribbon G.I. Education Enhancement
Program,'' Section 4 of the bill would require the VA Secretary to
carry out a program in partnership with an institution of higher
education (IHE) and agree to cover the full cost not covered by the
post-9/11 G. I. Bill incurred by veterans who are pursuing advanced
degrees in the mental health field at the IHE and intend to seek
employment as mental health professionals in VA.
DAV Resolution No. 122 calls on Congress and VA to establish
scholarships for future VA mental health practitioners. We are pleased
to support this important provision which seeks to make program
improvements related to suicide prevention and would improve access to
appropriate mental health services for service members and veterans who
need such services.
Section 5, would add to the five clinical occupations an additional
five nonclinical occupations for which the Office of Inspector General
(OIG) must annually determine are the largest staffing shortages
throughout the Department as calculated over the five-year period
preceding the determination.
We urge the Subcommittee include in this context of determining
capacity of the VA health care system other directly related factors
such as space shortages and requirements to meet the goals of the
Secretary for timely access to care for veterans.
Section 6 would eliminate the compensation panel recommendation
process required under 38 U.S.C. Sec. 7431(c)(4)(B) to determine
market pay for physicians and dentists. We understand that VA believes
the current compensation panel process is time consuming and yields no
additional value to other reviews conducted prior to the appointment.
We understand the ability for the Secretary to exercise
flexibilities in pay is a vital recruitment and retention tool. The
Secretary today has discretion over two components of compensation for
VA physicians and dentists under the title 38 pay system - market pay
and performance pay. Market pay combined with basic pay (which set by
law) is meant to reflect the recruitment and retention needs for the
specialty of assignment of the particular physician or dentist in a VA
facility. Performance pay, which the Secretary also has discretion
over, is a statutorily authorized element of annual pay paid to
physicians and dentists for meeting goals and performance objectives.
Furthermore, Congress has granted VA other pay flexibilities involving
discretion, including premium pay, on-call pay, alternate work
schedules, Baylor Plan, special salary rates, and recruitment and
retention bonuses.
It appears that market pay is the only part of VA compensation that
is determined through a peer-review process composed of a group of
physicians and/or dentists and based on factors such as the prospects
experience, qualifications, complexity of the position and difficulty
recruiting for the position. There is risk eroding the effectiveness of
market pay by eliminating this role without assurances that the local
peer-perspective, which ensures consistency and appropriateness of pay
proposals, will continue to be an important part of the approving
official's final decision.
Section 7 would establish a one-year fellowship program to provide
private sector claims processing training and experience for certain
Veterans Benefits Administration (VBA) and VHA executives. The private
sector entity would be engaged in the administration and delivery of
health care or other services similar to the benefits administered by
the Secretary.
We note that the eligible employer under this section of the bill
would be both VBA and VHA. However, the agreement under the proposed
new Section 721(e) between VA and the fellow is incongruous, which
appears to afford the opportunity for employment only in VBA and not
VHA, which we urge the Subcommittee to correct.
Section 8 proposes a new requirement for the Secretary to conduct
an annual performance plan for political appointees within the
Department similar to the annual performance plan conducted for a
career VA Senior Executive Service appointee.
Delegates to our most recent National Convention approved
Resolution No. 214, calling for the imposition of meaningful employee
accountability measures in VA, but with due process for employees
targeted for such sanctions. This section meets the intent of DAV's
resolution; therefore, DAV supports enactment.
Section 9 would modify veterans' preference in hiring for
employment in the federal government by including in the active duty
service requirement those veterans who have performed 180 days of
cumulative service and all military retired. The application of such
preference would also extend to the hiring of senior executive
positions in the VA.
DAV supports this provision based on Resolution No. 130, calling,
for among other things, a broader utilization of veterans and service-
disabled veterans hiring preferences and supporting federal, state and
local veterans' preference laws.
Section 10 would allow the Secretary to noncompetitively appoint a
qualified former employee to any position within the competitive or
excepted service positions that is one grade higher than the grade of
the position at the Department most recently occupied by the employee.
A former employee may not be appointed to a position that is more than
one grade (or equivalent) higher than the position at the Department
most recently occupied. The term ``qualified former employee'' means
any individual who formerly occupied any VA position within 2 years
before applying for re-employment at the Department; voluntarily left
such position, or was subject to a reduction in force, and had a
satisfactory performance record while occupying such position; and
since leaving such position has maintained relevant licensing
requirements, if any, and gained skill, knowledge, or other factors
related to the position.
Section 11 would authorize the establishment of a single database
that lists each vacant position in the VA that the Secretary determines
is critical to the mission of the Department, difficult to fill, or
both. If an applicant for a vacant position listed in the database is
qualified but is not selected for the position, the Secretary, at the
election of the applicant, shall consider the applicant for other
similar vacant positions listed in the database for which the applicant
is qualified.
Section 12 would require VA human resources professionals training
on how to best recruit and retain Title 38 employees, including any
recruitment and retention matters that are unique to the VHA. The
training would be provided in a manner deemed appropriate in light of
budget, travel, and other constraints. The Secretary shall ensure that
each VHA human resources professional receives the training as soon as
practical after being hired as a human resource professional; and
annually thereafter.
Section 13 would require VA to establish a promotional track system
for VA employees determined to be technical experts within one year of
it being enacted. The developed promotional track would provide
qualifying employees the opportunity to advance within VA without being
required to transition to a management position; it would provide for
the establishment of new positions within VA; and notwithstanding any
other provision of law, would provide for increases in pay.
DAV does not have a resolution calling for the provisions in
sections 10 through 13.
Section 14 would require the Government Accountability Office to
conduct a study on the succession planning at each VA medical facility,
the VBA, and the National Cemetery Administration. For each entity, the
study must include: A determination of the mission-critical positions
and the vacancy risk of such positions; An analysis of the future needs
for mission critical positions and gaps within the existing talent pool
of the entity; A description of strategies to close skill gaps through
the use of training for existing staff, targeted recruitment, and
hiring; A plan to regularly evaluate progress of staff and update
existing succession plans using clear and measurable metrics and
benchmarks; A demonstration of the capacity to execute succession plans
with successful succession management strategies, and; Any other
matters the Comptroller General determines appropriate.
The Comptroller General shall submit a report detailing each study
conducted to the House and Senate Committees on Veterans' Affairs no
later than one year after enactment.
We thank the Subcommittees attention to address one of VA's most
significant challenges is dealing effectively with succession an
succession planning-especially in the health sciences and technical
fields that so characterize contemporary American medicine and
healthcare delivery.
Section 15 would require the VA to measure and collect detailed
information on indicators of hiring effectiveness including
satisfaction of employment applicants and new hires. Personally
identifiable information of applicants and employees will be kept
private. The Secretary will submit a report of information collected to
the House and Senate Committees on Veterans' Affairs, and will annually
make the information collected publicly available in a consistent and
machine-readable format to allow for a comparison of hiring
effectiveness and experience by VISN or comparable public or private
sector organization.
DAV has been calling attention to VA's human resources policies,
which in recent hearings on VA mental health in the Senate, confirm
that the lack of responsiveness of human resources offices and
management policies are contributing to deficits in VA's mental health
programs. Sadly, unresponsive human resources practices are also
affecting all of VA's key missions. While we believe the collection of
this information may be useful, we urge the Subcommittee to carefully
examine VA and Office of Personnel Management appointment authorities
in statute and how they are being applied within VA to determine
whether additional legislation would offer any helpful resolution. VA
should develop and track measures of performance in human resources
recruitment, on-boarding and retention of clinical staff. Almost as
important, the Committee should provide targeted oversight in examining
why VA human resources programs are so weak and unaccountable at a time
when they should be acting forcefully and supportively to ensure VA
programs in VHA, VBA and Memorial Affairs are properly staffed to meet
their missions. With help from Congress, we believe this aspect of VA's
challenges can be solved with better leadership and more
responsiveness, beginning at the local level and extending throughout
the system.
Section 16 VA would allow for excepted service appointments of
students and recent graduates leading to conversion to career or career
conditional employment of a student or recent graduate of a qualifying
educational institution. The conversion authority shall be applicable
to individuals in good standing who are employed in a qualifying
internship or fellowship program at the Department; are employed in the
Department in a volunteer capacity and performing substantive duties
comparable to those of individuals in internship or fellowship programs
and meet the required number of hours for conversion; or who are
employed in the Department under a contract or agreement with an
external non-profit organization and performing substantive duties
comparable to those of individuals in internship or fellowship
programs.
DAV has no resolution on this specific provision; however, we
continue to hear from VA medical facility leaders on too many lost
opportunities due to the lengthy hiring process for medical students
who train in VA. As these medical professionals train in VA, they gain
institutional knowledge, which becomes and tremendous advantage in
successful transition. Thus, we would not oppose the favorable
consideration of this section in this regard.
Section 17 would require VA develop and carry out a standardized,
anonymous, and voluntary exit survey to be completed by career and non-
career employees and executives of the Department who voluntarily
leave. Data collected will be anonymized and personally identifiable
information will be removed, and the results of the survey would be
shared annually with directors and managers of VA facilities and the
VISN. Within one year after the date of the enactment, and annually
thereafter, the Secretary will submit a report containing the aggregate
results of the exit survey to the House and Senate Committees on
Veterans' Affairs.
DAV does not have a resolution calling for this section of the
bill.
Mr. Chairman and Members of the Subcommittees, this concludes DAV's
testimony. We appreciate the invitation to submit testimony for the
record, and are prepared to respond to any questions on the positions
we have taken with respect to the bill under consideration.
IRAQ AND AFGHANISTAN VETERANS OF AMERICA
Lauren Augustine
Chairman Wenstrup, Chairman Benishek, Ranking Members Takano and
Brownley, and Distinguished Members of the Subcommittees, on behalf of
Iraq and Afghanistan Veterans of America (IAVA) and our more than
450,000 members and supporters, we would like to extend our gratitude
for the opportunity to share our views on the draft legislation to
improve hiring practices at the Department of Veterans Affairs (VA).
As all in the veteran community are well aware, the need for
greater accountability at the VA is paramount to successfully restoring
veterans' trust in the system. However, just as important is the need
to employ and retain highly qualified, motivated professionals willing
to support the VA's mission. The VA has asked for, and should receive,
many of the provisions within this draft legislation, which are
necessary changes to their current hiring practices to support such
goals. IAVA is pleased to see many additional provisions within the
draft legislation that aim to meet those same needs among other key
changes to better the VA's hiring and retention process.
While the vast majority of VA employees serve veterans with
outstanding care and professionalism, the few underperforming or
negligent employees that discredit their service must be held
accountable in a swift manner that brings justice to the system while
also protecting whistleblowers and maintaining a culture professionals
want to work within. IAVA fully supports the measure within the draft
legislation to appoint Directors of Veterans Integrated Service
Networks (VISN) and Veterans Affairs Medical Centers (VAMC) under title
38, which has been requested specifically by the VA, to ensure less
bureaucracy and more accountability as it relates to disciplining
wrongdoing. This measure will also provide the VA greater flexibility
in offering competitive pay and compensation to attract and retain the
most qualified candidates for such positions. We cannot expect VA
Directors to perform at levels that meet or exceed their private-sector
counterparts if we are not willing to compensate them fairly.
Additional contributions to greater accountability in the
legislation require the VA to conduct an annual performance plan for
all political appointees in a similar manner Senior Executive Service
are evaluated. The evaluation would include measuring appointees'
ability to recruit and retain qualified employees, engage and motivate
employees, train employees and hold them accountable for any potential
performance issues. The ability for all VA leaders, including political
appointees, to successfully meet and exceed the requirements of such
tasks will continue to be a key aspect to ensuring quality leaders
exhibit the highest standards of professionalism.
In its efforts to institute better hiring practices, the VA must
also become more acutely aware of the actual need and capabilities of
its workforce in addition to instituting policies to support its
existing workforce. IAVA supports the measures within the draft
legislation to provide the VA better insight its hiring capabilities.
Specifically, IAVA supports the requirement to measure and collect
information on hiring effectiveness and to adjust the current
requirements to identify the five occupations with the highest staffing
shortages to include the five highest staffing shortages for both
clinical and nonclinical occupations. Understanding what the staffings
needs are coupled with a greater understanding of hiring effectiveness
will help streamline the process for those looking to serve within the
VA. Building on that is the need to ensure continued training and
growth opportunities for existing VA employees. The promotional track
for technical experts that eliminates a requirement to accept
managerial positions created within the legislation will help retain
those professionals looking to utilize their expertise without adding
unwanted responsibilities. Leveraging the existing expertise and talent
within the VA supports a greater continuity of institutional knowledge
and professional satisfaction.
Providing professional development and training opportunities for
VA employees are practices IAVA has frequently advocated for as a means
to support the VA workforce. As such, IAVA strongly supports the one
year private-sector fellowship for select Veteran Benefits
Administration (VBA) and Veterans Health Administration (VHA)
employees. Gaining best-in-practice knowledge, policies and procedures
from the private sector can only help strengthen the capabilities of VA
employees and their capacity to meet the VA's mission. Likewise, IAVA
supports the provision to provide training for human resources
professionals within the VA for recruiting and hiring Title 38
employees. Since Title 38 employees make up many of the occupations
with the VHA, understanding the nuances of the hiring process for these
employees will create a more efficient process.
The provisions within the draft legislation that consider
adjustments to education benefits through the Yellow Ribbon program and
modifications to veteran preference are both measures IAVA supports as
a means to increase both the number of applicants seeking to serve at
the VA and the number of veterans serving within the VA system. IAVA is
particularly supportive of incentivizing veterans to seek education
that will lead to becoming mental health care professionals within the
VA. As our members continue to express a need for greater access to
care and cultural understanding, IAVA recognizes the potential of such
incentives will help meet that need.
At IAVA, we believe our members, and all veterans, deserve the very
best our nation can offer when it comes to fulfilling the promises made
to them upon entry into the military. To support that cause and the
critical mission of the VA, IAVA fully supports equipping the VA with
the necessary authority to provide best-in-class hiring practices.
As the Committee works to finalize this legislation, IAVA strongly
recommends not paying for its provisions by cutting critical benefits
that our nation's 23 million veterans and their families have come to
rely upon. We look forward to reviewing the final language of the
legislation, continuing to work together as partners, and finding
veteran-centric solutions to the challenges facing the VA and the
veteran community.
RESERVE OFFICERS ASSOCIATION
The Reserve Officers Association of the United States (ROA) is a
professional association of commissioned, non-commissioned and warrant
officers of our nation's seven uniformed services. ROA was founded in
1922 by General of the Armies John ``Black Jack'' Pershing during the
drawdown years following the end of World War I. It was formed as a
permanent institution dedicated to national defense, with a goal to
inform America regarding the dangers of unpreparedness. Under ROA's
1950 congressional charter, our purpose is to promote the development
and execution of policies that will provide adequate national defense.
We do so by developing and offering expertise on the use and resourcing
of America's Reserve Components.
The association's members include Reserve and Guard Soldiers,
Sailors, Marines, Airmen, and Coast Guardsmen who frequently serve on
active duty to meet critical needs of the uniformed services. ROA's
membership also includes commissioned officers from the United States
Public Health Service and the National Oceanic and Atmospheric
Administration who often are first responders during national disasters
and help prepare for homeland security.
President: Col. James R. Sweeney II, USMC (Ret.) 202 09646 097706
Executive Director: Jeffrey E. Phillips 202 09646 097726
Legislative Director: Lt. Col. Susan Lukas, U.S. Air Force Reserve
(Ret.) 202 09646 097713
DISCLOSURE OF FEDERAL GRANTS OR CONTRACTS
The Reserve Officers Association is a member-supported
organization. ROA has not received grants, contracts, or subcontracts
from the federal government in the past three years. All other
activities and services of the associations are accomplished free of
any direct federal funding.
STATEMENT
ROA appreciates the opportunity to discuss proposed legislation for
improving the authority of the Secretary of Veterans Affairs to hire
and retain physicians and hire Guard and Reserve members. This
statement addresses a legislative priority developed by ROA as a result
of feedback from ROA members and Reserve Component service members.
SEC. 9. MODIFICATION TO VETERANS PREFERENCE
The Reserve Officers Association urges Congress to support SEC. 9.
MODIFICATION TO VETERANS PREFERENCE, which changes title 5, USC
2108(1)(B) and (D) to strike the word ``consecutive'' and change it to
``cumulative'' in each instance.
Reserve Component Participation
During the present war, nearly a million Guard and Reserve members
have been mobilized, proving essential to the war effort. The reliance
of the nation on its Reserve Components will not diminish.
Since September 11, 2001, more than 900,000 members of our reserve
components - the National Guard and Reserves of our Army, Navy, Air
Force, Marines and Coast Guard - have served in support of the war on
terrorism. More than 1,200 have died in that fight.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
``War is a national challenge, and, for our part, we cannot execute
without the Guard and the Reserve,'' said Army Chief of Staff Gen. Mark
Milley. You can't talk to a general or admiral for more than five
minutes without hearing a variation on that theme.
The chart below shows that the Guard and Reserve have been used in
increasingly higher amounts per year. While usage is dropping it will
not go down to previous peacetime levels because threats to the nation
and world have increased.
Usage of the Reserve Components
------------------------------------------------------------------------
Fiscal Year Man-Days Per Year
------------------------------------------------------------------------
1986 091989 1 million
------------------------------------------------------------------------
1996 092001 13 million
------------------------------------------------------------------------
2002 41.3 million
------------------------------------------------------------------------
2005 68.3 million
------------------------------------------------------------------------
2012 25.8 million
------------------------------------------------------------------------
Data from the Office of the Assistant Secretary of Defense for Reserve
Affairs (OASD/RA).
Background
According to Jeff Phillips, ROA Executive Director, in a recent op-
ed, ``It was over my first Philly cheesesteak sandwich - in
Philadelphia - that I learned Maj. Bonnie Carroll was not a veteran
despite her extraordinary service to our country.''
Reservists today serve virtually everywhere, alongside their
``active component'' comrades. In battle, the performance of these
trained and courageous citizen-warriors of all ranks, specialties, and
any other category has been recognized as indistinguishable from the
``regulars.'' They ask to serve; they deserve equity for that service.
Inequity is written into law; most of the legislation governing the
military was written before and during the Cold War. The reserves in
those days were a strategic reserve and not used much - that's where
the ``one weekend per month and two weeks in the summer'' model
evolved.
Desert Shield, Desert Storm and the present war changed all that.
The reserves are now considered ``operational.'' They are used
continually, like the active force. In the late 1980s, usage of the
reserves was 1 million man-days per year; it is now about 25 million
man-days. But the law hasn't kept up as important benefits are limited
only to those who serve in ``active military, naval, or air service.''
By ``important benefits,'' we are talking about who you are in the
eyes of federal law when it comes to being considered for hiring
preferences accorded to veterans.
We are talking about helping young, dynamic new professionals - who
understand service and dedication to higher cause - renew our graying
and often hidebound federal bureaucracy.
Bonnie stunned me when she told me she wasn't a veteran.
``But, of course you are, you've served in the Air Force,'' I
countered, momentarily forgetting my cheesesteak sandwich.
No, she told me, she had never amassed enough days on ``active
duty'' to qualify to be a veteran under titles 5 and 38 for federal
hiring preference. To be a veteran for hiring preferences, she needed
180 or more consecutive days on active duty - and that did not include
active duty while she was training. In those days, getting nearly six
consecutive months on active duty was tough.
As the operational tempo of the recent past changes and fewer
members of the Guard and Reserve deploy (a situation that will last
only until the next war) achieving 180 or more consecutive days on
active duty will become even more difficult. But it will always be much
more likely for these reservists to amass 180 or more cumulative days
on active duty. Inequity is an enduring theme unless we make this
simple change.
Both the Department of Veterans Affairs and the top leaders of our
reserve forces informally indicated to ROA there is no cost and they
would not object to such a change the law.
Recent legislation sought to grant ``honorary'' veteran status to
reservists with 20 or more years of service - legislation ROA
supported. These reservists are a fraction of the whole. We are here
urging a simple reform that would substantively help the vast majority
of reservists who are still serving as citizen-warriors or who
separated before military retirement.
Changing one word would provide significant equity to members of
our Guard and Reserve who affirm the wisdom of our founders in their
willingness to serve boldly, selflessly, and with great fidelity in the
defense of our way of life. They balance military service - a consuming
and uncompromising business - with the demands of a civilian work life
and the care of their families.
According to SGM (Ret) Frank Yoakum, Executive Director, EANGUS,
``Major Bonnie Carroll (retired) is one of thousands of National Guard
and Reserve retirees who were part of the 1% of America who served in
our military--not only served, but gave a lifetime of service--only to
find out that our Congress and our government, based on a technicality,
does not consider them veterans. In their careers, they were available
to go to war; they were trained to go to war; they were ready to go to
war; but the timing and placement of their service placed them in
support but not direct warfight roles. They should not continue to be
penalized for exemplary service. The time is now; the technical change
is simple; the personal reward and thanks of a grateful nation is
priceless. We strongly encourage Congress to do the right thing and
make this correction to the law on behalf of thousands of retirees who
really are veterans.''
Unemployment of the Guard and Reserve
Unemployment during the Gulf War steadily increased higher for
veterans than nonveterans, especially those from the current war. Of
that group, 30 percent of both Gulf War-era I and Gulf War-era II
veterans were reported to be current or past members of the Reserve or
National Guard.
``In 2014, 21.2 million men and women were veterans. Of these, 10.2
million veterans were employed, 573,000 were unemployed, and the rest,
10.5 million, were not in the labor force (neither employed nor seeking
employment).'' http://www.bls.gov/opub/ted/2015/veteran-unemployment-
decreases-in-2014.htm
unemployment rates of persons 18 years and over by veteran status,
period of serivce, sex, race, and ethnicity, 2014 annual averages
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
As of March 23, 2015
Since 2014 unemployment overall has decreased, in part because the
government increased their efforts to hire more veterans in the federal
government to reduce veteran homelessness. By the end of fiscal year
2014, the government was able to employ 516,075 veterans out of
1,990,033 employees. However, most agencies are below the average
percentage of 25.9 percent once you exclude the Departments of Defense
and Veterans Affairs (27.4% to 48.5%). The remaining agencies average
only 13.8 percent
Total On-Board Employees - Veterans with Preference
--------------------------------------------------------------------------------------------------------------------------------------------------------
All Employees Veterans with Preference %
--------------------------------------------------------------------------------------------------------------------------------------------------------
Agriculture................................................ 95,917 10,519 11.0%
Commerce................................................... 45,380 4,633 10.2%
Education.................................................. 4,195 369 8.8%
Energy..................................................... 14,992 2,879 19.2%
HHS........................................................ 84,588 5,714 6.8%
Homeland Security.......................................... 189,341 43,736 23.1%
HUD........................................................ 8,444 1,142 13.5%
Interior................................................... 69,955 10,203 14.6%
Justice.................................................... 113,240 21,751 19.2%
Labor...................................................... 15,940 3,093 19.4%
State...................................................... 12,694 2,195 17.3%
Treasury................................................... 92,619 8,629 9.3%
AID........................................................ 1,698 235 13.8%
EPA........................................................ 15,852 1,068 6.7%
GSA........................................................ 11,501 2,088 18.2%
NASA....................................................... 17,691 1,555 8.8%
NSF........................................................ 1,425 92 6.5%
OPM........................................................ 4,977 1,025 20.6%
NRC........................................................ 3,871 652 16.8%
SSA........................................................ 64,684 8,181 12.6%
SBA........................................................ 4,549 677 14.9%
--------------------------------------------------------------------------------------------------------------------------------------------------------
https://www.fedshirevets.gov/hire/hrp/reports/EmploymentOfVets-FY14.pdf
Changing the language for federal preference would provide a pool
of Guard and Reserve veterans for agencies to consider, thereby,
increasing their veteran hires. In 2012, the Center for New American
Security released a report, titled, Employing Americans Veterans that
said, ``Hiring veterans is good business, according to detailed and
lengthy interviews with 87 individuals representing 69 companies. The
companies reported 11 reasons they hire veterans, with an emphasis on
veterans' leadership and teamwork skills, character and discipline...''
The reasons include:
Leadership and teamwork skills. Veterans typically have
led colleagues, accepted direction from others and operated as part of
a small team.
Character. Veterans are perceived as being trustworthy,
dependable, drug-free and having a strong work ethic.
Structure and discipline. Companies, especially those that
emphasize safety, appreciate veterans' experience following established
procedures.
Expertise. Companies value veterans' occupational skills,
job-specific experiences and understanding of the military community.
http://www.cnas.org/files/documents/publications/CNAS--
EmployingAmericasVeterans--HarrellBerglass.pdf
These and the other reasons discussed in the report should equally
apply to why hiring a Guard or Reserve veteran makes sense for the
federal government.
Not unlike her citizen-warrior comrades, Bonnie is a remarkable
woman. Self-effacing and dedicated to the service of others, she asks
nothing for herself. ROA is urging this reform for today's reservists
now being shortchanged, and for the benefit of a nation that needs them
serving the public as civil servants.
In 1994 Bonnie founded Tragedy Assistance Program for Survivors
after her husband, an Army officer, was killed in a military plane
crash. TAPS supports those who have lost a loved one in military
service, but provides expertise to all who need that kind of help. They
are known for their unparalleled expertise in the care and recovery of
survivors.
For her work with surviving families, President Obama awarded
Bonnie the Presidential Medal of Freedom in November.
Maj. Bonnie Carroll ultimately retired after 32 years in both the
Air National Guard and the Air Force Reserve.
But according to federal law, she's not a veteran for federal
hiring benefits and did not get a 5-point preference that would have
increased her chances to be hired earlier in her career.
It's time that changed for the men and women serving today.
CONCLUSION
The Reserve Officers Association, the Enlisted Association of the
National Guard of the United States and the National Guard Association
of the United States supports legislation that would extend federal
preference to the deserving men and women of the Reserve Components.
AMERICAN PODIATRIC MEDICAL ASSOCIATION
Testimony of Dr. Phillip E. Ward, President
Chairmen Benishek and Wenstrup, Ranking Members Brownley and Takano
and members of the Subcommittees, I welcome and appreciate the
opportunity to submit testimony to you today on behalf of the American
Podiatric Medical Association (APMA). I commend these Subcommittees for
their focus to assist and direct the Veterans Administration (VA) to
effectively and efficiently recruit and retain qualified medical
professionals to treat veteran patients and improve access to quality
health care in the VA system by addressing the lengthy and burdensome
credentialing and privileging process.
I am Dr. Phillip Ward, member and president of the American
Podiatric Medical Association (APMA). I represent APMA and the
podiatric medical profession, and specifically our members currently
employed, and those seeking to be employed, by VA. While I do not
represent VA, I do speak for those with first-hand experience and
knowledge of hiring practices within VA, as well as knowledge of the
widespread disparity between podiatric physicians and other VA
physicians.
APMA is the premier professional organization representing
America's Doctors of Podiatric Medicine who provide the majority of
lower extremity care, both to the public and veteran patient
populations. APMA's mission is to advocate for the profession of
podiatric medicine and surgery for the benefit of its members and the
patients they serve.
Mr. Chairmen, as you know the Veterans Health Administration (VHA)
qualification standards for podiatry were written and adopted in 1976.
Podiatric education, training and practices in 1976 starkly contrasted
with that of other physician providers of the time, and with podiatric
medicine as it is today. Unlike forty years ago, the current podiatric
medical school curriculum is vastly expanded in medicine, surgery and
patient experiences and encounters, including whole body history and
physical examinations. In 1976, residency training was not required by
state scope of practice laws. Today, every state in the nation, with
the exception of four, requires post-graduate residency training for
podiatric physicians and surgeons. In 1976, podiatric residency
programs were available for less than 40 percent of graduates. Today
there are 609 standardized, comprehensive, three-year medicine and
surgery residency positions to satisfy the number of our graduates,
with 77 positions (or 13 percent) housed within the VA. In contrast to
1976, today's residency programs mandate completion of a broad
curriculum with a variety of experiences and offer a direct pathway to
board certification with both the American Board of Podiatric Medicine
(ABPM) and the American Board of Foot and Ankle Surgery (ABFAS). These
certifying bodies are the only certifying organizations to be
recognized by the Council on Podiatric Medical Education (CPME) and VA.
These bodies not only issue time-limited certificates, but they
participate in the Centers for Medicare and Medicaid Services (CMS)
Maintenance of Certification (MOC) reimbursement incentive program.
Unlike the residency curricula in 1976 (which were not standardized,
nor comprehensive), today's residency curriculum is comparable to MD
and DO residency training and includes general medicine, medical
specialties such as rheumatology, dermatology and infectious disease,
general surgery and surgical specialties such as orthopedic surgery,
vascular surgery and plastic surgery. CPME-approved fellowship programs
did not exist in 1976, but since their creation in 2000, they offer our
graduates opportunities for additional training and sub-specialization.
Today, podiatric physicians are appointed as medical staff at the vast
majority of hospitals in the United States, and many serve in
leadership roles within those institutions, including but not limited
to chief of staff, chief of surgery, and state medical boards. Many of
my colleagues have full admitting privileges and are responsible for
emergency room call as trauma and emergency medicine are now also
incorporated into post-graduate training. The competency, skill and
scope of today's podiatric physicians are vastly expanded and truly
differ from the podiatrist that practiced before 1976. Because of this,
CMS recognizes today's podiatrists as physicians, and Tricare
recognizes us as licensed, independent practitioners.
The total number of VA enrollees has increased from 6.8 million
in2002 to 8.9 million in 2013 (1). While we are slowly losing our
Vietnam veteran population, we are gaining a solid base of Operation
Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) patients,
returning from war with their unique lower extremity issues. The
projected patient population of Gulf War Era veterans is expected to
increase from 30 percent in 2013 to approximately 55 percent in 2043
(1). The number of service-connected disabled veterans has increased
from approximately 2.2 million in 1986 to 3.7 million in 2013 (1). Over
90 percent of disabled veterans were enrolled in VHA in 2012 (1). The
likelihood of service-connected disabled veterans seeking VA health
care generally increases with the veteran's disability rating (1). The
majority of male veterans who are currently seeking care from VA served
during the Vietnam era (1).
As a matter of fact, veteran patients are ailing and have more
comorbid disease processes than do age-matched Americans (2, 3, 4, 5,
6). This includes major amputation, where age-specific rates are
greater in the VHA compared to the US rates of major amputation (7).
Elderly enrolled veterans have substantial disease burden with
disproportionately poor health status compared to the same age enrolled
in Medicare (8). The prevalence of diabetes is substantially greater
among veteran patients compared to the general population, and
unfortunately, the prevalence is trending up (6). While diabetes
affects 8 percent of the US population, 20 percent of veteran patients
carry this diagnosis (9).The aging veteran population combined with
these increased rates of diabetes has increased the burden of diabetic
foot ulcers and amputations (10). Veteran patients with one or more
chronic diseases account for 96.5 percent of total VHA health care (9).
In addition to diabetes, some of the most common chronic conditions
documented in our veteran patients manifest in the lower extremity such
as hyperlipidemia, coronary artery disease, chronic obstructive
pulmonary disease, and heart failure.(9).
Socioeconomic and psychosocial issues often plague our veterans and
further complicate disease management. Veteran patients statistically
have lower household incomes than non-veteran patients (1). Sadly, many
of our veterans are homeless and suffer from comorbid conditions such
as diabetic foot ulcers, sometimes with a level of amputation, so
management of this patient population can be extremely challenging.
Health care expenses combined with disability and compensation coverage
account for the majority of VA utilization and have demonstrated
significant growth since 2005 (1).
This is the VA patient population, Mr. Chairman. Our VA provider
members serve patients who are statistically comorbid with psychosocial
and socioeconomic issues, all of which play a role in the delivery of
care and final outcome. I know that the veteran population is far more
complex to treat than patients in the private sector, as a whole.
Greater than 90% of the veteran podiatric patient population is 44
years and older, with the majority of our patients of the Vietnam era,
who are plagued by the long-term effects of Agent Orange. Because of
this and because of the increasing number of OEF, OIF, and Operation
New Dawn (OND) veterans with lower extremity conditions, one of our
major missions as providers of lower extremity care is amputation
prevention and limb salvage. The value of podiatric care is recognized
in at-risk patient populations. Podiatric medical care as part of the
interdisciplinary team approach reduces the disease and economic
burdens of diabetes. In a study of 316,527 patients with commercial
insurance (64 years of age and younger) and 157,529 patients with
Medicare and an employer sponsored secondary insurance, there was noted
a savings of $19,686 per patient with commercial insurance and a
savings of $4,271 per Medicare-insured patient, when the patients had
at least one visit to a podiatric physician in the year preceding their
ulceration (11). Nearly 45,000 veterans with major limb loss use VA
services each year. Another 1.8 million veterans within the VA
Healthcare Network are at-risk of amputation. These at-risk veterans
include 1.5 million with diabetes, more than 500,000 with sensory
neuropathy, and more than 80,000 with non-healing foot ulcers (12).
Despite having a large at-risk patient population from the Vietnam era,
VA podiatric physicians are seeing increasing numbers of OEF, OIF and
OND patients who are at-risk for amputation. Given the magnitude of
amputation reductions, podiatric physicians not only provide a cost-
savings to VA, but we also play an integral role in the veteran quality
of life (12).
While limb salvage is a critical mission of the podiatry service in
the VA, the care delivered by the podiatric physician is of much
broader scope. As the specialist of the lower extremity, we diagnose
and treat problems ranging from dermatological issues to falls
prevention to orthopedic surgery. As one of the top five busiest
services in VA, we provide a significant amount of care to our veteran
patients and the bulk of foot and ankle care specifically. In fiscal
year 2015, the foot and ankle surgical procedures rendered by the
podiatry services totaled 28,300, while foot and ankle surgical
procedures performed by the orthopedic surgery service was a sum total
of 4,047.
The mission of VA health providers is to maintain patient
independence and keep the patient mobile by managing disease processes
and reducing amputation rates. Podiatric physicians employed by VA
assume essentially the same clinical, surgical, and administrative
responsibilities as any other unsupervised medical and surgical
specialty. Podiatrists independently manage patients medically and
surgically within our respective state scope of practice, including
examination, diagnosis, treatment plan and follow-up. In addition to
their VA practice, many VA podiatrists assume uncompensated leadership
positions such as residency director, committee positions, clinical
manager, etc. Examples include:
Steve Goldman, DPM, Chief of Podiatry and Director of
Podiatric Medical Education at Department of Veterans Affairs,
Northport, NY;
William Chagares, DPM, Research Institutional Review Board
Co-Chair, Chair of Research Safety Committee and Research Integrity
Officer and Chair of Medical Records Committee at the James A. Lovell
Federal Heath Care Center;
Aksone Nouvong, DPM, Research Institutional Review Board
Co-Chair at the West Los Angeles VA;
Lester Jones, DPM the former Associate Chief of Staff for
Quality at the VA Greater Los Angeles Health Care System for eight
years, and podiatric medical community representative while serving on
the VA Special Medical Advisory Group;
Despite this equality in work responsibility and expectations,
there exists a marked disparity in recognition and pay of podiatrists
as physicians in the VA. These discrepancies have directly resulted in
a severe recruitment issue of experienced podiatrists into the VA, and
unfortunately have also been the direct cause of retention issues. The
majority of new podiatrists hired within the VA have stories just like
these. They have less than ten years of experience and they are not
board certified. As a result of the disparity the VA is attracting less
experienced podiatric physicians. After hiring, the majority of these
new podiatrists that hire into the VA separate within the first 5
years.
Compounding the recruitment and retention issues, there exists
lengthy employment vacancies when a podiatrist leaves a station. The
gap between a staff departure to the time of filling the position is in
excess of one year. Because of employment gaps as a consequence of the
inherent and chronic recruitment and retention challenges, wait times
within the VA for lower extremity care are unacceptably long. Since
October 2014, 22,601 of the 191,501 (11.8 percent) established patients
suffered a wait time of greater than 15 days, with some greater than
120 days. During this same time period, 23,543 of the 25,245 (93
percent) new patients suffered a wait time of the same magnitude. The
prolonged vacancy exists partly because the VA is not capable of
attracting experienced candidates, but also because the credentialing
process is ineffectively burdensome. There have been no reported
improvements in on-boarding since our last testimony was submitted on
this issue in May of 2015.
It is precisely because of the aforementioned issues that
legislative proposals to amend Title 38 to include podiatric physicians
and surgeons in the Physician and Dentist pay band, have been submitted
by the Director of Podiatry Services annually for the last ten years.
These proposals have been denied every single year. Additionally,
several requests for an internal fix have been denied, despite written
letters of support for this movement from the former Under Secretary of
Health, Robert Petzel, MD.
Six years ago the APMA's House of Delegates passed a resolution
making this issue a top priority. Since then we have alerted the VA to
our knowledge of this issue. In response, former Under Secretary Petzel
created a working group composed of Dr. Rajiv Jain, now Assistant
Deputy Under Secretary for Health for Patient Care Services, Dr.
Margaret Hammond, Acting Chief Officer for Patient Care Services, and
Dr. Jeffrey Robbins, Chief of Podiatry Service. We have participated in
several meetings with members of the working group and, most recently,
we have received written support of Patient Care Services and Podiatry
Service for a legislative solution to address this issue.
Occam's razor is a problem solving principle whereby the simplest
solution is often the best. I submit testimony to this committee today
to respectfully request that Congress help the VA and its patients by
passing legislation to recognize podiatric physicians and surgeons as
physicians in the physician and dentist pay band. We believe that
simply changing the law to recognize podiatry, both for the
advancements we have made to our profession and for the contributions
we make in the delivery of lower extremity care for the veteran
population, will resolve recruitment and retention problems for VA and
for veterans. Mr. Chairmen and members of the Subcommittees, thank you
again for this opportunity.
1.National Center for Veterans Analysis and Statistics, Department
of Veterans Affairs http://www.va.gov/vetdata/index.asp
2.Singh JA. Accuracy of Veterans Affairs databases for diagnoses of
chronic diseases. Prev Chronic Dis. 2009 Oct;6(4):A126.
3.Olson JM, Hogan MT, Pogach LM, Rajan M, Raugi GJ, Reiber GE. Foot
care education and self management behaviors in diverse veterans with
diabetes. Patient Prefer Adherence. 2009 Nov 3;3:45 0950.
4.Powers BJ, Grambow SC, Crowley MJ, Edelman DE, Oddone EZ.
Comparison of medicine resident diabetes care between Veterans Affairs
and academic health care systems. J Gen Intern Med. 2009 Aug;24(8):950
095.
5.Agha Z, Lofgren RP, VanRuiswyk JV, Layde PM. Are patients at
Veterans Affairs medical centers sicker? A comparative analysis of
health status and medical resource use. Arch Intern Med. 2000 Nov
27;160(21):3252 097.
6.Miller DR, Safford MM, Pogach LM. Who has diabetes? Best
estimates of diabetes prevalence in the Department of Veterans Affairs
based on computerized patient data. Diabetes Care. 2004 May;27 Suppl
2:B10 0921.
7.Mayfield JA, Reiber GE, Maynard C, Czerniecki JM, Caps MT,
Sangeorzan BJ. Trends in lower limb amputation in the Veterans Health
Administration, 1989 091998. J Rehabil Res Dev. 2000 Jan-Feb;37(1):23
0930.
8.Selim AJ, Berlowitz DR, Fincke G, Cong Z, Rogers W, Haffer SC,
Ren XS, Lee A, Qian SX, Miller DR, Spiro A 3rd, Selim BJ, Kazis LE. The
health status of elderly veteran enrollees in the Veterans Health
Administration. J Am Geriatr Soc. 2004 Aug;52(8):1271 096.
9.Neugaard BI, Priest JL, Burch SP, Cantrell CR, Foulis PR. Quality
of care for veterans with chronic diseases: performance on quality
indicators, medication use and adherence, and health care utilization.
Popul Health Manag. 2011 Apr;14(2):99 09106.
10.Johnston MV, Pogach L, Rajan M, Mitchinson A, Krein SL, Bonacker
K, Reiber G. Personal and treatment factors associated with foot self-
care among veterans with diabetes. J Rehabil Res Dev. 2006 Mar-
Apr;43(2):227 0938.
11.Carls GS, Gibson TB, Driver VR, Wrobel JS, Garoufalis MG,
Defrancis RR, Wang S, Bagalman JE, Christina JR. The economic value of
specialized lower-extremity medical care by podiatric physicians in the
treatment of diabetic foot ulcers. J Am Podiatr Med Assoc. 2011 Mar-
Apr;101(2):93 09115.
12.Preventing Amputation in Veterans Everywhere (PAVE) Program
[all]