[House Hearing, 115 Congress]
[From the U.S. Government Publishing Office]
MORE THAN JUST FILLING VACANCIES: A CLOSER LOOK AT VA HIRING
AUTHORITIES, RECRUITING, AND RETENTION
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HEARING
BEFORE THE
SUBCOMMITTEE ON HEALTH
OF THE
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED FIFTEENTH CONGRESS
SECOND SESSION
__________
THURSDAY, JUNE 21, 2018
__________
Serial No. 115-67
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
35-730 PDF WASHINGTON : 2019
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COMMITTEE ON VETERANS' AFFAIRS
DAVID P. ROE, Tennessee, Chairman
GUS M. BILIRAKIS, Florida, Vice- TIM WALZ, Minnesota, Ranking
Chairman Member
MIKE COFFMAN, Colorado MARK TAKANO, California
BILL FLORES, Texas JULIA BROWNLEY, California
AMATA COLEMAN RADEWAGEN, American ANN M. KUSTER, New Hampshire
Samoa BETO O'ROURKE, Texas
MIKE BOST, Illinois KATHLEEN RICE, New York
BRUCE POLIQUIN, Maine J. LUIS CORREA, California
NEAL DUNN, Florida CONOR LAMB, Pennsylvania
JODEY ARRINGTON, Texas ELIZABETH ESTY, Connecticut
CLAY HIGGINS, Louisiana SCOTT PETERS, California
JACK BERGMAN, Michigan
JIM BANKS, Indiana
JENNIFFER GONZALEZ-COLON, Puerto
Rico
BRIAN MAST, Florida
Jon Towers, Staff Director
Ray Kelley, Democratic Staff Director
SUBCOMMITTEE ON HEALTH
NEAL DUNN, Florida, Chairman
GUS BILIRAKIS, Florida JULIA BROWNLEY, California,
BILL FLORES, Texas Ranking Member
AMATA RADEWAGEN, American Samoa MARK TAKANO, California
CLAY HIGGINS, Louisiana ANN MCLANE KUSTER, New Hampshire
JENNIFER GONZALEZ-COLON, Puerto BETO O'ROURKE, Texas
Rico LUIS CORREA, California
BRIAN MAST, Florida
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
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Thursday, June 21, 2018
Page
More Than Just Filling Vacancies: A Closer Look At VA Hiring
Authorities, Recruiting, And Retention......................... 1
OPENING STATEMENTS
Honorable Neal Dunn, Chairman.................................... 1
Honorable Julia Brownley, Ranking Member......................... 2
WITNESSES
Max Stier, President and Chief Executive Officer, Partnership for
Public Service................................................. 3
Prepared Statement........................................... 30
Debra A. Draper, Director, Health Care, Government Accountability
Office......................................................... 5
Prepared Statement........................................... 36
The Honorable Michael J. Missal, Inspector General, Office of the
Inspector General, U.S. Department of Veterans Affairs......... 7
Prepared Statement........................................... 43
Peter Shelby, Assistant Secretary for the Office of Human
Resources and Administration, U.S. Department of Veterans
Affairs........................................................ 8
Prepared Statement........................................... 46
Accompanied by:
Jessica Bonjorni MBA, PMP, SPHR, Acting Assistant Deputy
Under Secretary for Health for Workforce Services,
Veterans Health Administration, U.S. Department of
Veterans Affairs
STATEMENTS FOR THE RECORD
American Federation of Government Employees(AFGE)................ 49
Whistleblowers of America (WOA).................................. 52
MORE THAN JUST FILLING VACANCIES: A CLOSER LOOK AT VA HIRING
AUTHORITIES, RECRUITING, AND RETENTION
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Thursday, June 21, 2018
U.S. House of Representatives,
Committee on Veterans' Affairs,
Subcommittee on Health
Washington, D.C.
The Subcommittee met, pursuant to notice, at 10:00 a.m., in
Room 334, Cannon House Office Building, Hon. Neal Dunn
presiding.
Present: Representatives Dunn, Bilirakis, Higgins, Mast,
Roe, Brownley, Takano, Kuster, O'Rourke, and Correa.
OPENING STATEMENT OF NEAL DUNN, CHAIRMAN
Mr. Dunn. This meeting will come to order. Thank you. Good
afternoon, good morning. Thank you all for joining us today as
we take a closer look at the staffing across the Department of
Veterans Affairs and the health care system. Just last week the
Inspector General released a fourth annual VA staffing shortage
report, and for the first time the report included a staffing
shortage information about each VA medical center. It also
included information on shortages for clinical and non-clinical
positions in recognition of the fact that many VA facilities
struggle to hire custodians, and police officers, and human
resource professionals, just as much as they struggle to hire
doctors and nurses.
To no one's surprise, the report found a wide variety of
staffing needs on the ground. It also found persistent
challenges to improve staffing, due primarily to a lack of
qualified applications, and an inability to compete with the
private sector, and some high turnover problems. The
consequence of VA's failure to address these challenges are
almost unparalleled as the VA cannot function on any level
without high performing, appropriately staffed facilities.
Last summer, the Committee passed the VA Choice and Quality
Employment Act of 2017 which contained 14 provisions to improve
the VA's ability to hire clinicians and support staff. The VA
Mission Act which was signed into law just three weeks ago
included an additional 11 provisions to further improve the
VA's ability to attract those professionals to our medical
facilities.
During today's hearing, I want to examine how well the
authorities that we have provided to the VA, how well those are
working from last summer, and the additional authorities that
we provided this summer, also what further actions need to be
taken to overcome the Department's considerable barriers to
better recruitment and retention.
I am grateful to all of our witnesses for being with us
this morning to discuss this important issue, and I do want to
note that the American Federation of Government Employees was
invited also to testified today and initially accepted that
invitation, ultimately declined. I believe that hearing the
perspective of the employee union would have been valuable to
today's conversation. I regret that they were unable to send a
representative here today.
With that, I yield to Ranking Member Brownley for any
opening statement that she may have.
OPENING STATEMENT OF JULIA BROWNLEY, RANKING MEMBER
Ms. Brownley. Thank you, Mr. Chairman, and thank you for
holding this hearing on VHA's efforts to recruit, hire, and
retain quality staff in both clinical and non-clinical
positions.
Nearly a year ago, this Congress passed the VA Choice and
Quality Employment Act which provided the VA with even more
tools to aid medical center directors as they attempt to hire
quality employees. However, neither these tools nor previously
authorized hiring authorities have been coupled with the
resources and leadership necessary to ensure the mission is
actually carried out.
For instance, GAO found that VHA has failed to execute a
comprehensive review of the authorities granted to it over the
years. The failure to complete this review means that when this
Committee discusses these incentives, such as increased salary
caps or expanded physician training opportunities, we have no
clue what actually works and what doesn't. When we are talking
about an agency responsible for translating limited tax dollars
into the unlimited commitment that this country owes veterans,
every dollar counts.So efficiency, effectiveness, and
transparency are paramount.
As this Committee considers the staffing shortages of VHA
today, it would be irresponsible to ignore VA's vacant
executive suite. It has been nearly five weeks since the
President announced his nominee for Secretary of VA. However,
it took until yesterday to formally submit this nomination to
the Senate. It has been 16 months since VA had a permanent
Under Secretary of Health. There are no less than nine deputies
Under Secretary and assistant deputy Under Secretary positions
without permanent appointees.
How can VA be expected to deliver timely, quality health
care to over nine million veterans when this administration
refuses to prioritize the need for stable, qualified, fully
vetted leaders within the agency? How can we truly expect VHA
to prioritize recruitment, hiring, and retention efforts at the
local level when this administration and President Trump show
no desire to do the same? This administration needs to lead by
example, and that means putting the leadership in place who
will get the job done.
I also ask medical facility directors and VHA frontline
employees to hold strong as we do our best to hold this vacant
VA accountable. I believe today's hearing is a first step
towards a fully staffed VHA. However, I have concerns regarding
the VA's central office commitment to this process, a process
that must include communication, data collection, and analysis,
and fully supported and informed decision making.
I hope to hear today how we can ensure the VA has the
focus, dedication, and resources to carry out this process. I
appreciate the majority and the witnesses for their willingness
to engage in today's discussion, and I thank you, and I yield
back.
Mr. Dunn. Thank you very much, Ranking Member Brownley. I
would like to also thank the Chairman of the overall Committee
for coming in, Chairman Phil Roe. Thank you, sir.
Joining us this afternoon on our first and only panel is
Max Stier, the President Chief Executive Officer of the
Partnership for Public Service. Welcome.
Ms. Debra Draper, Health Care Director for the Government
Accounting Office for Health. Great to have you here.
The Honorable Michael J. Missal, the VA Inspector General,
and a fellow graduate of Washington and Lee University. Go
General.
And also, Peter Shelby, the VA Assistant Secretary for the
Office of Human Resources and Administration. And he is joined
by Ms. Bonjorni, the VA Acting Assistant Deputy Under Secretary
for Health for Workforce Services who was on a panel here just
last week, if I remember you. So it is welcome back.
Thank you all for being here today, and Mr. Stier, we are
going to begin with you, and you are now recognized for five
minutes for your opening statement.
STATEMENT OF MAX STIER
Mr. Stier. Thank you very much, Mr. Chairman, Ranking
Member Brownley, and the Members of the Committee. I just want
to start by saying how exceptional it is that you are holding
this hearing. Typically, we see legislation done, then the
Committee moves on and doesn't come back to see whether it is
actually working. The engagement you have had in trying to make
the VA better on a bipartisan basis is really model performance
in Congress in my view. So thank you for all the work that you
are doing. I also want to thank the folks from VA itself who
are doing really hard work and making some progress.
So I want to start by putting us in a larger context here
about what is happening, and I think you have to begin, again,
with the people of the agency who are the fundamental resource
that the organization has to produce results, and there is a
real issue here because morale at the VA is not good and it is
getting worse. VHA ranks 292 out of 339 agency subcomponents
that we measure in the Partnership's Best Places to Work
rankings, and that number went down last year whereas the rest
of government went up.
Morale is very important because it is directly related to
the performance of the agency. It is related to customer
experience, and much more relevant to us today, right here, it
is related to retention, and there are real retention issues at
the VA. Over the past six years, the VA has seen nearly a third
of its medical personnel leave. That is double the attrition
average of the Federal government. So again, the hiring is
important, but you have got to hold on to your talent. They are
intimately related, and morale is fundamental to making that
work right.
And then, Ranking Member Brownley, I think you hit on a
very critical issue. You have no permanent secretary, no
permanent deputy secretary, no Under Secretary, and you have a
lot of acting folks underneath, and no organization can work
effectively, certainly not take on the really big challenges
that need to be done here, without that leadership in place.
So I am going to offer nine recommendations in three
buckets: oversight, short-term legislative fixes, and some
long-term legislative issues that I think will make a big
difference if you can get them done.
Two ideas on the oversight issue, first. Number one, back
to the leadership issue. It is the most important, and we need
leaders to own the actual health of the organization. In the
legislation you provided last year, there is a requirement for
a performance plan for political appointees. I think the new
secretary should be held accountable in implementing that. You
can hold them accountable by using that performance plan, and
employee morale ought to be one of the core issues that is
included. So I would press on that.
Secondly, I think it is very important that we look to the
folks that are on this panel on the oversight side to help.
They have done great work here. Two ideas that might actually
help even further, one of which is that in every report that
the IG and GAO does, it would be very helpful, where possible,
to put promising practices in. The tendency in government is to
find problems and not to find where there are bright spots that
you can learn from, and I think the IG and GAO could do a lot
if you asked them to find promising practices for every issue
that they identify.
Secondly, it would be really helpful if they also found
things that the VA should stop doing. One of the big
challenges, and one of the reasons why implementation is so
hard, is the folks at the VA are being asked to do more and
more and more and more. It builds on top of each other. No one
goes back and says, ``Is that really important? Is that the
priority?'' And the cost means that the important things don't
get done, and I think if you directed the VA and the oversight
folks to find the things that they shouldn't be doing, the
reports they should not be giving you, that would be a huge
benefit.
Alright, let me move to some legislative opportunities.
First, Congress should authorize market pay for medical center
directors. This is the most important group in terms of
performance at the VA. They are the folks that are leading the
hospital centers and the VISNs, and right now they are being
paid by and large under the SES system which was not designed
for medical center directors. There are only about 170 of them,
and if you provided market-base pay, or market-sensitive pay,
for them that would be hugely important. You gave VA a direct
hire authority already, but that authority is coming in even
underneath the SES pay. That is a big problem. Fixing that
would make a big change.
Number two, give the VA the authority to certify senior
executives. We have a process right now where everything goes
through OPM at the front end. It slows everything down. You
need to reverse this. Allow the VA to make its own SES
appointments, and then have oversight after the fact so that
the process doesn't become overwhelming and then chase away a
lot of candidates. That is also true around critical pay
authority, and I would also advocate that you codify the
authority to make conditional offers to job candidates.
I am going to jump to two long-term suggestions, here. The
VA staff right now in HR has to operate with three personnel
systems: Title 38, Title 5, and a hybrid Title 38. That makes
no sense. It is a waste of time. You should create one system
for VA. That would enable them, bluntly, to do their work much
better. next, Congress should also get rid of the current
classification system. I recognize that it is a big lift. It
was a system that was created long ago for a world that doesn't
exist anymore and the nature of work has changed. This reform
should be made for all of government, but certainly here at VA.
And I am happy to talk slower and offer a few more of those
ideas, but I don't want to take more than my five minutes.
Thank you.
[The prepared statement of Max Stier appears in the
Appendix]
Mr. Dunn. Thank you very much, Mr. Stier. We appreciate you
squeezing so much information into five minutes. I know how
hard it can be.
Ms. Draper, you are now recognized for five minutes.
STATEMENT OF DEBRA A. DRAPER
Ms. Draper. Chairman Dunn, Ranking Member Brownley, and
Members of the Subcommittee, thank you for the opportunity to
be here today to discuss VA's ability to recruit, retain an
onboard high-quality clinicians and support staff to care for
our Nation's veterans.
Physicians provide and supervise a broad range of care,
including primary and specialty care, and are vital to VA's
mission of providing quality and timely health care to
veterans. Factors such as VA's lengthy hiring process, a
limited supply of candidates, and a highly competitive
recruitment environment have resulted in physicians occupying a
top spot on VA's annual list of mission-critical occupations.
Over the past two decades, we and others have expressed
concern about VA's ability to ensure that it has the
appropriate clinical workforce to meet the current and future
needs of veterans. For example, a 2015 independent assessment
found that VA may be unable to meet the projected demand for
services if it doesn't increase the number of clinical staff,
including physicians. In 2016, we found that physician losses
steadily increased over the previous five years, due primarily
to voluntary resignations and retirements.
Additionally, the Health Resources and Services
Administration projects that by 2025 the national demand for
physician services will exceed supply. These shortages are
expected to be considerably worse in rural areas where
communities struggle to attract and keep well-trained
providers. This is particularly concerning given that
approximately one in four VA medical centers is located in a
rural community.
In October, we reported the VA's information on the number
of physicians providing care at its medical centers was
incomplete because it lacked data on the number of contract
physicians and only had limited data on the number of physician
trainees, two types of physicians that augment the care
provided by VA employed physicians. As a result, the VA does
not know how many physicians it has, impeding not only its
ability to determine current needs, but also to appropriately
plan for the future.
In our October report, we recommended that VA implement a
systematic process to count all of its physicians which would
result in complete and accurate information. VA did not concur
with this recommendation and recently reiterated its
nonconcurrence. Although VA has implemented a new personnel
database, HRsmart, that could help provide an accurate count,
it does not plan to use the system to track physicians it does
not directly employ. This is despite VA officials acknowledging
that their workforce planning processes do not include data on
all physicians. We continue to believe that it is imperative
for VA to have an accurate count of all of its physicians.
Also in October, we reported that although VA provides its
medical centers with some guidance on how to determine the
number of physicians and support staff it needs, there is
insufficient guidance for the medical and surgical specialties.
As a result, medical center officials told us that they are
often unsure if their staffing is adequate.
We recommended the VA issue guidance to its medical centers
on determining appropriate physician staffing levels and VA
concurred. VA recently told us it has taken steps to address
this recommendation. For example, it established a work group
to develop a staffing model for specialty care. VA anticipates
that the work--will issue guidance in December.
Additionally in October, we found that VA uses a number of
strategies to recruit and retain physicians, but has not
evaluated them to determine their effectiveness. These
strategies include, for example, a national physician training
program and financial incentives. We recommended that VA
conduct a comprehensive evaluation of its physician recruitment
and retention efforts, and establish an ongoing monitoring
program, and establish a system-wide process to share
information about physician trainees to help fill vacancies
across medical centers.
VA concurred with our recommendations and has taken steps
to address them. For example, VA recently told us that they are
in the process of completing a review of its physician
recruitment and retention incentives, including an effort to
evaluate and recommend a systematic approach for allocating
resources, such as those for their education debt reduction
program. This review is expected to be completed later this
year.
In conclusion, our October report identified a number of
weaknesses with regards to VA's ability to recruit, retain an
onboard high-quality physicians, and we made a number of
recommendations. It is critical for VA to fully implement all
of our recommendations to ensure its ability to attract and
retain physicians, particularly given the continuing growth and
demand for VA health care, an increasingly competitive
recruitment environment, and looming shortages.
Mr. Chairman, this concludes my opening remarks. I would be
happy to answer any questions.
[The prepared statement of Debra Draper appears in the
Appendix]
Mr. Dunn. Thank you very much, Ms. Draper. We now yield to
Inspector General Missal five minutes.
STATEMENT OF MICHAEL J. MISSAL
Mr. Missal. Chairman Dunn, Ranking Member Brownley,
Chairman Roe, and other Members of the Subcommittee, thank you
for the opportunity to discuss my office's recent report, OIG
Determination of Veterans Health Administration's Occupational
Staffing Shortages for Fiscal Year 2018.
Although this is the fifth OIG report on staffing shortages
within VA's health care system, it is the first report that
includes facility specific data reported by leaders at 140 VA
medical centers. Since January 2015, the OIG has reported on VA
clinical staffing shortages as required by the Veterans Access
Choice and Accountability Act of 2014. In our prior reports, we
recommended that VHA develop and implement staffing models for
critical occupations. We recognize that VHA has implemented
staffing models in specific areas, such as primary care and in-
patient nursing. However, operational staffing models that
comprehensively cover critical occupations are still needed.
The VA Choice and Quality Employment Act of 2017 expanded
the reporting requirements to include both clinical and non-
clinical positions, as well as requiring information for each
VA medical center. Consequently, the OIG conducted a facility-
specific survey to determine current local staffing levels and
identify shortages. The OIG requested that VA medical center
directors designate and rank each occupation for which there is
a shortage at their facility. This shortage information should
assist VHA in determining how to best meet facility-specific
needs and improve the quality of health care.
Recent OIG reports have demonstrated the importance of
including non-clinical positions in our reports of staffing
shortages. For example, in our March 2018 report, critical
deficiencies at the Washington D.C. VA Medical Center, we
detail how excessive vacancies in key departments can impact
patient care. In that report, we found an inadequately staffed
human resources function that contributed to key vacancies
throughout the facility, including shortages in logistics,
prosthetic ordering, sterile processing, and environmental
management services.
In our 2018 survey, medical center directors most commonly
cited the need for medical officers and nurses, which is
consistent with the OIG's four previous VHA staffing reports.
Our analysis showed that 138 of 140 facilities listed the
medical officer occupational series as experiencing a shortage,
with psychiatry and primary care positions being the most
frequently reported. Of the 140 facilities, 108 listed the
nurse occupational series as experiencing a shortage, with
practical nurse and staff nurse as the most frequently
reported. With non-clinical occupations, the OIG found that
human resources management and police occupations were among
the most often cited as shortages.
The results of our survey demonstrate that although there
are clusters of commonalities, there is also wide variability
and occupational shortages reported by individual medical
centers. This is critically important to recognize because
facilities have distinct staffing needs that must considered.
For example, a rural facility that specializes in the treatment
of mental health will need to be staffed differently than an
urban facility that provides a broad array of services.
The report also identified challenges to meeting staffing
goals. The three most frequently cited challenges were lack of
qualified applicants, non-competitive salaries, and high staff
turnover.
Our 2018 report repeats the OIG's previous calls for VHA to
develop a new staffing model that identifies and prioritizes
staffing needs at the national level, while supporting
flexibility at the facility level, to ensure taxpayer dollars
are invested in delivering the highest quality care to
veterans. VA's focus on developing a comprehensive staffing
model will lead to more efficient hiring practices, and result
in fewer recruitment challenges, and an increased capacity to
serve veterans' needs.
In conclusion, for VA to meets its mission of providing
high quality health care to veterans, VA must have a better
understanding of each facility's staffing needs. Our 2018
report should provide prompt and meaningful discussions at both
the local and national levels about how to implement, support,
and oversee staffing in VA medical centers.
Mr. Chairman, this concludes my statement. I would be
pleased to answer any questions that you or other Members of
the Committee may have. Thank you.
[The prepared statement of Michael Missal appears in the
Appendix]
Mr. Dunn. Thank you very much, Mr. Missal. Assistant
Secretary Shelby, we now recognize you for five minutes.
STATEMENT OF PETER SHELBY
Mr. Shelby. Thank you, sir. Morning Chairman Dunn, Ranking
Member Brownley, Chairman Roe, and distinguished Members of the
Committee. Thank you for this opportunity to discuss staffing
at the Department of Veterans Affairs. I am accompanied by Ms.
Jessica Bonjorni, our acting Assistant Deputy Under Secretary
for Health.
The Department of Veterans Affairs, and I personally as a
24-year veteran of the Marine Corps, appreciate your steadfast
commitment to America's veterans with your recent passage of
several legislative acts, including the VA Mission Act and last
year's VA Choice and Quality Employment Act. These bills enable
the department's comprehensive efforts to recruit, develop, and
retain the high-quality professionals who provide health care,
benefits assistance, and memorial services to our veterans.
Last week, the Office of Inspector General released its
report on VHA occupational staffing shortages. Their findings
are consistent with prior annual reviews of VHA staffing, with
physicians and nurses topping the list. For the first time,
non-clinical shortages were also identified, which consist of
HR specialists, police officers, and custodial staff.
VA continues to develop strategies to address shortages in
these critical areas. Every occupation is critical to our
ability to successfully deliver the highest quality care to our
veterans. Inclusion of non-clinical positions in the GAO study
is recognition of this reality.
Strong HR is paramount to VA's ability to serve our
veterans. The complexity of VA's three personnel system
exacerbates our inability to fill HR vacancies and meet
critical requirements. The only non-clinical occupation
consistently in VHA's top mission-critical occupations, year
after year, is HR. Despite this challenge, our HR capabilities
and services continue to improve.
Last year's GAO report on VHA human capital provided
numerous recommendations to clarify lines of authority and
provide comprehensive training and competency assessments to
improve HR services. We are implementing these and many other
changes to address our customers' needs. I am committed to
exploring every option, technology, and innovation to develop
and sustain highly effective human resources capabilities
across the Department of Veterans Affairs.
VA appreciates the legislative support of this Committee.
Enhanced accountability and hiring authorities help us deliver
critical recruitment and staffing services to sustain a vast
department. VA is the second largest Federal agency with over
380,000 employees distributed across all 50 states and all U.S.
territories. The scope and scale make vacancies numbers often
quoted in the media seem very high. Taken in context, VA's
vacancy and turnover rates are very low. We fluctuate between
nine and ten percent, which compares very favorably with the
private sector. Since March 2018, we have filled more than
16,000 vacancies and increased our end strength by nearly
3,000.
To meet key performance indicators, VA, like Kaiser,
Cleveland Clinic, and DoD, approach staffing holistically by
addressing the entire employee life cycle; recruitment,
onboarding, development, and retention. Our staffing strategy
targets one key performance indication: How well we meet the
needs of the veterans we serve. Staffing issues in certain
areas of our health care system impede our ability to provide
optimal care to veterans. We are working diligently to correct
those issues and continuously strive to improve.
Recent events in some of our health care facilities raised
concerns about VA staffing capabilities, and our processes for
assessing and monitoring adequate staffing levels. Congress,
GAO, and OIG have provided recommendations to improve staffing
and to proactively identify occupational shortages.
VA has established a manpower management office, and we
have upgraded our HR system of record to enhance our talent
acquisition capabilities. VHA has developed new staffing
models. They now benchmark access, quality, and staffing
against similar health care systems, and they can identify
facilities at risk of critical staffing shortfalls. These
efforts, combined with longstanding clinical staffing models,
and non-clinical models being developed, validated, and
refined, will provide VA's holistic staffing capability.
VA is also making progress in implementing provisions of
the VA Choice and Quality Employment Act of 2017. The
Accountability Act provided direct higher authority to fill
medical center and network director positions. However, it does
not include authority to provide pay commensurate with other
senior executives.
In conclusion, we thank Congress for your continued support
of the Department of Veterans Affairs. We serve and honor the
men and women who have served this country, America's veterans.
I personally welcome every opportunity to engage the Committee
in dialogue and explore how we best work together to meet the
needs of our veterans.
Mr. Chairman, Jessica and I are prepared to answer any
questions you and Members of the Committee may have.
[The prepared statement of Peter Shelby appears in the
Appendix]
Mr. Dunn. Thank you very much, Mr. Shelby. We will turn to
the question portion of the panel, and I am going to ask the
panelists if you can keep your answers, sort of, succinct. I
know that is hard sometimes, but we are constrained by time. So
appreciate your efforts on behalf of that.
I will now yield myself five minutes for questions and
begin, if I may, with Inspector General Missal.
We have pretty--the same recommendations year after year,
at least since 2015. I am going to ask you, you know, it feels
like we are stuck. Are we stuck, and if we are not stuck--well,
if we are stuck, why? Where?
Mr. Missal. We agree with you that we have been making the
same recommendation on a staffing model, first to develop, then
to implement. That still hasn't been closed out by us. We
believe VA is making progress on it, but not as quickly as we
would like.
Mr. Dunn. So on the implementation, the model is there?
Mr. Missal. Implementation, right. They do have some
staffing models, as I said, in primary care and some nursing
positions, but they need a comprehensive staffing model, so
they really understand where they need positions, how to spend
the dollars, and how to budget.
Mr. Dunn. Do you think that is the biggest barrier? The VA,
is that the biggest barrier to meeting staffing shortages, is
the lack of implementation of model, or is it shortage of--
Mr. Dunn [continued]. --adequate personnel?
Mr. Missal. That is a significant issue. If they can get a
staffing model where they really understand what they need. I
think that goes a long way towards improving the staffing.--
Mr. Dunn. So that is a start. All right.
Mr. Shelby, thank you for your service. How many
vacancies--let's see--no, how--you said this. This is great,
you addressed the vacancy rate is not that different from other
large health care systems, but it--clearly, we have shortages.
So I am guessing, that is all specialty specific. Does it match
up to the gaps we have in the staffing models?
Mr. Shelby. Yes, sir. What is critically important to focus
on is our critical shortfalls. Overall vacancy rate doesn't
tell me where we are not meeting the needs of veterans.
Focusing on critical shortfalls does, and noted in the IG, you
saw a great difference in the types of shortages they have
across. We have several that are common, and they will parallel
the private sector health care. All right? There is a shortage
of psychiatrists across--
Mr. Dunn. Across the Nation.
Mr. Shelby [continued]. --the Nation. So we compete for
that limited--
Mr. Dunn. I remember, we are always looking for nurses.
That is--so, a great, great profession.
Let me--do you have any direct authority over the HR
functions at VA?
Mr. Shelby. Yes, sir. You have full authority over all HR
functions at the VA.
Mr. Dunn. Okay. So, this sort of sounds like HR is in your
wheelhouse to implement these models that we have talked about:
can you give us any good news here?
Mr. Shelby. We have--in the past, it has been three or four
different HR organizations, very decentralized. We are
consolidating that into a single HR authority. We work as a
single executive HR team now and we are figuring out how to
consolidate official and effective HR.
If I have 182 people doing a single HR function and divide
them over 182 organizations, any one of those that goes on
vacation, that particular facility loses 100 percent of their
capability. If I start consolidating those capabilities into
regional support centers, they meet the needs.
Mr. Dunn. We like that. In terms of consolidations, I
notice you have 19 physician recruiters for the entire system;
is that roughly a correct number, 19 physician recruiters?
Mr. Shelby. Yes.
Mr. Dunn. Yes? Okay. So, do they have a lot of staff? Each
of them has staff, because--no? That is just 19 people, total,
front to back.
Okay. Have you been using civilian recruitment--physician
recruitment forms--vendors?
Mr. Shelby. Yes, Jessica can speak specifically to the ones
we use, but we use all resources at our disposal to meet the
recruiting and staffing needs of the VA.
Mr. Dunn. So, what feedback do we get from our vendors, you
go asking them for fine doctors and they come back empty-
handed, what feedback are they giving us?
Mr. Shelby. Jessica?
Ms. Bonjorni. Sure. So, similar challenges that you might
see across any health care system. I think the challenge that
we have is by using those private sector recruiters, it is
significantly more expensive than using the ones that we have
in-house, who are extremely effective. We just need more of the
in-house recruiters.
Mr. Dunn. So, I have used recruiters over the years, and I
agree, it can be expensive, but I also think we can negotiate
those fees. You are the largest health care system in the
country. I think you can negotiate a break on that. And there
is expertise involved in recruiting physicians and expertise in
getting each specialty.
I think I will yield back at this point to Ms. Brownley,
the Ranking Member.
Ms. Brownley. Thank you, Mr. Chairman.
This Committee has heard time and time again that hiring
medical center directors has had its own specific challenges
and that is why vacancies remain open for long periods of time.
So, I was happy when we passed the VA Choice and Quality
Employment Act, which mandated the VA to develop a plan to
address hiring medical center directors.
And, recently, I became aware that there was a plan
submitted. It was roughly three months late. It was four pages
long and, basically, the gist of the whole report is to say
that VHA will utilize the current recruitment process to select
candidates. So, we asked to do a plan to overcome challenges.
We got a plan that says we should just use the regular
recruitment process.
So, Ms. Draper, based on your experience, what constitutes
a good plan to address this issue around hiring, in a timely
way, medical center directors?
Ms. Draper. Well, I think a lot of lessons can be learned
from us on VA high-risk, but a good plan has a number of
different elements. I think the very first thing that needs to
be done is a root cause analysis, because there obviously was
some issue with hiring medical center directors. There is some
problem that either there is not enough candidates or qualified
candidates or not able to retain them. So, I think
understanding the issues that are leading to that issue is
really critical. So, that is really a first plan in developing
the first action in developing a good plan.
And there needs to be corrective actions; those need to be
clearly identified. Resources need to be identified and
allocated looking at timelines, looking at metrics--how are you
going to measure this--and looking at what are your expected
outcomes.
And one key thing is that you need to assign will
accountability: who is going to be responsible for making sure
that this plan is carried out?
Ms. Brownley. Have you seen this plan?
Ms. Draper. It was on the table here, so ...
Ms. Brownley. So, have you had a chance to review it a
little?
Ms. Draper. I reviewed a really quickly. I mean, I think
the thing that struck me was that they are going to continue to
use the same process that they have done and to me that was a
little surprising.
Ms. Brownley. So, you feel that is a valid concern, that
they--the plan says to just use the existing recruitment
process?
Ms. Draper. Well, to me, if you look at the elements of a
good plan, it really didn't contain many of those elements, so
...
Ms. Brownley. Thank you.
Mr. Shelby, first, let me thank you for your 24 years of
service with the Marine Corps. And so, you know, what is your
response for that? If you think that, you know, our recruitment
efforts are fully adequate, what evaluations do you have to
confirm that?
Mr. Shelby. I don't particularly think all of our
recruitment efforts are fully adequate and I am working on
getting more diagnostic capabilities. One of the biggest things
that jumped out in the changes we made is we were way too
decentralized. So, you have individual organizations trying to
meet all of their needs on a local level and we have
commonalities; in particular, medical center directors, nurses,
certain physicians. We have raised that to a national
capability, rather than a lower capability so we can target a
broader audience, have targeted teams that focus on the
onboarding and hiring of these critical shortfalls. And so, we
actually did change that.
Ms. Brownley. Well, let's get back to what Ms. Draper said
in terms of root causes. Do you think a plan to mitigate
challenges with regards to recruiting medical directors, do you
think we need to get down total root causes, in order to have a
positive, effective plan?
Mr. Shelby. Yes, ma'am.
Ms. Brownley. And do you think the VA is going to initiate
that or, you know, how are we going to get to that place where
we can understand what the root causes are?
Mr. Shelby. Yes, the VA is absolutely doing that, and it is
across the board. We found several reasons why it varies why we
don't have strong retention in certain positions. Medical
center directors, it is the demand and the pay. It is an
extremely demanding job. The counterparts in the private
sector, in some cases, make four or five times what we are
capable of paying in certain markets. And so, you combine that
with the workload, it is very difficult to retain them. And
then recruiting them, like we alluded to at the beginning, we
got Direct-Hire Authority. We moved to use that, and we are
capped on salary at $153,000.
We tried Direct-Hire on two medical centers. We got through
the entire process, made the offer, and they rejected the offer
just because we could not meet their salary demands.
Ms. Brownley. My time is over. I yield back.
Mr. Dunn. Thank you, Ms. Brownley.
We have been joined by the Chairman of the Full Committee,
Dr. Phil Roe. I now yield to you 5 minutes, sir.
Mr. Roe. Thank you, Mr. Chairman and Ranking Member.
Medical staffing is something I know a lot about and spent
a career dealing with it. And we have at VA, some incredible
challenges going forward, I can tell you that. We had a
roundtable in this room a week ago that the AAMC, the American
Academy of Medical Colleges said that we would have a forty to
a hundred-thousand-dollar doctor shortage by 2030. That is not
very far away.
I mean military--folks that have served in the military,
like you, Mr. Shelby--and, again, thank you for your service in
the Marine Corps--who are just starting; that is going to
affect them.
So, I think we do need to have a long-term strategy, but
all health care is local, as you all pointed out. I mean, what
Mr. Missal said was if you are doing maybe it is mental health
in one place, those needs are different in a rural area than
they are and the challenges--and you can't do that centrally. I
think you have to recruit locally. That is where a lot of your
people are from, and it is hard to move and up people into a
place.
So, one of the things that we have done in our Committee is
we have sent people out to various VA hospitals and--you know,
with just one-hours' notice just to sort of see what was going
on at that medical center and one of the things that struck me
was that one of the material weaknesses I think I found was HR,
is recruiting. You have someone who is--has this position as
the HR director trying to recruit a professional person and
they don't know how to recruit to these people, and it was
amazing to me to see the disconnect.
I totally agree with you that, as I help run a hospital,
you are no better than the weakest link in that hospital and
that may be the environmental services, food services, staff in
the ORs to make sure the instruments are clean; all those are
critically important. They are just as important as I was as a
physician in the operating room. If they didn't do their job
well, I couldn't do my job well.
So, I think you have got a huge challenge ahead of you. And
one of the things, Mr. Shelby, you said, was if we are meeting
the needs of the veterans, I would disagree with that, because
if we were, we wouldn't need the Choice Program or the Mission
Act we just passed. So, I think we have huge challenges ahead
and I think HR, believe it or not is one of the critical ones.
And I don't know how you are going to recruit all of these
people.
I know my hospital at home recruits nationwide. We had a
huge nursing shortage, so what did they do? They provided
scholarships for nursing students, their third and fourth years
of school, and for that, when you ended up with no debt when
you left, you had a time obligation to serve at that hospital.
It is worked incredibly well. They stopped it for a while and
learned their lesson. They started over again.
So, if you could bring us ideas like that, we want to help.
We want to be--we are not here fussing; we want to be part of
the solution in trying to help.
And Ms. Draper, I think you mentioned something that
shocked me a little bit, but it was that a third of the medical
personnel turned over in what length of time was that orb
someone said there was that much turnover with the physicians
and nurses and so forth or maybe it was--
Mr. Stier. That was in six years, so 2011 to 2017
Mr. Roe. That is amazing.
Mr. Stier. So, it is double the attrition rate for the rest
of the Federal government.
Mr. Roe. Yeah, that is--why is that?
Mr. Stier. I think that is a good question that I am not
likely to offer you real insight on. I do think that
fundamentally it begins with the question that the Chairman
asked before: What are the big issues here? It starts at the
top and making sure that you have medical center directors in
place and that they are going to be there for a long period of
time, which requires a different funding model than you have
right now.
If you think about it, you offer Direct-Hire, but at a
lower pay than what you were able to do before. You are paying
the medical center directors less than you are paying the
individual physicians in a marketplace in which those folks, as
you heard earlier, can make four, five, six times that amount.
You asked for real concrete things Congress can do, like
the scholarship issue. Offer market-sensitive pay for medical
center directors to those folks. As you say, it is all local;
they are going to figure out a lot of the answers that they
need to in their own hospital or hospital system.
Mr. Roe. Now, I agree with you. We have a hospital--a
private hospital and VA campuses that meet each other, and I
can assure you that the hospital director at the private
hospital is not compensated the same as the one at the VA is; I
agree with that 100 percent.
Any other suggestions that you all have of how we can be of
help to you all in making think job easier for you in getting
those personnel that you need?
Mr. Shelby. Yes, sir. I think Max alluded to it; having
three pay systems does not give us the agility that we need.
And as you saw in the IG report, it is very unique and local
and having a market rate-based personnel system will give the
agility we need in each market to target the town and compete
with the local competition there. And then you have a national
strategy for implementing all of your HR strategies, but you
have the flexibility at the local level for them to meet the
needs there.
Mr. Roe. Just--thank you--just one other comment before I
yield back is that in my opinion, all the years I worked in
health care, I don't--the personnel, the people who work in the
systems are the most important. That is the engine. I don't
care if you have got a shiny outside--brand new hospital at
Denver, Colorado--if you don't have great people working in it,
you will not have a good facility. So, the people are the most
important part of a health care system, more so than buildings;
they are the engine that drive it. They are the face of it who
provide the care.
So, anything that we can do to help you all do your job, we
are here to do. I yield back.
Mr. Dunn. Thank you, very much, Chairman Roe.
Now, I yield 5 minutes to Representative Takano from
California.
Mr. Takano. Thank you, Mr. Chairman.
You know, as Members of this Committee, we can't find
solutions to problems until we understand the full scope of the
problems that we are facing. We saw over the last few years,
the staffing reports mandate under the Choice Act weren't
giving us all the details that we needed. I am pleased to see
that this latest report by the IG breaks down the staffing
shortages into more specific occupations and also includes non-
clinical positions.
Of all the employees at our medical centers, all of our
employees play a vital in ensuring veterans receive the highest
quality of care that they deserve. And I know from visiting
Loma Linda in my own--near my own district, one of the
challenges they face is hiring custodial staff and I see that
reflected in the IG's findings.
I want to get right into my questions. This Committee has
long been raising the issue of VA's lack of staffing models. At
present, VA only has three staffing models: primary care,
mental health, and nursing.
Mr. Shelby, when can we expect to see additional clinical
staffing models?
Mr. Shelby. Sir, I would like to yield that to Jessica,
because she's been working on several staffing models.
Mr. Takano. Of course, yes.
Ms. Bonjorni. Sure. Thank you, sir.
As Ms. Draper mentioned, I think, and Mr. Missal, we have
been working on those staffing models for some time, for some
time. We have a specialty care workgroup that is working on
developing multiple staffing models for clinical occupations
that will be done by the end of this year.
Mr. Takano. By the end of this year?
Ms. Bonjorni. Yes.
Mr. Takano. By the end of this calendar year?
Ms. Bonjorni. Yes.
Mr. Takano. Okay. Mr. Stier, as I look over the findings
from the GAO and IG, both make recommendations for the under
secretary of health to improve hiring at the VA; unfortunately,
that position is currently vacant, and we still don't have a
nominee. There has been uncertainty about who would lead the
Department as secretary for nearly two months.
Based on your organization's mission, can you speak to the
importance of having stable leadership in key positions and
what impact these vacancies may have on the VA's success.
Mr. Stier. So, I think that is a question that you have
answered already. Anyone who has been involved in any
organization knows that stable leadership is fundamental to the
success of that organization. It is one of the unique
challenges we have in our own government that you have so many
political appointees--4,000 of them. No other democracy has
anything else like that. By its very nature, these folks aren't
sticking around for a long period of time.
What we are seeing right now at the VA is particularly
problematic and it has massive impact. It is very difficult to
run an organization when people are in short-term positions. My
analogy is the substitute teacher: they may be wonderful
educators, but the reality is that they don't get a lot of
respect from the people in the classroom or they don't take on
the long-term challenges.
So, if we want to see VA succeeding, we need to see long-
term, capable, stable leadership.
Mr. Takano. So, I am really concerned about our move toward
the electronic medical records and our attempt to get them
interoperable with the Department of Defense and our non-VA
providers. Are you concerned at all that lack--you know, these
vacancies are going to set us up for some sort of failure or
boondoggle down the road?
Mr. Stier. I think the reality is that these are incredibly
challenging issues, whether it is staffing medical professions
where there is a shortage, or changing electronic medical
systems which are phenomenally complex systems. You want
everything aligned right to make it work and right now we don't
have that, so for sure, this adds another risk factor.
Mr. Takano. As you know, the commission on--you might
have--are you familiar with the Commission on Care report? All
of you are nodding your head.
Mr. Stier. Yes.
Mr. Takano. You know, I recall those hearings very, very
vividly about--we had them about accountability and they said
you can't have accountability--we know done an accountability
bill and we spent a lot of time on that, but I don't believe--I
don't think the Commission on Care, the bipartisan co-chairs
believe that accountability will be achieved without a robust
HR Department which does the hiring, but also the kind of
training with progressive discipline that our managers need to
implement to be able to really--they said you can't fire your
way to excellence and you can't discipline your way to--you
need trained personnel.
I understand that through April 2018, VA has hired 4222
human resource specialists. We also know that from work that
GAO has done that attrition rates among HR specialist rose 7.88
percent in 2013 to 12.1 percent in 2015.
How many vacancies are there currently for these positions?
Mr. Stier. That is not a question that I would be able to
answer.
Mr. Takano. Mr. Shelby?
Ms. Bonjorni. We have--we still have several hundred
vacancies for HR specialist, however our turnover rate did go
down over the last year, but that was primarily because of the
Federal hiring freeze, so they couldn't leave for other
agencies.
Mr. Takano. Do you collect exit surveys for these
positions?
Ms. Bonjorni. I'm sorry?
Mr. Takano. Do you collect exit surveys for these
positions?
Ms. Bonjorni. Yes, we do.
Mr. Takano. And if so, why are the general reasons listed
for why they are exiting and what are you doing to address
them?
Ms. Bonjorni. For HR specialists our exit-survey data shows
that they are leaving for advancement at other organizations or
concerns about the volume and nature of the work, due to the
complexity of the work.
Mr. Takano. Okay. Thank you.
I yield back, Mr. Chairman.
Mr. Dunn. Thank you, Mr. Takano.
And we now recognize Mr. Bilirakis from Florida for 5
minutes.
Mr. Bilirakis. Thank you, Mr. Chairman. I appreciate it
very much.
Mr. Shelby, thank you for your service. I have a question
for you. The testimony mentions 422 new HR specialists hired
into the VA and that is good. While this is--again, it is
progress--one of the last year's--one of last year's GAO
reports express concerns about the attrition rate amongst the
HR staff. I understand 13 and a half percent in fiscal year
2015; significantly higher than the VA employees in general.
What does VA plan on doing to help continue the progress
and retain those 422 new specialists that you have hired in
2018?
Mr. Shelby. Part of what we are doing is developing them.
We have re-implemented a development program to make them more
effective and efficient at their jobs. The other things are we
are way too decentralized, so there is too much demand at local
level. We are consolidating into centers of excellence so you
have depth at any given organization, and they can shift their
resources to the demand signal rather than have a full burden
on a single one and you miss capacity where there is capacity.
So, we are consolidating those.
And we also have to get operations much more involved in
HR. The supervisors and managers have to get involved in talent
management. They own their organizations. HR is a consultant to
make sure we hire it legally. They are the experts that run
their organizations and understand the talent they need, and so
they have to be more involved and so we are working towards
that model where HR is a consultant and a business partner, and
we have operations supporting every effort to find the right
talent to bring into those organizations.
Mr. Bilirakis. Very good.
Ms. Draper, do you have any suggestions? Does GAO have any
suggestions, additional suggestions, recommendations for VA in
order to reduce the attrition rate?
Ms. Draper. Yeah, in our report that we issued in 2017, we
made a number of recommendations and it wasn't just about the
hiring. The hiring--the attrition was very high, but it is also
about training the HR specialist and making sure that they are
adequately trained to do their jobs.
There are other issues that we identified. One was
problematic information technology systems that really did not
support good practices. So, that was a--so that is another big
issue, is our multiple systems that HR has to use.
The other thing is that there is just poor performance
management system that really does not provide clear
distinctions amongst staff and their abilities and, also, it
limits employee accountability.
And I think the other thing we identified is that weak
internal control. So, the overall oversight of HR functions was
inadequate. So, those were all in that 2017 report.
Mr. Bilirakis. Okay. Mr. Shelby, I mean, can you respond to
that--
Mr. Shelby. Yes, sir. We have addressed--
Mr. Bilirakis [continued]. --with regard to inadequately
training--
Mr. Shelby. We have implemented training. So, there is no
organization or school outside of government that is going to
create an HR professional to work in the government and, in
particular, in the VA. We are the only education around Title
38, hybrid Title 38. And so we are implementing a robust
development program to give those HR professionals that we
bring in, the education they need.
Mr. Bilirakis. Okay.
Mr. Shelby. But we absolutely need systems, right. When all
the demand is on individuals, rather than systems to support,
and self-service of our customers, there is always going to be
too much tactical demand in non-HR professionals. We have
upgraded our HR SMART system. Are cleaning up data corruption.
I inherited a system that they told me was going to cost $120
million to clean up. We have spent nothing. We have gotten to
the 70 percent solution. We are able to give accurate data on
vacancies now.
In the next few weeks, I anticipate us cleaning up enough
where we can launch individual self-service and manage-self-
service. So, as I alluded to, more and more onus upon
operations to lead and manage their people where HR can be
consultants and we can move them from the tactical day-to-day
personnel actions up to the talent-management, recruiting, and
getting the people onboard they need to run their
organizations.
Mr. Bilirakis. Very good. I have a second question, again,
for you Mr.--VA is currently expanding residency training and
has recently offered scholarships to those currently in school.
You say in your testimony that the VA is in the process of
completing a review of physician- recruitment strategies. When
will the review be complete and what is VA doing for the
current employees to ensure retention, such as educational--
education reduction programs, which are very important?
Mr. Shelby. We are using every resource at our disposal to
retain those that we have. I personally don't think we tapped
into enough. Almost every doctor in America, about 80 percent,
come through our systems and we don't--we haven't been
proactive enough in recruiting those.
Nurses, same thing--offering scholarships--we have to catch
them early. We are exposed to them early in their educational
career and we haven't taken advantage of that. I want to start
bringing in interns between their sophomore and junior years
and vet them then, and then at the end, between their junior
and senior year, vet them again and if they are meeting the
standards of the VA and if they are somebody we want to bring
onboard, I want to start offering tentative job offers, so we
get a whole year ahead of them. So, a year before they are
graduating, they have a tentative offer from the VA and then
using the resources that you have giving us with debt reduction
and debt repayment in order to entice them to come.
Mr. Bilirakis. Okay. Can we help you with that? Do you need
legislation for anything like that?
Mr. Shelby. Where we run into problems is caps, you know,
current caps--
Mr. Bilirakis. Yeah.
Mr. Shelby [continued]. --the recruiting, retention, and
relocation bonuses, we have caps. We appreciate the bump in
that cap that we just had, but we have the resources there. We
have already burned through that bump in the cap. So, we
absolutely need to flexibility. It is market-based. Somewhere
we are going to have offer more than in other markets and if we
have caps on it, we are always going to run into that.
Mr. Bilirakis. Thank you very much for bringing that up. I
appreciate it. Thank you.
I yield back, Mr. Chairman.
Mr. Dunn. Thank you, Mr. Bilirakis.
Now, recognized for 5 minutes, Mr. O'Rourke from El Paso,
Texas.
Mr. O'Rourke. Thank you, Mr. Chairman.
Mr. Stier, I appreciate your points about the need to
ensure that we have leadership and we, in El Paso, saw
firsthand the consequence of not having that leadership. We
were out a medical center director for two years, had a series
of interim directors. There was no captain setting the course
and holding everybody else accountable and we, at one point,
had the worst performance in mental health care wait times in
the country; out of 141 measured systems, we ranked 141st.
We--the veterans there, their families understood that care
delayed became care denied. It led to really tragic outcomes.
With the director that we now have, permanent director, we
now sometimes match and are better than the national wait time
average for mental health care. We are better than the national
wait time for primary health care. We have consistency in
recruitment and retention. So, it really makes a difference.
One of the challenges that you laid out to hiring all of
these directors is the pay. And I just heard Mr. Shelby say
that he has capped out at 153,000. What does market pay look
like?
Mr. Stier. Well, it is going to be dependent on the market,
so--
Mr. O'Rourke. Give me a ballpark. Give me a range.
Mr. Stier [continued]. --I mean, there are--and it depends
on the nature of the medical center, but there are medical
center directors that are paid in excess of a million dollars.
I don't think you have to do that. One of the incredible
advantages VA has is the mission. The mission is powerful, but
you can't pay a tenth or, you know, a fifth and then expect
that you are either going to be able to recruit people in or
retain them. Right now, I think the average is under three
years that you have medical center directors in place. It is
essential to ensure that VA can offer more flexibility in terms
of salary, surely more than you are going to offer just with an
individual doctor and making sure that the Direct-Hire
Authority you provided doesn't actually require a lower level
of pay than the standard SES pay scale. I am confident if you
do that, you have great folks at the VA who will use that
authority to great impact. That is the point of highest
leverage.
The last thing I want to say is I was very impressed the
last time I was in here when you described how you personally
recruited the medical center director. It matters when you hear
from a Member of Congress that they want you, that it is
important that they take this job. That kind of engagement is
phenomenal.
Mr. O'Rourke. Let me ask Mr. Shelby, 153,000 is the cap
right now. What would the cap need to be for you to have the
flexibility necessary to hire the directors that you are
missing?
Mr. Shelby. The cap has to be flexible. It is market-based.
Mr. O'Rourke. Unlimited?
Mr. Shelby. No.
Mr. O'Rourke. To the moon?
Mr. Shelby. So--
Mr. O'Rourke. So, what should the cap be?
Mr. Shelby. So, if you combine our mission--
Mr. O'Rourke. Okay. I am just looking for a number.
Mr. Shelby. Six-hundred-thousand dollars.
Mr. O'Rourke. Okay. How many medical center directors are
you missing right now, permanent medical center directors?
Mr. Shelby. We have 20 vacancies right now. I think we have
five impending vacancies. I believe we are recruiting right now
for 15.
And what we have changed is we do national recruiting
efforts, rather than individual requisitions, so we are being
much more proactive in finding those vacancies and putting
several of them out at the at the same time every single month.
So, we are trying to stay ahead of that turnover.
Mr. O'Rourke. How many clinical positions are you short?
Mr. Shelby. I can't tell you specifically how many clinical
positions we are short.
Mr. O'Rourke. Is that to Ms. Draper's point, that the VA
doesn't know?
Mr. Shelby. It is a--
Mr. O'Rourke. If you don't have an accurate count of the
physicians that you have, do you agree with that assessment?
Mr. Shelby. I agree.
Mr. O'Rourke. Okay. And is that why you can't answer our
question?
Mr. Shelby. No, I can't specifically answer the question
because it is such a large system and it is changing every
single day.
Mr. O'Rourke. It is a pretty important question.
Mr. Shelby. And if you look on the IG report, on every
single day--
Mr. O'Rourke. Yeah.
Mr. Shelby [continued]. --it is different and in every
single market it is different.
Mr. O'Rourke. Give me a ballpark. Thirty thousand is the
number that I have heard; that is the most recent number that I
have heard. I have heard as high as 40,000 from the secretary
of the VA. Where--are we in the ballpark, 30,000 clinical?
Mr. Shelby. Yes. So, a 10 percent rate in 385,000 is 38,000
on any given day.
Mr. O'Rourke. Okay.
Mr. Shelby. So, I can give you that. But, specific--maybe I
understand--you wanted specific clinical vacancies, and it
fluctuates so much--
Mr. O'Rourke. And do you have a ballpark of how many of
those are mental health care positions?
Mr. Shelby. I know we are very short. So, in mental health,
we have targeted that. Our goal is to increase it by 1,000 by
the end of the year. We have already increased it, net gain, of
over 400, and we are targeting by January of this year, to
reach that thousand.
Mr. O'Rourke. Last question. Mr. Stier was talking about
some of the morale challenges within the VA. Talked about
double the attrition rate. One of the lowest morale rankings in
the Federal government. That doesn't seem to match your
description of what is going on in the VA. You offered a far
rosier picture.
Is he wrong? Are you right? Do you see what he has seeing?
Do you acknowledge the attrition rate and the morale challenge?
Mr. Shelby. I absolutely acknowledge the attrition rate. It
is very difficult in a system where we are competing for
limited talent, you have a high demand, and we are working
people a lot. So we have to get better at that.
But I can tell you this, I have been out to medical
centers. I have been out to benefits offices. I have been out
to cemeteries. And the VA workforce is the most amazing,
dedicated workforce I have ever seen, and their morale is high.
And we have to help them be successful because of us and not in
spite of us. We have removed impediments--and a lot of these
are hiring impediments--and the market--and our inability to
compete in the markets that they work in for the talent we
need.
Mr. O'Rourke. The last thing, and I am going to yield back
to the chair, but you say morale is high and I think morale is
something that can be measured and maybe imperfectly, and it
seems to be measured low. I would love to understand, maybe for
the record, maybe for a future conversation, why the
discrepancy between what we are measuring and hearing from VA
employees and what you are telling Members of the Oversight
Committee right now.
Mr. Shelby. I have our own employee survey out now. It goes
to 100 percent of our employees. We expect a 65 percent return
rate on that. So, that is nearly 300,000 employees. I will have
a clearer picture and I would welcome the opportunity to come
back and share that information with you.
Mr. O'Rourke. Thank you. Appreciate it.
Mr. Dunn. Thank you, Mr. O'Rourke.
And I wouldn't wait to come back. If you would share that
report when you get it, I know we would all be interested in
it.
I now recognize Captain Clay Higgins from St. Landry's
Parish, Louisiana, for 5 minutes.
Mr. Higgins. Thank you, Mr. Chairman.
Mr. Shelby, you gave us a number of $600,000. I think that
is probably a good estimation on your part regarding the
disparity between the pay for directors of our medical centers
and our VISNs, compared to the hundred-and-fifty- three-
thousand-dollar cap that you are currently working with. And we
can certainly understand the challenge of maintaining those
positions and filling those slots and retaining qualified
personnel in those positions because of the disparity of pay
that is available in the civilian world, but at the same time
can you imagine how a regular American veteran, you know,
coming from a middle-class family, earning $34,000 a year would
feel when they can't get an postponement for weeks and weeks
and weeks at a medical center, knowing that the director is
getting paid 600 grand?
As a marine, give me your feelings on that, sir.
Mr. Shelby. Yes, sir. I am the checking account person you
described. I am the eighth of nine kids. Joined the Marines
when I was 17. My father was a police officer, retired. And
that type of pay is mind-boggling to me. I never anticipated my
father would make a hundred thousand dollars so--
Mr. Higgins. Exactly. We talk about numbers in this body
like it is--like we are operating in a vacuum and in many ways,
DC is a vacuum; it is certainly a bubble that is in far too
many instances, is disassociated from the reality of American
struggle.
So, I would hope--I am very glad that we are focused on
directors and filling these positions. Mr. Chairman, Madam
Ranking Member, my colleagues have brought up these challenges
that we face, and I would hope that we have a spirit of being
able to do more with less and tapping into the patriotic
service of the Americans and medical professions across the
country that have a desire to serve their country.
So, I am going to shift to what you had stated, sir,
regarding recruitment out of our universities' medical schools.
I am very encouraged by what you stated regarding offering jobs
to pending graduates coming out of medical schools. How is that
process going? Have you had any success with it? Because I
think that is certainly an answer.
For a graduate, a medical school graduate to have a job
waiting for them when they graduate is important and the VA has
not been participating in recruiting during that internship of
their medical training in the past and you are telling us they
are now. How is that working? Have you had success? Is anybody
in place right now, based upon that level of recruitment?
Mr. Shelby. They are not. This is a disrupter. This is a
complete change in the mindset of how we do government hiring.
Mr. Higgins. Congratulations. That is a damn good change
and I encourage you to pursue it aggressively.
Is there anything this body can do, that this Committee can
do legislatively to help your clear any obstacles to that
mission, because I think that is key.
Mr. Shelby. I think part of it is the caps. We need to be
able to offer scholarships and debt reduction and that is going
to fluctuate. And so, working with Congress to identify what
the demand is going to be on that, but I promise you this, I
will do a cost-benefit analysis in losing that talent and not
being able to bring them in and how that impacts wait times and
our ability to serve veterans.
To me, it is a no-brainer, right; the costs far outweigh
not doing it. And I am working closely with OPM. I am hoping to
get policies and process in place. You know, we are in the
midst of civil-service reform with them, as well. We need them
to facilitate the ability to do our job and not be an
impediment to that and I am confident that we are going to get
to that with working with OPM.
Mr. Higgins. And, quickly, with regard to filling the slots
to directors' positions, is there a way to incorporate a
similar policy of recruiting out of the collegiate level? Do
they just not have the life experience?
Mr. Shelby. We could put them into an intern program, like
a management intern program--
Mr. Higgins. Yes, sir.
Mr. Shelby [continued]. --but it is going to take, you
know, 10, 12, 15 years in my estimation, to develop to the
point where you can run a facility.
Mr. Higgins. Understood. Thank you for your candid
response, sir, and thank you for your service to our country.
Mr. Chairman, I now yield back.
Mr. Dunn. Thank you, Mr. Higgins.
I now recognize Representative Correa from California for 5
minutes.
Mr. Correa. Thank you, Mr. Chairman.
First of all, I want to thank the Members on the panel for
your good work and, of course, thank our veterans that are here
today with us, thank you for your service for our great
country.
And I wanted to start out by following up with some of the
comments that Mr. Higgins made, which are, you know, our
priorities should be--is and should be taking care of veterans
in a timely manner, best quality health care. And as I listen
to the testimony, not only of you here, but of our Members here
of this Committee, I was thinking to myself, what are the
impediments that we, as a legislature, legal impediments,
regulatory impediments that we putting upon you, because we
are, again, addressing a set of issues that have been with us
5, 10 years, maybe longer and we keep doing the same thing over
and over again.
I am not pointing the fingers at you. What are we not doing
up here to help you do your job? Dr. Roe talked about some of
the things that he was doing when he was practicing medicine,
scholarships, how do you recruit nurses, how do you recruit
folks, do you need more flexibility?
Dr. Roe, my wife is also a doctor and she will come home
and tell me we have got a doctor shortage in this area of the
organization and they go out and they have to raise salaries to
bring in folks.
You talked about decentralization and then you talk about
centralization. I don't think that is really the issue. What I
am hearing is you don't have the flexibility to respond to the
market forces in your area. If it is West LA, I don't care who
you are hiring in West LA, you are going pay that person more
than you are somebody in the Midwest; that is just the way it
is.
And I guess I am asking--and maybe you don't answer it
today--but what can we do to give you that flexibility? And it
is going to cost more, but maybe we can get innovative and make
it less costly by some of the ideas that you are talking about
already--some scholarships, some debt forgiveness. There are a
lot of patriots that are graduating from medical school, from
nursing school that maybe do want to come to the VA to learn
things and also to give back.
Can we help them with scholarships with debt forgiveness?
Can we legislate a good program to move ahead in this
direction, so the VA becomes a place that everybody wants to go
to, to learn and to serve America? What can we do to move in
that direction?
Again, we keep doing the same thing over and over again
expecting different outcomes. And I think we are really tying
you up, because, again, you are moving from decentralized to
centralized, but I don't think that is the issue. I think the
issue is you don't have the ability to move to react to recruit
people that you need.
Mr. Shelby. Exactly, sir. We need the agility in each of
our markets to compete with the local market there for talent.
And so, I want to build a pipeline of youth--youth nurses,
youth doctors. And so, having the flexibility and the funding
to have those scholarships and debt-reduction programs to
entice them as they are going through school would be huge for
us.
Mr. Correa. Do you need a legislative act by this body to
help you go through?
Mr. Shelby. I would like the opportunity to come back and
see what flexibilities we have. I want to explore everything--
you have already been generous with and given us--and make sure
that we are taking advantage of those and if there are still
gaps in that, I would like the opportunity to bring that back.
I think the most glaring is the market pay, as you alluded
to. West LA is going to pay much differently than Louisiana. I
want the flexibility within that market to compete with the
local talent there and I won't have to pay as high. The
benefits packages that the Federal Government provides are
better than most private-sector benefits packages. That
combined with the mission of serving veterans, we can compete,
and we won't have to pay as high, but we can't pay as set, 5
percent, 10 percent, 15 percent of what their market value is.
We have to be able to compete at that 80 percent level.
Mr. Correa. You know, I keep hearing about these wonderful,
brilliant people graduating from high school, graduating from
college wanting to go to the Peace Corps, wanting to serve
somewhere in that world, wanting to give back. I am just trying
to figure out, is there a place for them at the VA where they
can come and spend a few years moving in another direction and
fulfilling their life's dream and help our veterans help our
country do some real good work with you.
Mr. Shelby. Absolutely. You know, I was a chief learning
officer for 10 years and I think we need to target them in
middle school, right. So, they are getting the grades. They see
that they have an opportunity. There are Federal programs that
will help them pay for their bachelor's degree, their master's
degree, even all the way up to their Ph.D.--
Mr. Correa. I have got 7 seconds, so my question is, I
presume you also have programs that hire our veterans that are
coming out of the service to get to the next level of life?
Mr. Shelby. Absolutely.
Mr. Correa. Thank you, very much.
To the Chair, I yield.
Mr. Dunn. Thank you, Mr. Correa.
Now recognized for 5 minutes, Representative and Army Major
Brian Mast.
Mr. Mast. Thank you, Mr. Dunn.
I want to start with one of the comments my friend,
Representative Higgins, made about the ability to do more with
less and this is an opinion question for you, Mr. Shelby. It is
your opinion that those that are VA directors are willing to
take on the job by doing more with less or are we hiring people
at a certain pay scale amount that we are bringing in somebody
who is unqualified? If they are willing to do more than less,
are you saying that there is a fuse on that and at a certain
point, they are just saying, we are going to turn this over.
Mr. Shelby. I have always called it ``more with different''
rather than ``more with less.'' You have got to change the way
you think about your business model and I think we absolutely
bring in people that are capable of that.
What I am doing now is developing them to be able to engage
their staffs and their teams. Great ideas come from everywhere
and the diversity of thought and thinking of different ways of
doing business have to be a team effort. And so, engaging the
entire team to figure out how to do things better, faster,
cheaper, is the way to go and we can absolutely get there.
Mr. Mast. Thank you. Mr. Missal, I would like to go to some
of the questions--it hasn't really been touched yet--but the VA
inspector general's fiscal year 2018 report dismiss also talk
about staffing shortages, as it related to police officers
within the VA. I have gone to the headquarters here in DC,
spoke to the focus that run everything as it relates to the VA
police force.
The report said in the state of Florida that the State of
Florida is 18 officers shy of the number they need; that is 14
in Orlando and 4 in Tampa. I was wondering if you could
elaborate a little bit on that. What are the metrics that are
used to determine VA police staffing for facilities? Does it go
by what the VA medical center director wants? Does it go by
what is determined here in Washington? How is that number
determined and what level of security is needed at a facility
when we do know in the past, groups like ISIS have called and
said, Let's go to a VA medical center, there is a bunch of
veterans there, let's go target them. How do you determine
that?
Mr. Missal. The VA police actually report to the medical
center director, so it is up to the medical center director to
determine what is an appropriate level of staffing at the
police. So, in our staffing report a number of the medical
center directors did identify critical shortages with police.
I do also want to note that we are coming out with an audit
report in the near term with respect to looking at the whole
governance structure of the police force and other issues
because we have been concerned about some of the issues related
to the police force.
Mr. Mast. Okay. So, if a security need is not reported by a
hospital director, then there is an assumption here by DC that
there is no security shortfall if it doesn't make it from the
security force through the director to DC?
Mr. Missal. It was up to the medical center director to
determine what they believed were the critical shortages. We
didn't verify that or look behind it; we relied on what they
told us.
Mr. Mast. Okay. I appreciate your answers on this. I want
to continue on this track a little bit. What is the stance,
when it comes to the VA, on who should have access to the
grounds of a VA hospital? What is the stance of the VA on who
should have access to the grounds of a VA hospital?
Mr. Missal. In terms of, are we talking about the police or
are we talking just in general?
Mr. Mast. Any individual that wants to enter the premises
of a VA hospital, what is the stance of who should have access
to get on, walk in the doors? Who should be allowed to walk in
the doors?
Mr. Missal. I don't know if there is a set policy--in a
number of the facilities, I think it is up to the director to
determine the level of security within a particular facility.
Mr. Mast. And I have to believe that you are right in
saying that. In my VA hospital, it feels to me like we have on
and off policies of enforcing, okay, we are going to check
people's ID at the door and an hour later there is not going to
be somebody there to check somebody's ID at the door and then
an hour later there is going to be somebody there.
So, it is as though they want to make sure that the right
people are entering the VA, but there is not a priority that is
necessarily put on. It is not a paid position, I believe. I
believe it is volunteers that check these IDs at the door. And
that is something that also plays into the security of our
veterans on this facility. So, I would appreciate it if you
would take a look into that as you are looking at metrics on
what is needed for VA facility security. What is the stance of
who you believe should have access to the VA medical centers
and what are you doing to actually ensure that that is enforced
by the VA police force and that might have an impact on the
numbers that you determine you need in terms of a VA police
force and their presence in each state.
And that, I will yield back any additional time Mr. Dunn.
Thank you.
Mr. Dunn. Thank you very much, Representative Mast.
I now recognize for 5 minutes, Representative Anne Kuster
from Concord, New Hampshire.
Ms. Kuster. Thank you very much, Mr. Chairman, and thank
you to our panel.
I am going to move quickly because I have a number of
issues to cover, but--oh, I was hoping Dr. Roe had--would stay.
I agree with his assessment and one of the most effective
recruitment measures would be loan forgiveness for the
incredible public service of people working within the VA, but
I need his help in convincing the speaker not to bring to the
floor the Prosper Act because one of the greatest concerns is
that bill H.R. 4508 eliminates the Public Service Loan
Forgiveness Program; it is completely contrary to the whole
purpose of this hearing. And so, I will work with Dr. Roe and
my Republican colleagues to make sure that that Prosper Act
does not come to the floor.
And, in fact, what I would prefer to do is to increase the
incentives for people to join public service at the VA. And to
that end, I have sponsored a bill that has been passed in the
House, the Grow Our Own Act. This is with regard to medics and
other health care professionals coming out of their military
service who have the skills to serve the needs of our VA
population. It gives them competitive pay and it also--the
House version recognizes the skills that they gained in the
field during their military service.
I am just wondering if you have considered that for any
other types of medical credentials. Ours was focused on
physician assistants, but is that something that is under
consideration and would you need legislation to do that? And
that is for the VA.
Mr. Shelby. I am going to have Jessica respond to that to
see if we need legislation.
Ms. Bonjorni. Thank you. We would welcome the opportunity
to work with you on that. I know that we have been focused
quite recently on hiring corpsman and medics to come into our
Intermediate Care Technician Program and we are really trying
to grow that program because it gets rave reviews from our
veterans. They appreciate being seen by those who have also
served. So, we would welcome the opportunity to work with you
on that.
Ms. Kuster. Absolutely. And the other issue, I just think
it is a waste of people power. They have fantastic skills and
they're coming back, and it is making for a very difficult
transition when they are told they have to go back to school
for two years to get a specific credential. So, we would love
to work with you.
I am going to switch gears entirely to a March 2018 Merit
Systems Protection Board release report on the incidents of
sexual harassment across the Federal government. The VA was the
worst offender with 22 percent of the employees reporting
sexual harassment. And I just would like everyone on this panel
to consider the impact on morale and certainly on retention
when 1 in 5 employees in the VA has experienced sexual
harassment, it is no wonder that we have very high turnover and
we lose valuable and qualified employees and it is no wonder
that it would be difficult to recruit and retain qualified
employees.
So, one very specific question: With the rate of our human
resources officers being so low with the shortage, where are
employees expected to go if they have a sexual harassment
complaint and if you could also comment on sexual harassment
training and how we are going to lower this abominable rate. I
am embarrassed that it is the VA that has the very worst rate
across the Federal government. Thank you.
Mr. Shelby. Yes, thank you for allowing me to respond to
that. I took a look at the study. It was done--the data was
collected between 2014 and 2016 and they only interviewed 1100
people so, about .003 percent of the VA population--
Ms. Kuster. That is quite a big sample, 1100 people.
Mr. Shelby. And since 2016, we have implemented a very
robust civility in the workforce program. We have continuous
training. We have an office of resolution management with
several hundred people--you have a difference between 201s and
ORM. They are embedded throughout the organization.
Ms. Kuster. To you have a statistic on the number of VA
employees that have received this sexual harassment training?
Mr. Shelby. One hundred percent. It is required learning--
everybody, including supervisors and managers. We have six and
a half hours of training for supervisors and managers and three
and a half hours for general employees. Our statistics--in
2017, there were only 17 reports of sexual harassment and only
3 total in 385,000 were validated as a problem--
Ms. Kuster. Well, sir, I apologize for interrupting--my
time is up--I have requested of Chairman Bergman that we have
an oversight and investigation Subcommittee hearing on this
topic, and we would be very interested in hearing the progress
that has been made since that original statistic was gathered.
So, I yield back.
Mr. Shelby. We look forward to that.
Mr. Dunn. Thank you, Representative Kuster.
If there are no other questions, the panel is now excused.
And I ask unanimous consent that all Members have 5 legislative
days to revise and extend their remarks and include extraneous
materials.
Without objection, that is ordered, and the hearing is now
adjourned. Thank you very much.
[Whereupon, at 11:23 a.m., the Subcommittee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Max Stier
Chairman Dunn, Ranking Member Brownley, members of the Subcommittee
on Health, thank you for the opportunity to appear before you today to
discuss the implementation of the VA Choice and Quality Employment Act
of 2017 (P.L. 115-46). I am Max Stier, President and CEO of the
Partnership for Public Service. The Partnership is a nonpartisan,
nonprofit organization that works to revitalize our federal government
by inspiring a new generation of Americans to enter public service and
by transforming the way our government works.
The success of the Department of Veterans Affairs depends upon a
highly qualified, engaged and accountable workforce operating at full
capacity and equipped with the knowledge and resources it needs to
achieve its mission. Congress is an essential partner to the department
in building and sustaining this workforce, and I commend this committee
for its continuing focus on how best to do so, including by holding
this hearing and passing laws like the one we are discussing today. The
Partnership strongly supports this legislation and believes that, if it
can be fully realized, it will reduce critical vacancies in key
mission-critical occupations and, more importantly, ensure that
veterans receive the care they have earned through their service.
But this law, though helpful, represents just a first step. To the
department's credit, it has continued to add employees-its total
medical workforce grew by 2.9 percent in 2017. \1\ The department has
also reduced wait times overall and maintained satisfaction levels
equal to or above those of the private sector. \2\ However, over the
next decade, our nation will face potential shortages of between 42,600
and 121,300 physicians, and this will be the environment in which VHA
must recruit. \3\ More action needs to be taken to modernize the VA,
including smart implementation of the tools provided by the VA Choice
and Quality Employment Act, better data about the agency's workforce,
talent needs and applicant pools, additional legislation to address
fundamental problems with the VHA's complex and burdensome personnel
systems, leaders at the VA who are focused on and committed to these
issues, and sustained oversight by this committee.
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\1\ ``U.S. Office of Personnel Management - Ensuring the Federal
Government Has an Effective Civilian Workforce.'' FedScope - Diversity
Cubes (Enhanced Interface). Accessed June 18, 2018. https://
www.fedscope.opm.gov/employment.asp.
\2\ Sisk, Richard. ``VA Wait Times As Good or Better Than Private
Sector: Report.'' Military.com. Accessed June 18, 2018. https://
www.military.com/daily-news/2017/09/20/va-wait-times-good-better-
private-sector-report.html.
\3\ ``New Research Shows Increasing Physician Shortages in Both
Primary and Specialty Care.'' AAMCNews. April 11, 2018. Accessed June
18, 2018. https://news.aamc.org/press-releases/article/workforce--
report--shortage--04112018/.
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State of VA Choice and Quality Employment Act Implementation
When Congress passed the VA Choice and Quality Employment Act last
summer, it provided VA with several new authorities and tools to
streamline the hiring of mission-critical talent. These included an
expanded direct hire authority, unique promotional tracks for technical
experts, better sharing of information regarding applicants for
shortage positions, and new training for human resources staff.
Collectively, this legislation and the personnel authorities granted by
the VA Accountability and Whistleblower Protection Act of 2017 (P.L.
115-41) empower VA to recruit, hire and retain the talent it needs to
serve veterans.
Our understanding is that the VHA is working hard to implement the
bill and has already made progress on several fronts. The agency is
working with the Department of Defense to stand up joint programs that
will bring more transitioning service members into the VHA, as directed
by Section 207 of the Act. The agency as a whole is continuing efforts
begun in the prior administration to improve collaboration and
coordination with the DOD. Next, the VHA is beginning to make use of
the direct hire authority authorized under Section 213. \4\ The Office
of Personnel Management has approved a set of fourteen positions, both
clinical and non-clinical, which the VA can fill through the use of
this authority. \5\ Our understanding is that the VHA has already begun
to use the authority to fill vacancies. We also understand that the VHA
is looking at how to use the authority granted under Section 206, which
speeds the hiring of students and recent graduates, to fill vacancies
on the business side of the agency.
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\4\ Statement of the Honorable David J. Shulkin, M.D. Secretary of
Veterans Affairs for Presentation before the Senate Committee on
Veterans Affairs, 10 (January 17, 2018). 115th Congress
\5\ United States of America. Department of Veterans Affairs.
Office of Inspector General. OIG Determination of Veterans Health
Administration's Occupational Staffing Shortages FY2018. Washington,
DC, 2018. 2
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For an agency the size of the Veterans Health Administration, any
change, however small, will take time to implement. And because the
authorities and programs enacted by this legislation did not come with
significant new funding, implementation will be slower as a result. In
this case, the example of the 2015 Enhanced Physician Recruiting and
Onboarding Model (EPROM) is instructive: the VHA issued a set of
recommendations to VAMCs designed to improve physician recruitment and
speed hiring. However, GAO found that a lack of resourcing and capacity
at the facility HR level led many VAMCs to ignore the EPROM or
implement it in only a limited fashion, resulting in minimal impact
overall. \6\ Turnover among HR specialists in facilities across the VHA
system is also contributing to lagging action on various provisions of
the legislation. A large number of relatively new HR specialists means
more preparation and work required to make sure the agency implements
new rules and programs effectively. Long-term under-resourcing of the
agency's HR function is acting as a drag on the agency's ability to
implement the new law as quickly as the committee and stakeholders
might prefer. For example, in 2015 more than 80 percent of VAMCs failed
to meet target staffing ratios of one HR specialist to 60 employees and
it is our understanding that this remains an issue today. \7\ These
challenges underscore the importance of focusing the committee's
oversight on how to ensure the VHA can implement the law and seeking
additional ways to improve its personnel system.
---------------------------------------------------------------------------
\6\ United States of America. Government Accountability Office.
Veterans Health Administration: Better Data and Evaluation Could Help
Improve Physician Staffing, Recruitment, and Retention Strategies.
Washington, DC, 2018. 27.
\7\ Ibid. 13
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Enabling More Effective Implementation
More and Better Data
An organization cannot manage what it cannot or does not measure.
For the Department of Veterans Affairs and the Veterans Health
Administration, a failure to effectively combine and scale strategic
priorities with data about the composition and commitment of its
workforce hinders effective hiring and talent management. More broadly,
a risk-averse culture which resists change makes the task of using data
and building a performance culture even more difficult. Research by the
Partnership has found that while many agencies have ``taken the first
step toward creating a performance management culture'' by regularly
and systematically collecting data, few are processing it in a
meaningful way. \8\ John Kamensky of the IBM Center for the Business of
Government has similarly noted that agencies have plenty of data but
are ``information poor.'' \9\ Like other agencies, the VHA has plenty
of data, particularly at the facility level, but fails to make full use
of it. The decentralized nature of the organization means data is not
aggregated to provide a complete picture of the state of the
organization. This lack of data is especially true in the workforce
space, where GAO has found that VHA lacks detailed information about
the overall composition of its workforce and use of hiring incentives.
\10\ Better data about the composition of the workforce and more
sophisticated dashboards that offer real-time views of the critical
information that enables better management decisions would greatly
enhance the department's talent management and use of workforce
flexibilities such as those authorized by the Act.
---------------------------------------------------------------------------
\8\ Taking Measure: Moving from Process to Practice in Performance
Management. Report. Washington, DC: Partnership for Public Service,
2013. 8
\9\ Kamensky, John. ``Government Is Data Rich, But Information
Poor.'' Editorial. Government Executive, June 12, 2018.
\10\ United States of America. Government Accountability Office.
Veterans Health Administration: Better Data and Evaluation Could Help
Improve Physician Staffing, Recruitment, and Retention Strategies.
Washington, DC, 2018. 12
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An effective hiring process makes use of data both at the front end
to determine needs and at the back end to evaluate results, and it also
provides a means of holding leaders accountable for the state of talent
in the organization. The Act took positive steps towards providing more
and better data by requiring GAO to examine the department's succession
planning practices, mandating the creation of a comprehensive list of
vacant positions across VA, and codifying the department's current exit
survey. Moving forward, the Partnership believes the VHA should look at
ways to align this workforce data with the organization's strategic and
service priorities. Better integrating employee satisfaction and
commitment data already available to the agency through the VA All-
Employee Survey (AES) and the Federal Employee Viewpoint Survey (FEVS),
which the Partnership uses to produce its Best Places to Work in the
Federal Government Rankingsr, will be key to this integration. In
looking at ways to fill mission-critical vacancies, the department and
this committee should not lose sight of the fact that employee
engagement is a necessary ingredient for developing a high-performing
workforce and attracting top talent. The committee should also look at
ways it can use its oversight to track key metrics of the hiring
process and agency outcomes, perhaps on a quarterly basis, to work with
the department to adjust in real time.
Better use of all of these types of data will be particularly
critical because of the troubling quit rates at VHA. Between 2011 and
2017, employees with less than two years of service quit at a rate of
nearly 32 percent. \11\ This attrition rate is especially problematic
because less than one-quarter of VHA employees in clinical roles is
under the age of 40. \12\ Each of these statistics highlights serious
retention issues at the VHA. The department's Office of Inspector
General noted in September 2017 that, despite some hiring gains, ``the
percentage of regrettable losses to total onboard staff in many
critical need occupations was high relative to overall increases in
onboard staff.'' \13\ Minimizing regrettable losses and retaining
talent will require the department not just to understand the size and
composition of its workforce, but combining it with insights pulled
from surveys like the AES to design national retention strategies. The
next step for VHA will be to create an integrated, comprehensive
process for gathering and distributing critical workforce data across
VAMCs to encourage learning and best practice sharing in the use of
various hiring authorities and flexibilities and to get leaders at the
facility level to act on it. To its credit, the VHA Office of Workforce
Management and Consulting has begun looking at how it can collect and
share data better. I strongly encourage the committee to follow up on
this work.
---------------------------------------------------------------------------
\11\ ``U.S. Office of Personnel Management - Ensuring the Federal
Government Has an Effective Civilian Workforce.'' FedScope - Diversity
Cubes (Enhanced Interface). Accessed June 18, 2018. https://
www.fedscope.opm.gov/employment.asp.
\12\ Ibid.
\13\ United States of America. Department of Veterans Affairs.
Office of Inspector General. OIG Determination of VHA Occupational
Staffing Shortages FY 2017. Washington, DC, 2017. I.
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Modernizing the Department's Personnel System
The challenges faced by the Veterans Health Administration in
recruiting, hiring and retaining mission-critical talent are by no
means unique. Agencies across the federal government struggle to
function within a system that is ``stuck in the past, serving as a
barrier rather than an aid in attracting, hiring and retaining highly
skilled and educated employees.'' \14\ Much of the Title 5 civilian
personnel system dates back to 1949 and has not been revisited by
Congress since 1978. Title 38 was created in 1946 at a time when the
state of healthcare was far different than it is today. \15\ The
accretion of new laws, regulations, and court rulings has also added
significant complexity to the process. The VHA faces a particular
challenge in that it operates three different personnel systems: Title
5, Title 38 and Title 38 Hybrid, each with unique rules and processes.
Organizations from GAO to the VA Office of Inspector General and VHA
Commission on Care, created by Congress as part of the Veterans Access,
Choice, and Accountability Act of 2014, have cited the challenge
presented by the department's multiple personnel systems for
recruitment \16\ and \17\ retention \18\. Fixing the department's
broken personnel management will ultimately require significant reform
and, ideally, consolidation of the personnel systems under which it
operates.
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\14\ Building the Enterprise: A New Civil Service Framework.
Publication. Washington, DC: Partnership for Public Service, 2014. 7.
\15\ United States of America. Merit Systems Protection Board.
Office of Policy and Evaluation. The Title 38 Personnel System in the
Department of Veterans Affairs: An Alternative Approach. Washington,
DC, 1991.
\16\ United States of America. Government Accountability Office.
Veterans Health Administration: Management Attention Is Needed to
Address Systemic, Long-standing Human Capital Challenges. Washington,
DC, 2016.
\17\ United States of America. Department of Veterans Affairs.
Office of Inspector General. OIG Determination of Veterans Health
Administration's Occupational Staffing Shortages FY2018. Washington,
DC, 2018.
\18\ United States of America. Veterans Health Administration.
Commission on Care. Commission on Care: Final Report. Washington, DC,
2016.
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Perhaps the clearest example of the way in which outdated and
inflexible personnel systems limit the department's ability to recruit
and hire is in the area of classification. A June 2018 report by the VA
OIG stated that ``many facilities noted that...outdated OPM
classifications affected their ability to offer competitive salaries
and advance opportunities within the organization'' with the result
that facilities were ``less competitive in attracting new staff and
retaining highly skilled staff.'' \19\ The link between classifications
and uncompetitive salaries is long-standing and critical. GAO noted in
its October 2017 report that one VAMC reported losing its chief of
cardiac surgery to a nearby hospital, which increased the individual's
salary from $395,000 to $700,000. \20\ The VHA has attempted to tackle
some issues piecemeal, by working to consolidate classification
procedures at the VISN level for example. \21\ However, this reform is
unlikely to address many of these long-standing challenges on its own.
Unfortunately for the VA, it is operating in an environment in which it
competes not just with the private sector for talent, but with other
federal agencies as well. Regrettable losses caused by the resignation
of medical professionals is a symptom of the broader problem.
---------------------------------------------------------------------------
\19\ United States of America. Department of Veterans Affairs.
Office of Inspector General. OIG Determination of Veterans Health
Administration's Occupational Staffing Shortages FY2018. Washington,
DC, 2018.
\20\ United States of America. Government Accountability Office.
Veterans Health Administration: Better Data and Evaluation Could Help
Improve Physician Staffing, Recruitment, and Retention Strategies.
Washington, DC, 2018. 28
\21\ United States of America. Government Accountability Office.
Veterans Health Administration: Management Attention Is Needed to
Address Systemic, Long-standing Human Capital Challenges. Washington,
DC, 2016.
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Operating multiple different systems also hurts the effective
functioning and retention of the department's human resources staff.
The VHA struggles to hold on to HR talent-the VA OIG's FY2018
determination of staffing shortages report noted that HR has ranked
among the top ten shortage occupations since 2011. \22\ Attrition among
HR specialists is a significant challenge as well, as three-quarters of
HR assistants who left VHA in 2015 did so in their first two years.
Overall attrition rates for the position rose from 7.8 percent in 2013
to 12.1 percent in 2015, where they have roughly held. \23\
Unfortunately, there is little reason to think this trend has abated;
in recent testimony to this committee on May 22, 2018, VA Inspector
General Michael Missal stated that vacancies in mission-critical
positions at the Washington, DC VAMC were caused in part by turnover in
the facility's HR office. \24\ There is plenty of evidence to suggest
that HR specialists are leaving VHA due to their dissatisfaction with
understaffing and complexity of the work. \25\ The result is
administrative delays that further lengthen the time needed to recruit,
hire and onboard badly-needed talent.
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\22\ United States of America. Department of Veterans Affairs.
Office of Inspector General. OIG Determination of Veterans Health
Administration's Occupational Staffing Shortages FY2018. Washington,
DC, 2018. 6
\23\ United States of America. Government Accountability Office.
Veterans Health Administration: Management Attention Is Needed to
Address Systemic, Long-standing Human Capital Challenges. Washington,
DC, 2016. 10
\24\ Statement of The Honorable Michael J. Missal Inspector General
of the Department of Veterans Affairs Before the Committee on Veterans'
Affairs U.S. House of Representatives Hearing on ``The Curious Case of
the VISN Takeover: Assessing VA's Governance Structure'', 115th Cong.,
13 (2018).
\25\ United States of America. Government Accountability Office.
Veterans Health Administration: Management Attention Is Needed to
Address Systemic, Long-standing Human Capital Challenges. Washington,
DC, 2016.
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In the short term, there are several actions the committee might
consider to strengthen further the department's ability to fill
mission-critical vacancies and improve service to veterans. I describe
these actions in greater detail in the recommendations below. The
committee should address the technical issue artificially limiting pay
for VAMC and VISN directors created by the VA Accountability and
Whistleblower Protection Act that serves as a significant disincentive
to recruitment and retention of these essential leaders. The
Partnership also believes the delegation of authority to assess
candidates for senior executive roles without advance OPM permission
and to make direct hire determinations at the agency level would be
highly beneficial. Finally, using provisions authorized by the VA
Choice and Quality Employment Act, we recommend the committee work with
the department to build a scorecard or other assessment mechanism that
can be used to hold VA leaders accountable for their organization's
health, including talent management practices.
Beyond small-bore changes to the department's current personnel
operating authorities, however, the Partnership strongly encourages the
committee to work with the administration to move towards a unified
personnel system for the department that will allow the VHA to fully
address its hiring, classification, pay and accountability issues. The
system should be the product of strong leadership across the branches,
employee buy-in, and investment in agency HR and other implementation
functions, and should reflect a commitment to the Merit System
Principles that serve as the bedrock of the civil service system. The
VHA Commission on Care came to this same conclusion. The panel stated
that VHA uses ``talent management approach from the last century'' and
that Congress should ``create a simple-to-administer alternative
personnel system, in law and regulation, which governs all VHA
employees, applies best practices from the private sector to human
capital management, and supports pay and benefits that are competitive
with the private sector.'' \26\ Fortunately, the provisions of the VA
Choice and Quality Employment Act offer a blueprint for how other
committees might jumpstart the process. \27\ While the Partnership
would prefer that Congress apply this system to all of government, the
Veterans Health Administration, with its massive scale, specialized
workforce, and complex mission, represents a good place to start.
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\26\ United States of America. Veterans Health Administration.
Commission on Care. Commission on Care: Final Report. Washington, DC,
2016.
\27\ Neal, Jeff. ``How the VA Choice and Quality Employment Act of
2017 May Drive Civil Service Reform.'' Editorial. Federal News Radio,
August 15, 2017. Accessed June 18, 2018. https://federalnewsradio.com/
commentary/2017/08/how-the-va-choice-and-quality-employment-act-of-
2017-may-drive-civil-service-reform/.
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Promoting Leader Ownership
The next secretary of the Department of Veterans Affairs and his
leadership team will have a big job ahead of them and relatively little
time to do it. History suggests that the department's political
appointees, once confirmed by the Senate, are unlikely to stay in their
jobs more than two years. They will be in charge of managing an
organization with over 300,000 employees, 145 medical facilities, and 9
million veteran patients. \28\ The secretary and his team will also be
operating in a complex environment in which the White House, Congress,
veterans' service organizations, employee groups and the private sector
will all be demanding action. The incentives faced by the department's
incoming political appointees will be to focus on policy and headlines,
rather than the sometimes invisible work of strengthening the VA's
management systems and structure. It is this work that has some of the
most lasting impacts on improving services for America's veterans, even
if the sheer size of the department means that achieving results may
take years. In other words, the incoming leaders of the department need
to take ownership of the health of the organization they run and leave
it in a state that is better than the one it was in when they arrived.
---------------------------------------------------------------------------
\28\ Statement of The Honorable Michael J. Missal Inspector General
of the Department of Veterans Affairs beforethe Committee on Veterans'
Affairs U.S. House of Representatives Hearing on ``The Curious Case of
the VISN Takeover: Assessing VA's Governance Structure'', 115th Cong.,
13 (2018).
---------------------------------------------------------------------------
Section 203 of the VA Choice and Quality Employment Act included
important language to this effect, specifically requiring that the
Secretary and other political appointees of the department have annual
performance plans which hold them accountable for talent management,
employee engagement and development, and promoting effective
performance management practices. This provision provides an excellent
opportunity both to the department and to Congress. The Partnership's
Best Places to Work in the Federal Government Rankings have
consistently found that quality of leadership is a key driver of
employee satisfaction, but views of senior leadership in the department
do not provide much reason for optimism. In 2017 VA ranked 17th out of
18 agencies in employee satisfaction with the effectiveness of agency
leadership, declining slightly from 2016. \29\ Further, FEVS data
showed that fewer than half of VA employees had a high level of respect
for senior leaders and just 36.1 percent of employees were satisfied
with the policies and practices of these leaders (the number rose
slightly to 36.3 percent at the Veterans Health Administration). \30\
And, as noted above, data on talent management at the department shows
similar problems and, while removals have gone up, there are concerns
that new accountability procedures are being weaponized to retaliate
against rank-and-file employees. \31\
---------------------------------------------------------------------------
\29\ Partnership for Public Service. ``Department of Veterans
Affairs.'' Best Places to Work in the Federal Government. Accessed June
18, 2018. http://bestplacestowork.org/BPTW/rankings/detail/VA00#tab--
category--tbl.
\30\ Partnership analysis of the 2017 Federal Employee Viewpoint
Survey
\31\ Arnsdorf, Isaac. ``Trump's VA Is Purging Civil Servants.''
Politico Magazine, March 12, 2018. https://www.politico.com/magazine/
story/2018/03/12/trump-is-trying-to-fix-the-vabut-its-backfiring-
217348.
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These data reinforce the importance of the role of Congress and
this committee in particular. Congress is itself an ``owner'' of the
Department of Veterans Affairs and has an important stake in its
success or failure. To its great credit, this committee has recognized
its stewardship role and done excellent bipartisan work elevating
important issues of talent management and performance. There is more
the committee can do to build on its work to date. Asking for more
real-time data on vacancies and leadership, utilizing a scorecard to
measure and assess the department's leadership, and encouraging system-
wide learning by highlighting best-in-class practices would reinforce
important norms around leader ownership. These additional reforms would
create the lasting expectation that those appointees who answer the
call to serve our nation's veterans are capable of and accountable for
effectively leading the agency. Many of the provisions of the VA Choice
and Quality Employment Act, including Section 203, provide the
committee with precisely these tools.
As of the date of this hearing, the Department of Veterans Affairs
lacks a confirmed secretary, deputy secretary, under secretary for
health and assistant secretary for information and technology. \32\ The
effect of these vacancies should not be understated. The Under
Secretary for Health leads the largest healthcare system in the U.S.,
with a budget of $65 billion, hundreds of thousands of employees, and
hundreds of facilities. \33\ The Assistant Secretary for Information
and Technology oversees a staff of over 8,000 employees and a $4
billion budget that is comparable in scope to the largest private
sector IT operations. Further, the VA Central Office (VACO) has a
significant number of acting officials, which further hampers policy
and management execution within the department. The changes that this
committee and the VA's many stakeholders want to see, including filling
mission-critical vacancies, require permanent leadership. The
administration and Senate must, therefore, take swift action to
nominate and confirm candidates for these critical positions. I
strongly urge the members of this committee to speak up for the need
for qualified, confirmed leadership in the agency.
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\32\ ``Trump Nominations Tracker''. The Washington Post. Accessed
June 18, 2018. https://www.washingtonpost.com/graphics/politics/trump-
administration-appointee-tracker/database/?utm--term=.af6b57628757.
\33\ Ibid.
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Recommendations
Short-Term
Authorize Market Pay for VAMC and VISN Directors
While medical professionals are the individuals on the front line
delivering care, the effective functioning of the VHA enterprise is
dependent on experienced and capable VAMC and VISN directors. I commend
this committee for authorizing direct hire authority for this cohort,
and the department deserves credit for maintaining low vacancy rates
among this group. But retention of these leaders remains an issue, and
a sure way of improving retention is increasing pay, as the SES pay
scale was simply never designed for positions like medical facility
directors. Individuals in these positions and other similar highly
skilled federal employees-those with a professional degree or
doctorate-tend to earn far less than their private sector counterparts.
Toward this end, the Partnership recommends enacting market pay for
this select group of leaders who are so essential to ensuring quality
care for veterans. Additionally, we urge the committee to address
limitations on the current direct hire authority for this cohort that
prevents the VA from paying even at the top of the SES pay scale,
hampering successful recruitment.
Use the performance plan required under Section 203 to hold leaders
accountable for successfully managing the organization
As noted above, VA lacks critical data to manage its talent or link
personnel and resources to strategic priorities and does little to make
political leaders take ownership of the organization's success or
failure. The VA Choice and Quality Employment Act of 2017 provides new
performance planning and data collection requirements that can provide
this accountability and give Congress greater visibility into how the
VA's leaders are managing the organization. The Partnership recommends
the committee work with the department to conduct regular oversight of
the extent to which leaders are truly taking ownership and moving the
department in the right direction.
Delegate authority to conduct Qualifications Review Boards to VA
The Partnership has previously stated in testimony to this
committee that the VA would benefit from the ability to make final
selections for SES positions with appropriate OPM oversight. Today, the
VA is still forced to ask applicants for senior executive roles,
including VAMC directors, to write lengthy essays explaining their
qualifications and then to put those individuals before a
Qualifications Review Board (QRB) assembled and led by OPM. The QRB
serves as the last step in the SES selection process, extending the
hiring process but adding limited value. Today, we reiterate our view
that Congress should remove this requirement from VA and increase the
department's flexibility to recruit the leadership talent it needs to
strengthen the VHA healthcare system. The Senate's Fiscal Year 2019
National Defense Authorization Act proposes granting this authority to
the Defense Department.
Delegate direct hire authority from OPM to the department
Direct hire authority is an important tool for filling mission-
critical vacancies, as this committee has recognized through recent
legislative actions to expand its use across the department. However,
the current statute still requires the department to receive approval
from OPM before finalizing and utilizing this authority. This step adds
months to implementation and creates an extra layer of process and
complexity. The Partnership recommends addressing this issue by
granting the Secretary of Veterans Affairs the ability to designate
positions eligible for direct hire authority, with appropriate OPM
oversight on the back end and metrics to ensure that it VA uses it
responsibly and fairly.
Develop, collect and report more comprehensive measures of hiring
effectiveness
The Partnership has previously advocated for expanded collection
and reporting requirements for aggregated applicant and hiring data.
Given the ongoing concerns about shortages of workforce data raised by
GAO and others, the Partnership believes this recommendation remains
relevant. Beyond simply looking at vacancies in specific clinical or
non-clinical positions, these data would also examine applicant pools,
recruiting efforts and manager satisfaction with candidates. In fact,
data on applicant pools such as physician trainees would be especially
important given GAO's finding that VHA does not currently track the
number of trainees hired following graduation, even though this group
represents a valuable recruiting source. \34\ The Federal Hiring
Process Improvement Act of 2010, introduced by former Senators Daniel
Akaka and George Voinovich, includes several measures of hiring
effectiveness that could be instructive. \35\ Providing such detailed
information would make it easier for the committee to target future
reforms to the VHA's talent management process.
---------------------------------------------------------------------------
\34\ United States of America. Government Accountability Office.
Veterans Health Administration: Better Data and Evaluation Could Help
Improve Physician Staffing, Recruitment, and Retention Strategies.
Washington, DC, 2018.
\35\ Federal Hiring Process Improvement Act, S. S.736, 111th Cong.
(2010).
Authorize VHA to make conditional offers to employees on the strengths
---------------------------------------------------------------------------
of their qualifications
It is common in the private sector for hospitals and other entities
competing for medical talent to make conditional offers, pending the
individual's completion of their training or educational program. The
federal government, however, tends to bias the hiring process against
individuals without significant professional experience, even if they
possess the skills to succeed. While VHA can technically make these
offers now, GAO has found that many VAMC officials believe otherwise.
\36\ A congressional imprimatur in favor of early offers could give VHA
officials more cover to promote contingent offers and increase the
amount of younger talent.
---------------------------------------------------------------------------
\36\ United States of America. Government Accountability Office.
Veterans Health Administration: Better Data and Evaluation Could Help
Improve Physician Staffing, Recruitment, and Retention Strategies.
Washington, DC, 2018. 29
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Long-Term
Create a unified personnel system for VHA
As discussed above, the unruly tangle of personnel systems is a
weight around the neck of the Veterans Health Administration.
Classification under these systems forces employees to accept salaries
below those of both the private sector and comparable federal
positions. The complexity of administering three separate systems
drives human resources specialists into other federal agencies. The
need to understand the unique rules and processes for each adds
unnecessary time to the hiring process. The Partnership believes it is
time, and well worth the investment of energy and political capital, to
create a unified personnel system for the VHA. While there are
legitimate concerns about the further balkanization of the federal
civil service system, the uniqueness of the agency's mission and the
pressing challenges it faces in recruitment, hiring and retention
demand action sooner rather than later.
Reform the classification system
The General Schedule classification system, which determines pay
for the vast majority of the federal workforce, is nearly seventy years
old and hopelessly out of step with modern compensation practices. \37\
Many facilities cite uncompetitive salaries stemming from
administration of the classification system specifically as a key
barrier to effective recruitment and retention. \38\ Modernizing this
system in a way which gives the department flexibility to craft
competitive compensation packages will go a long way towards allowing
the VHA to bring in the talent it needs and better serve veterans.
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\37\ Building the Enterprise: A New Civil Service Framework.
Publication. Washington, DC: Partnership for Public Service, 2014. 16.
\38\ United States of America. Department of Veterans Affairs.
Office of Inspector General. OIG Determination of Veterans Health
Administration's Occupational Staffing Shortages FY2018. Washington,
DC, 2018. 13.
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Conclusion
Chairman Dunn, Ranking Member Brownley, members of the Subcommittee
on Health, thank you for the opportunity to present the Partnership's
views on the implementation of the VA Choice and Quality Employment Act
of 2017 and the continuing mission-critical hiring challenges of the
Veterans Health Administration. I applaud the committee for its
ongoing, bipartisan commitment to ensuring America's veterans receive
the care they have earned. I look forward to continuing to work with
you and the department to help it meet its goals and am happy to answer
any questions you may have.
Prepared Statement of Debra A. Draper
Steps Taken to Improve Physician Staffing, Recruitment, and Retention,
but Challenges Remain
Chairman Dunn, Ranking Member Brownley, and Members of the
Subcommittee:
Thank you for the opportunity to participate in today's hearing on
the ability of the Department of Veterans Affairs (VA) Veterans Health
Administration (VHA) to recruit and retain high-quality physicians. A
strong clinical workforce capable of providing quality and timely care
to our nation's veterans is critical to the success of VHA, which
operates one of the largest health care systems in the United States,
providing care at 1,252 facilities, including 170 VA medical centers
(VAMC). \1\ As the demand for VHA's services grows-due in part to
increasing demand from servicemembers returning from the United States'
military operations in Afghanistan and Iraq, and the growing needs of
an aging veteran population-attracting, hiring, and retaining top
talent is critical to VHA's mission to provide high-quality and timely
health care for our nation's veterans.
---------------------------------------------------------------------------
\1\ In addition to the 170 VAMCs, VHA also operates 1,082
outpatient sites of care, such as health care centers and community-
based outpatient clinics.
---------------------------------------------------------------------------
Physicians-who provide and supervise a broad range of care,
including primary and specialty care-serve an integral role in VHA's
mission. VHA indicated that physicians occupy a top spot on its annual
list of mission-critical occupations, as a result of factors including
the time frames needed for VHA's hiring process, a limited supply of
candidates, and competition for candidates. \2\ Within the physician
category, VHA has also identified the top five physician occupations
that are the hardest to recruit and retain. We use the term ``mission-
critical physician occupations'' to refer to the top five physician
occupations VHA identified in fiscal year 2016 as most in need of
staffing: primary care, mental health, gastroenterology, orthopedic
surgery, and emergency medicine. VHA hires more than 2,800 mission-
critical physicians annually. Yet, physicians have consistently been
identified by VHA as a critical staffing priority due to recruitment
and retention concerns.
---------------------------------------------------------------------------
\2\ VHA obtains data from its Veterans Integrated Service Networks
and VAMCs on which occupations are the highest priority for recruitment
and retention based on known recruitment and retention concerns, among
other factors. See U.S. Department of Veterans Affairs, Veterans Health
Administration, Mission-Critical Occupation Report (2016).
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Over the past two decades, we and others have expressed concerns
about VHA's ability to ensure that it has the appropriate clinical
workforce to meet the current and future needs of veterans. \3\ A 2015
independent assessment found that if VHA does not increase its total
number of clinical employees, including physicians, it will be
difficult for it to meet the projected demand for services. \4\
Further, in July 2016, we found that the number of physicians who leave
VHA had steadily increased from fiscal years 2011 through 2015. During
this time, physicians were among the 10 occupations with the highest
rates of attrition each year. \5\ The attrition was primarily due to
voluntary resignations and retirements.
---------------------------------------------------------------------------
\3\ We and the VA Office of the Inspector General have issued at
least 16 reports between 1981 and 2017 that raised a variety of
concerns about VHA's workforce. Recent GAO reports include, GAO,
Veterans Health Administration: Better Data and Evaluation Could Help
Improve Physician Staffing, Recruitment and Retention Strategies, GAO
18 124 (Washington, D.C.: Oct. 19, 2017); Veterans Health
Administration: Management Attention Is Needed to Address Systemic,
Long-standing Human Capital Challenges, GAO 17 30 (Washington, D.C.:
Dec. 23, 2016); and Veterans Health Administration: Personnel Data Show
Losses Increased for Clinical Occupations from Fiscal Year 2011 through
2015, Driven by Voluntary Resignations and Retirements, GAO 16 666R
(Washington, D.C.: July 29, 2016).
\4\ See RAND Corporation, Assessment B (Health Care Capabilities),
(Santa Monica, Calif: Sept. 1, 2015).
\5\ See GAO 16 666R.
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My statement today is based on our October 2017 report examining
VHA physician staffing, recruitment, and retention strategies. \6\ In
particular, my statement focuses on (1) VHA information on how many
mission-critical physicians provided care at VAMCs; (2) VHA guidance
for determining its physician staffing needs; and (3) the strategies
VHA used to support the recruitment and retention of physicians at
VAMCs, and the extent to which it has evaluated these strategies to
determine their effectiveness. As part of that work, we made several
recommendations for VHA to improve staffing, recruitment, and retention
strategies for physicians.
---------------------------------------------------------------------------
\6\ See GAO 18 124.
---------------------------------------------------------------------------
To do the work for our October 2017 report, we reviewed key
documents and interviewed knowledgeable officials from VHA in
headquarters offices, as well as in six VAMCs across the country. More
detailed information on the objectives, scope, and methodology for our
2017 report can be found in that report. For this statement, we
obtained information from VHA officials in June 2018 about any steps
they have taken to implement our 2017 recommendations.
This statement is based on work conducted in accordance with
generally accepted government auditing standards. Those standards
require that we plan and perform the audit to obtain sufficient,
appropriate evidence to provide a reasonable basis for our findings and
conclusions based on our audit objectives. We believe that the evidence
obtained provides a reasonable basis for our findings and conclusions
based on our audit objectives.
Background
The attrition among VHA physicians has been of particular concern
given that the Health Resources and Services Administration (HRSA)
anticipates that by 2025 the national demand for physician services
will exceed supply. HRSA's Office of Rural Health Policy reported, in
2017, that physician shortages were exacerbated in rural areas, where
communities struggle to attract and keep well-trained providers. \7\
This difficulty has posed a particular challenge for VHA, as
approximately one in four VAMCs is located in a rural area.
---------------------------------------------------------------------------
\7\ Department of Health and Human Services, Health Resources and
Services Administration, Designated Health Professional Shortage Areas
Statistic, HRSA Data Warehouse, accessed May 31, 2017.
---------------------------------------------------------------------------
Most physicians providing care at VAMCs are employed by VHA. VHA
also supplements the capacity of its employed physician staff by
acquiring additional physician services through fee-basis arrangements
or contracts. Under fee-basis arrangements, providers are paid a pre-
agreed-upon amount for each service provided. Under contracts,
physician services may be obtained on a short-term basis; for example,
through sole-source contracts with academic affiliates. \8\ VAMCs may
also use physicians who volunteer their time, who are referred to as
work-without-compensation providers.
---------------------------------------------------------------------------
\8\ The term academic affiliate describes any of the following
three entities in a partnership with a VAMC: (1) a university medical
school, (2) a university hospital, or (3) a university affiliated
physician practice group. If VA requires heath care resources-such as
physician services, medical equipment usage, or clinical space-and
intends to acquire these resources from its affiliate due to its
connection with a residency program, VA can enter into a non-
competitive contract with that affiliate. See 38 U.S.C. Sec.
8153(a)(3)(A).These sole source contracts are available only to VAMCs
and their affiliates, and allow a VAMC to obtain physician services
directly from the affiliate without competition if those services are
necessary to support learning opportunities for physicians during their
residency training in VAMCs. See Department of Veterans Affairs, Health
Care Resources Contracting-Buying, Title 38 U.S.C. 8153, VA Directive
1663 (Aug. 10, 2006).
---------------------------------------------------------------------------
In addition to VHA-employed, contract, and fee-basis physicians,
VAMCs often supplement their capacity by using physician trainees, who
include medical residents and advanced fellows. \9\ In 2016, 135 of the
170 VAMCs had active physician training programs. According to VHA
officials, there were 43,768 medical residents who trained at a VAMC in
2016. VHA has been expanding its physician training program, as
directed by the Veterans Access, Choice, and Accountability Act of
2014, as amended. \10\ In 2017, VHA added 175 physician trainee
positions across VAMCs nationwide, including 3 VAMCs that did not have
physician trainees prior to this expansion. VHA's objective is to add
953 additional physician trainee positions to its VAMCs by 2025 in
order to improve access and hire additional physicians. Further, VHA
officials told us they want to continue to add new positions that would
eventually allow all VAMCs access to physician trainees.
---------------------------------------------------------------------------
\9\ A medical resident or fellow is a physician who practices
medicine under the direct or indirect supervision of an attending
physician. Successful completion of a residency program is a
requirement to obtaining an unrestricted license to practice medicine.
Advanced fellows are individuals who have completed all desired
residency training (including fellowships) and have stayed in VHA for
additional training.
\10\ Pub. L. No, 113-146, Sec. 301(b)(2), 128 Stat. 1754, 1785
(2014), as amended by Pub. L. No. 114-315, Sec. 617(a), 113 Stat.
1536, 1577 (2016) (codified at 38 U.S.C. Sec. 7302 note).
VHA Lacked Information on the Total Number of Mission-Critical
Physicians Who Provided Care at VAMCs and Does Not Plan to Collect
---------------------------------------------------------------------------
this Information
In our October 2017 report, we found that VHA's data on physicians
who provided care at VAMCs were incomplete. Specifically, we found that
VHA had data on the number of mission-critical physicians it employed
(more than 11,000) and who provided services on a fee-basis (about
2,800), but lacked data on the number of contract physicians and
physician trainees. As a result, VHA did not have data on the extent to
which VAMCs used these arrangements and thus, underestimated its
physician use overall. Therefore, VHA was unable to ensure that its
workforce planning processes sufficiently addressed any gaps in
staffing.
All six VAMCs included in our review used at least one type of
arrangement other than employment for physicians, and five of the six
used contract physicians or physician trainees. (See fig. 1.) On
average, contract and fee-basis physicians made up 5 to 40 percent of
the physicians in a given mission-critical physician occupation at each
VAMC in our review. \11\ For example, officials from a large, highly
complex VAMC told us that, in March 2017, they augmented the 86
employed primary care physicians with eight contract and three fee-
basis physicians, which represented about 16 percent of their primary
care physician workforce. \12\ Further, this VAMC also had about 64
primary care physician trainees providing certain medical services
under the supervision of a senior physician.
---------------------------------------------------------------------------
\11\ Officials from one of the six VAMCs we reviewed told us that
they used both contract and fee-basis physicians, but they were not
able to determine if these physicians worked in mission-critical
physician occupations. Also, because physicians who are compensated on
a fee-basis do not have an assigned full-time equivalent (FTE), we were
unable to calculate the percentage of FTEs that contract and fee-basis
physicians contribute to a VAMC. VAMC officials told us that, in order
to ensure a physician is on-call 24 hours a day, 7 days a week, they
may have a number of physicians on contract that only provide a limited
amount of care.
\12\ The contract and fee-basis physicians constituted
approximately 6 percent of the VAMC's primary care FTE positions, which
is lower because contract primary care physicians were often used on a
part-time basis. Officials from this VAMC told us that employed primary
care physicians filled 85 FTE positions, while contract physicians
filled 3, and fee-basis physicians filled about 1 FTE.
[GRAPHIC] [TIFF OMITTED] T5730.001
During the course of our work for the October 2017 report, VHA
officials told us that its personnel databases were designed to manage
VHA's payroll systems, but that these databases did not contain
information on contract physicians or physician trainees. VHA officials
told us they were working to include information on physician trainees
in a new human resources (HR) database-HR Smart-which at the time of
our review, was scheduled to be implemented in 2017. However, these
officials were not aware of plans to add information to the database on
contract physicians. Instead, VAMC leaders used locally devised methods
to identify and track contract physicians, fee-basis physicians, and
physician trainees. For example, one VAMC in our October 2017 review
used a locally maintained spreadsheet to track its physicians under
arrangements other than employment, while another VAMC asked department
leaders to identify how many of these provided care within their
respective departments. At each of the six VAMCs in our review, we
found that department leaders were generally knowledgeable about the
total number of physicians that provided care within the departments
they managed. However, this locally maintained information was not
readily accessible by VHA officials.
To address the limitations in VHA's data, we recommended in our
October 2017 report that VHA develop and implement a process to
accurately count all physicians providing care at each of its VAMCs,
including physicians not employed by VHA. VHA did not concur with this
recommendation, stating that it uses other tools for workforce
planning. However, a VHA official acknowledged that data sources used
for workforce planning may not include all types of contract physicians
or work-without-compensation physicians.
As we discussed in our prior report, implementing such a systematic
process would eliminate the need for individual VAMCs to use their own
mechanisms, such as a locally developed and maintained spreadsheet to
track its physician workforce, as was done by one VAMC in our prior
review. Further, local mechanisms may not be readily accessible to VHA
officials engaged in workforce planning, resulting in incomplete
information for decision-making purposes.
Since our report, VHA officials told us that they have completed
implementation of HR Smart, which provides the capability to track
every position with a unique position number, and each employee's full
employment history. However, VHA officials told us they do not plan to
enhance the capability of HR Smart to track contractors.
We continue to believe that having a systematic and consistent
process to account for all physicians who provide care across VAMCs,
including physicians not employed by VHA, would help address concerns
that VHA is unable to identify all physicians providing care at its
VAMCs.
VHA Has Begun to Develop Guidance for Determining Its Staffing Needs
for All Physicians
In our October 2017 report, we found that VHA gave responsibility
for determining staffing needs to its VAMCs and provided its facilities
with guidance, through policies and directives, on how to determine the
number of physicians and support staff needed for some physician
occupations. Specifically, VHA provided this guidance for primary care,
mental health, and emergency medicine, but lacked sufficient guidance
for its medical and surgical specialties, including occupations such as
gastroenterology and orthopedic surgery. For these occupations, VHA
provided guidance on the minimum number of physicians, but did not
provide information on how to determine appropriate staffing levels for
physicians or support staff based on the need for care.
Specifically, the VHA guidance available at the time set a minimum
requirement that VAMCs of a certain complexity level have at least one
gastroenterologist and one orthopedic surgeon that is available within
15 minutes by phone or 60 minutes in person 24 hours a day, 7 days a
week. \13\ VHA guidance did not include information on how to use data,
such as workload data, to manage the demand for care or help inform
staffing levels for these physician occupations beyond this minimum
requirement. Officials from four of the six VAMCs we reviewed for our
October 2017 report told us that because they lacked (1) guidance on
how to determine the number of physicians and support staff needed, and
(2) data on how their staffing levels compared with those of similar
VAMCs, they were sometimes unsure whether their staffing levels were
adequate.
---------------------------------------------------------------------------
\13\ VHA categorizes VAMCs according to complexity level, which is
determined on the basis of the characteristics of the patient
population, clinical services offered, educational and research
missions, and administrative complexity. There are three complexity
levels with level 1 representing the most complex facilities and level
3 the least complex. Level 1 is further subdivided into categories 1a,
1b, and 1c. Therefore, VAMCs that are categorized as level 1a would
offer the most advanced and complex medical treatment within VHA's
medical care system.
---------------------------------------------------------------------------
In our October 2017 report, we discussed that VHA had previously
established, in 2016, a specialty physician staffing workgroup that
examined the relationships between staffing levels, provider workload
and productivity, veterans' access, and cost across VAMCs for its
medical and surgical specialties, including gastroenterology and
orthopedic surgery. This group's work culminated in a January 2017
report that found VHA was unable to assess and report on the staffing
at each VAMC, as required by the Veterans Access, Choice, and
Accountability Act of 2014, because a staffing model for specialty care
had not been established and applied across VAMCs. This report made a
number of recommendations, including that VHA provide guidance to its
VAMCs on what level of staffing is appropriate for its mission-critical
physician occupations. However, as we noted in our October 2017 report,
VHA leadership had not yet taken steps to develop such staffing
guidance. We reported that, according to a VHA official, other
priorities were taking precedence and continued work in this area had
not yet been approved by VHA leadership. Although VHA officials agreed
that further steps should be taken, they did not indicate when these
would occur. In our report, we concluded that until VHA issues guidance
on staffing levels for certain physician occupations that provide
specialty care to veterans, there would continue to be ambiguity for
VAMCs on how to determine appropriate staffing levels.
To address this, we recommended that VHA develop and issue guidance
to VAMCs on determining appropriate staffing levels for all mission-
critical physician occupations. VHA concurred with our recommendation
and reported it would evaluate and develop staffing guidance for its
medical and surgical specialties.
Since our report, VHA officials told us that on November 27, 2017,
the Executive-in-Charge for VHA signed the specialty care workgroup
charter. The primary goal of the workgroup is to develop a specialty
care staffing model that will include staffing information for all
specialty care. VHA anticipates completing its work and issuing
staffing guidance by December 2018.
VHA Used Multiple Strategies for Physician Recruitment and Retention,
but Has Not Comprehensively Evaluated Them to Assess Effectiveness
In our October 2017 report, we found that VHA used various
strategies to recruit and retain its physician workforce, including
providing assistance recruiting for mission-critical physician
occupations through the National Recruitment Program; policies and
guidance; financial incentives to enhance hiring and retention offers;
and a national physician training program. (See table 1.)
Table 1: VHA Physician Recruitment and Retention Strategies
Providing assistance recruiting for VHA operates the National Recruitment Program that provides direct
mission-critical physician physician recruitment services to Veterans Affairs medical centers
occupations (VAMC) for hard-to-recruit positions, including physicians. This
program, which had 19 physician recruiters as of May 2017, according to
officials, represents VHA at medical conferences, screens resumes, and
develops marketing materials, among other things, to identify and refer
physician candidates to VAMCs.
----------------------------------------------------------------------------------------------------------------
Policies and guidance VHA administers the policies and guidance developed by VA that provide
the basic framework for hiring, paying, promoting, and retaining
physicians. Using in-person and webcast sessions, VHA also provides
basic and advanced training to VHA staff on personnel policies.
----------------------------------------------------------------------------------------------------------------
Financial incentives VHA provides financial incentives to strengthen efforts to recruit and
retain physicians and help to narrow the differences between VHA salary
offers and those of private sector employers. VAMCs adjust market pay,
one component of physician compensation, to reflect a physician's
training, experience, and prevailing pay levels in the local medical
community. Additionally, VHA may offer other types of financial
incentives such as the Education Debt Reduction Program, which
reimburses qualifying education loan debt for employees, including
physicians, in hard-to-recruit positions.
----------------------------------------------------------------------------------------------------------------
Physician training program VHA's physician training program provides VAMC officials with the
ability to regularly interact with trainees and identify top-performing
physicians who would be a ``good fit'' for permanent employment.
According to officials, access to this pool of potential hires serves as
an important recruitment resource.
Source: Veterans Health Administration (VHA) / GAO 18 623T
In our October 2017 report, we found that VHA faced challenges
using its strategies for recruiting and retaining physicians. For
example, according to VHA officials, budget shortfalls in the Education
Debt Reduction Program-which reimburses qualifying education loan debt
for employees, including physicians, in hard-to-recruit positions-
reduced VAMCs' ability to offer this recruitment incentive to physician
candidates. In addition, the relatively small number of physician
recruiters in VHA's National Recruitment Program-19 recruiters for the
170 VAMCs at the time of our report-limited their ability to understand
the particular nuances of some markets, particularly in rural areas.
Further, despite VHA's large and expanding graduate medical
training program, VAMCs experienced difficulties hiring physicians who
received training through its residency and fellowship programs. VHA
did not track the number of physician trainees who were hired following
graduation, but officials told us that the number was small in
comparison to the almost 44,000 physician trainees educated at VAMCs
each year.
We found that VAMCs faced challenges hiring physician trainees, in
part, because VHA did not share information on graduating physician
trainees for recruitment purposes with VAMCs across the system. VHA
officials told us that recruitment efforts could be improved by
developing and maintaining a database of physician trainees, but said
that VHA had no such database. According to VHA officials, information
sharing could help both VAMCs in geographically remote locations that
do not have a residency program and help identify trainees who want to
work at VHA after graduating, but who received no offers from the VAMC
they trained at due to the lack of vacancies in their specialty.
We also reported in October 2017 that VHA did not have complete
information on whether its recruitment and retention strategies were
meeting its needs. VHA had gathered feedback on barriers VAMCs face
when offering financial incentives to physician candidates through its
Education Debt Reduction Program and created a workgroup to look at its
overall use of physician retention strategies, although it had not
completed a comprehensive review of its recruitment and retention
strategies to identify any areas for improvement. As a result, VHA did
not have complete information on the underlying causes of the
difficulties VAMCs faced or whether its recruitment and retention
strategies met its objective of having a robust physician workforce to
meet the health care needs of veterans.
To address these issues, we recommended that VHA (1) establish a
system-wide method to share information about physician trainees to
help fill vacancies across VAMCs, and (2) conduct a comprehensive,
system-wide evaluation of its physician recruitment and retention
efforts, and establish an ongoing monitoring program. VHA concurred
with our recommendations, and reported it planned to enhance its
personnel database, HR Smart, to include physician trainees.
Additionally, VHA said it planned to complete a comprehensive, system-
wide evaluation of the physician recruitment and retention strategies.
Since our report, VHA reported taking some steps to address these
recommendations. Specifically, officials told us they are working to
include information in the newly implemented HR Smart database on work-
without-compensation employees, such as physician trainees, and
anticipate conducting pilot projects at various sites before fully
implementing this capability by September 30, 2019. Additionally,
officials said that they are in the process of completing a review of
physician recruitment and retention incentives. Furthermore, according
to VHA officials, beginning in October 2017, VHA's Office of Workforce
Management and Consulting partnered with the Partnered Evidence-based
Policy Resource Center-an internal VHA resource center-to evaluate and
recommend a systematic approach for allocating workforce management
resources, such as the Education Debt Reduction Program. VHA expects to
complete its efforts by September 2018.
Chairman Dunn, Ranking Member Brownley, and Members of the
Subcommittee, this concludes my statement. I would be pleased to
respond to any questions you may have.
GAO Contact and Staff Acknowledgments
For further information about this statement, please contact Debra
A. Draper at (202) 512-7114 or [email protected]. Contact points for our
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the last page of this testimony. Key contributors to this statement
were Janina Austin (Assistant Director), Sarah Harvey (Analyst-in-
Charge), Jennie Apter, Frederick Caison, Alexander Cattran, and Krister
Friday.
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Prepared Statement of Michael J. Missal
Mr. Chairman, Ranking Member Brownley, and members of the
Subcommittee, thank you for the opportunity to discuss my office's
recent report, OIG Determination of Veterans Health Administration's
Occupational Staffing Shortages for Fiscal Year 2018. \1\ Although this
is the fifth Office of Inspector General (OIG) report on staffing
shortages within VA's healthcare system, it is the first report that
includes facility-specific data reported by leaders at 140 VA medical
centers.
---------------------------------------------------------------------------
\1\ The report was published on June 14, 2018.
---------------------------------------------------------------------------
Previous OIG reports examined Veterans Health Administration (VHA)
national staffing shortages for clinical staff only. The report
released last week, in contrast, allows users to examine the particular
self-reported needs of an individual facility as opposed to only
national data. In keeping with statutory changes, this report also
includes nonclinical occupations (such as human resources and custodial
personnel) that ultimately affect the ability of VHA facilities to
provide quality and timely patient care in a safe environment. This
shift to facility-specific data reveals the staffing gaps in both
clinical and nonclinical occupations identified by each VA medical
center, which have not been apparent in previous reports containing
only aggregate data. The results underscore how variable the needs are
from one medical facility to another.
BACKGROUND
Since January 2015, the OIG has reported on VHA clinical staffing
shortages as required by the Veterans Access, Choice, and
Accountability Act of 2014 (PL 113-146). \2\
---------------------------------------------------------------------------
\2\ OIG Determination of Veterans Health Administration's
Occupational Staffing Shortages reports were previously published on
September 27, 2017; September 26, 2016; September 1, 2015; and January
30, 2015.
---------------------------------------------------------------------------
Our past reports have described the following aspects of staffing:
Mission critical occupations - Medical officer, nurse,
psychologist, and physician assistant were occupations consistently
included in our top five determinations of occupational staffing
shortages. Physical therapist was initially in the top five, but was
replaced by medical technologist in our 2017 report.
Gains and losses - We reported that overall hiring at VHA
is increasing. Our analysis of staffing gains and losses shows that for
mission critical occupations, a significant percentage of total gains
were offset by losses. We made recommendations regarding reducing the
number of regrettable losses and voluntary departures. \3\
---------------------------------------------------------------------------
\3\ Regrettable losses are defined as those individuals who resign
from VA or who transfer to other government agencies. Regrettable
losses are staff who potentially could have continued employment in VA
and represent an opportunity for VA to retain staff.
---------------------------------------------------------------------------
Staffing models - The OIG has recommended that VHA
develop and implement staffing models for critical occupations. We
recognize that VHA has implemented staffing models in specific areas
such as primary care and inpatient nursing. VHA has also expanded the
occupations covered by such models. However, operational staffing
models that comprehensively cover critical occupations are still
needed. The OIG 2017 report states that, ``In the absence of facility-
specific staffing targets or an operational staffing model, determining
whether facilities are making meaningful progress in filling critical
staffing shortages is challenging.''
The 2017 report also notes that despite having staffing models for
some occupations, many medical centers reported relying on additional
data when evaluating their staffing needs. An overwhelming majority
specified they continued to use a locally developed process as opposed
to a formal staffing model. Even when they have a methodology,
additional data is desired and greater refinement is needed.
VHA'S OCCUPATIONAL STAFFING SHORTAGES FOR FISCAL YEAR 2018
The VA Choice and Quality Employment Act of 2017 (PL 115-46)
expanded the reporting requirement to include both clinical and
nonclinical positions as well as requiring information for each VA
medical center. Consequently, the OIG conducted a facility-specific
survey to determine current local staffing levels and identify
shortages. The OIG requested that VA medical center directors designate
and rank each occupation for which there is a shortage at their
facility. This shortage information should spur discussions about how
best to meet facility-specific needs.
As in previous years, the OIG analyzed staffing data using the
Office of Personnel Management's (OPM) occupational series. We
augmented our analysis this year by including VHA assignment codes to
provide additional detail about the shortages in the medical officer
and nurse occupational series. For example, these codes help
distinguish a psychiatrist from a neurosurgeon-two physicians that
would fall under the umbrella OPM occupation series of ``medical
officer'' but provide significantly different types of care.
Recent OIG reports have demonstrated the importance of including
nonclinical positions in reports of staffing shortages. For example in
our March 2018 report, Critical Deficiencies at the Washington DC VA
Medical Center, we detail how excessive vacancies in key departments
can affect patient care. An inadequately staffed human resources
function contributed to key vacancies throughout that facility,
including shortages in logistics, prosthetics ordering, sterile
processing, and environmental management services. Without properly
cleaned instruments, clinical areas, and storage rooms, the risk of
infection increases to patients. Failing to have enough staff to order
prosthetics and supplies, and track them, also can impact patient care.
Clinical and Nonclinical Results
Medical center directors most commonly cited the need for medical
officers and nurses, which is consistent with the OIG's four previous
VHA staffing reports. Our analysis showed that 138 of 140 facilities
listed the medical officer occupational series (or a related VHA
assignment code) as experiencing a shortage, with the psychiatry and
primary care positions being the most frequently reported. Of the 140
facilities, 108 listed the nurse occupational series (or a related VHA
assignment code) as experiencing a shortage, with practical nurse and
staff nurse as the most frequently reported.
Within nonclinical occupations, the OIG found that human resources
management and police occupations were among the most often cited as
shortages. Included in Appendix A is a table with the frequency of
facility-designated occupational shortages.
The results demonstrate that although there are clusters of
commonality, there is also wide variability in occupational shortages
reported by individual medical centers. This is critically important to
recognize because facilities have distinct staffing needs that must be
considered. For example, a rural facility that specializes in the
treatment of mental health will need to be staffed differently than an
urban facility in downtown Manhattan that provides a broad array of
services.
Reasons for Shortages
The report also identified challenges to meeting staffing goals.
Because VHA utilizes OPM's criteria for supporting evidence that must
be submitted to claim a ``severe shortage of candidates'' in generating
its Mission Critical Occupation Report, we applied the same criteria.
We provided the directors being surveyed with information from Title 5
of the Code of Federal Regulations regarding OPM's Direct Hire
Authority Severe Shortage of Candidates. The directors were able to use
free text for providing information on the reasons for shortages, and
the reasons varied significantly. OIG staff's thematic analysis of the
responses resulted in three frequently cited categories: (1) lack of
qualified applicants, (2) non-competitive salaries, and (3) high staff
turnover. \4\
---------------------------------------------------------------------------
\4\ The thematic analysis categories were developed after reading
all the responses. Responses that fell outside of the developed
categories were classified as ``other.''
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
---------------------------------------------------------------------------
Recommendations
Our 2018 report repeats the OIG's previous calls for VHA to develop
a new staffing model that identifies and prioritizes staffing needs at
the national level while supporting flexibility at the facility level
to ensure taxpayer dollars are invested in delivering the highest
quality of care to veterans. Without the ability to analyze accurate
data, VHA risks spending significant dollars without any measurable
improvement in the quality of health care. VA's focus on developing a
comprehensive staffing model will lead to more efficient hiring
practices and result in fewer recruitment challenges and an increased
capacity to serve veterans' needs.
CONCLUSION
The OIG's 2018 survey provides facility specific data on staffing
shortages reported by the leaders of the 140 VA medical centers and
highlights the need for a model that identifies and prioritizes
staffing needs allowing flexibility at the facility level. This report
should prompt meaningful discussions at both the local and national
levels about how to implement, support, and oversee staffing in VA
medical centers that will result in the best possible care for
veterans.
Mr. Chairman, this concludes my statement, and I would be pleased
to answer any questions you or other members of the Subcommittee have.
Table 1. Frequency of Facility-Designated Occupational Shortages
----------------------------------------------------------------------------------------------------------------
Occupational Series or Number of Facilities Marked the
Assignment Code Occupation Occupation as a Shortage
----------------------------------------------------------------------------------------------------------------
1 31 Psychiatry 98
----------------------------------------------------------------------------------------------------------------
2 0201 Human Resources Management 92
----------------------------------------------------------------------------------------------------------------
3 P1 Primary Care 66
----------------------------------------------------------------------------------------------------------------
4 0180 Psychology 58
----------------------------------------------------------------------------------------------------------------
5 0644 Medical Technologist 56
----------------------------------------------------------------------------------------------------------------
6 0801 General Engineering 55
----------------------------------------------------------------------------------------------------------------
7 0083 Police 52
----------------------------------------------------------------------------------------------------------------
8 K6 Hospitalist 49
----------------------------------------------------------------------------------------------------------------
9 16 Emergency Medicine 48
----------------------------------------------------------------------------------------------------------------
10 0620 Practical Nurse 46
----------------------------------------------------------------------------------------------------------------
11 3566 Custodial Worker 46
----------------------------------------------------------------------------------------------------------------
12 25 Gastroenterology 45
----------------------------------------------------------------------------------------------------------------
13 88 Staff Nurse 44
----------------------------------------------------------------------------------------------------------------
14 12 Urology 42
----------------------------------------------------------------------------------------------------------------
15 7 Orthopedic Surgery 42
----------------------------------------------------------------------------------------------------------------
16 0603 Physician's Assistant 39
----------------------------------------------------------------------------------------------------------------
17 0622 Medical Supply Aide and Technician 39
----------------------------------------------------------------------------------------------------------------
18 0647 Diagnostic Radiologic Technologist 39
----------------------------------------------------------------------------------------------------------------
19 75 Nurse Practitioner 39
----------------------------------------------------------------------------------------------------------------
20 0633 Physical Therapist 37
----------------------------------------------------------------------------------------------------------------
21 0649 Medical Instrument Technician 37
----------------------------------------------------------------------------------------------------------------
22 20 Dermatology 36
----------------------------------------------------------------------------------------------------------------
23 30 Neurology 35
----------------------------------------------------------------------------------------------------------------
24 38 Radiology-Diagnostic 33
----------------------------------------------------------------------------------------------------------------
25 0631 Occupational Therapist 31
----------------------------------------------------------------------------------------------------------------
26 1 Anesthesiology 31
----------------------------------------------------------------------------------------------------------------
27 7408 Food Service Worker 31
----------------------------------------------------------------------------------------------------------------
28 0858 Biomedical Engineering 30
----------------------------------------------------------------------------------------------------------------
29 21 General Internal Medicine 30
----------------------------------------------------------------------------------------------------------------
30 26 Pulmonary Diseases 29
----------------------------------------------------------------------------------------------------------------
31 40 Geriatrics 29
----------------------------------------------------------------------------------------------------------------
OIG Determinations of Veterans Health Administration's Occupational Staffing Shortages, June 14, 2018, page 11
Prepared Statement of Peter J. Shelby
Good morning, Mr. Chairman, Ranking Member Brownley, and Members of
the Committee. Thank you for the opportunity to discuss staffing for
the Department of Veterans Affairs (VA). I am accompanied today by Ms.
Jessica Bonjorni, Veterans Health Administration (VHA) Acting Assistant
Deputy Under Secretary for Health for Workforce Services.
We are excited to report to you the progress VA has made in the
last year to support recruitment and retention for the professionals
who provide healthcare, benefits assistance, and memorial services to
our Veterans.
Leadership Training Plan
VA is partnering with numerous private-sector organizations to
strengthen the leadership and technical skills of VA executives, while
at the same time leveraging the relationships to identify innovative
strategies, best practices and technologies to drive transformational
changes in VA healthcare management and delivery systems. The Executive
Management Fellowship (EMF) program allows for reciprocal assignments
of private-sector executives in VA facilities and VA executives in
private sector healthcare organizations. VA is currently finalizing the
hosting agreements and identifying the VA participants in this program,
with the initial cohort to be selected by mid-July 2018. Once the
fellowship agreements are in place, VA will extend reciprocal
Fellowship opportunities to employees in the partner private-sector
organizations. We anticipate having up to 20 EMFs in the year-long
program in private-sector healthcare organizations across the country
beginning this October, with private-sector EMFs being hosted in VA
facilities shortly thereafter.
Military Transition
VA has developed a three-pronged approach to encouraging
transitioning Servicemembers to consider employment at the Veterans
Health Administration. VA has partnered with Department of Defense
(DoD) military installations in the National Capital Region on an
initiative called Military Transition and Training Advancement Course
(MTTAC). MTTAC is an entry-level training program for Servicemembers
currently enrolled in the transition process, who anticipate being
released from active duty within 90 to 120 days. This training program
is modeled after VA's very successful Warrior Training Advancement
program, which trains transitioning Servicemembers to serve as benefits
claims examiners. VA's MTTAC program is currently set up to train
Servicemembers to become medical support assistants, with the goal of
hiring them into VA immediately upon separation from the military. As
part of the course, Servicemembers are also provided with general
Federal employment tips, including how to write a Federal resume and
how to apply for Federal jobs. The first course was in May 2018, and
the next class is scheduled for July 16-27, 2018 at Walter Reed
National Military Medical Center. This course is expected to be offered
at Fort Belvoir and Aberdeen Proving Ground in August 2018.
VA is also using a direct marketing campaign to attract military
medical professionals currently enrolled in the transition process. VA
uses the VA-DoD Identity Repository data to identify Servicemembers,
time of discharge, and military occupational specialty. The first
campaign will launch on June 30, 2018.
In addition, the Intermediate Care Technician (ICT) Program is an
established VA program to recruit former military medics and corpsmen
into positions in VA Medical Center (VAMC) emergency departments and
other specialty areas. ICTs are aligned organizationally under licensed
independent practitioners in the clinical setting to maximize their
utility and value to Veteran care. This program has been piloted in VA
and was deployed to 23 VA VAMCs at the start of fiscal year (FY) 2018.
VA intends to expand this program to all 171 VAMCs.
System-wide Method to Share Information about Physician Trainees
In close partnership with the Office of Personnel Management, VA
has evaluated new requirements necessary to track physician trainees in
HR-Smart and is developing requirements for VA's interface with the USA
Staffing information system. The current USA Staffing interface design
does not currently include ``without compensation'' employees. A 90-day
pilot is currently underway to test the technical solution being
proposed to track physician trainees to assess employment and retention
of trainees. Afterward, additional pilot projects at various sites will
be performed, including full application of the trainee onboarding
initiative. The anticipated completion date for these pilot projects is
the fourth quarter of FY 2019.
Physician Recruitment & Retention Strategies
VA has taken steps to complete a comprehensive, system-wide
evaluation of the physician recruitment and retention strategies. VA's
Office of Workforce Management and Consulting (WMC) is in the process
of completing a review of physician recruitment, relocation, and
retention incentives by specialty as well as a comparison of salary
data for local markets.
VA's WMC is working with VA's Partnered Evidence-based Policy
Resource Center to evaluate the impact of market trends and recruitment
and retention incentives to target resources effectively. To date,
analysis is conducted at the VAMC level. Targets for FY 2018, Q3 are
focusing on analysis at the individual employee level to provide a
richer variation and more statistical power to measure the impact of
Federal-private wage differential, impact of incentives such as the
Education Debt Reduction Program, recruitment, retention and relocation
incentives on employees receiving such benefits and other variables of
interest.
WMC is also actively collaborating with Quality Enhancement
Research Initiative partners to evaluate and refine strategic
allocation of workforce resources for critical staffing needs within
the top clinical staffing shortage occupations (physicians, registered
nurses, physician assistants and psychologists). Ongoing activities
include evaluation and development of existing recruitment and
retention incentives, loan repayment and scholarship programs.
Components of the recruitment and retention evaluation specific tasks
include not only evaluating the effectiveness of these recruitment and
retention programs, but also exploration of predictive turnover,
retention profiling, and a pilot design for a strategic approach of
workforce resources. The study is expected to conclude by the end of FY
2018.
Staffing Models for Critical Need Occupations
The VA Specialty Care Staffing Working Group continues its efforts.
The team is building and establishing an integrated set of costing,
forecasting and productivity tools based upon the latest 2016 and 2017
information. Previous work by the team established a data baseline,
demonstrating the relationship between Veteran demand for Specialty
Care services with corresponding cost, complexity and productivity
factors. The team is now evaluating the results and developing staffing
models and decision matrices for medical facilities to use when setting
Specialty Care staffing requirements. The anticipated completion date
for initial delivery is September 2018.
Meanwhile, VA continues to evolve its clinical staff modeling and
workforce planning for other practice areas. VA is leveraging long-
standing staffing models for primary care, mental health, and nursing;
and is developing, evaluating, and refining additional staffing models
for other functional areas. VA provided technical support to the Office
of the Inspector General (OIG) for an OIG independent assessment of
field occupational staffing priorities in February 2018. VA OIG
released their report to VA, the results will be incorporated into the
next round of clinical staffing planning assessments. The anticipated
completion date is September 2018. The Medical Center results will be
published in the Federal Register by September 2018.
VA is establishing a manpower capacity for the entire Department,
with the creation of a permanent manpower office in the Office of
Management, and is leveraging HR Smart as a technical solution-enabling
position management. VHA is closely integrated with the Department's
efforts and is committed to deploying a position management solution
for both clinical and non-clinical requirements.
An updated, efficiently aligned position categorization structure
will enable VA facilities to more precisely define their clinical and
non-clinical staffing requirements. Such a structure will also enable
staffing predictive power on the part of VAMCs and Veterans Integrated
Service Networks, and will simultaneously enable the flow of staffing
requirements to the enterprise level, facilitating national recruitment
efforts and budget formulation.
Predicting Staffing Changes
The VA Enrollee Health Care Projection Model (EHCPM), developed in
1998, is a sophisticated healthcare demand projection model and uses
actuarial methods and approaches to project Veteran demand for VA
healthcare. These approaches are consistent with the actuarial methods
employed by the Nation's insurers and public providers, such as
Medicare and Medicaid. The EHCPM projects enrollment, utilization, and
expenditures for the enrolled Veteran population for more than 90
categories of healthcare services 20 years into the future.
A key component in of the EHCPM is ``reliance.'' A unique aspect of
the enrolled Veteran population is that enrollees have many options for
healthcare coverage in addition to VA: Medicare, Medicaid, TRICARE, and
private insurance. Approximately 80 percent of enrollees have some type
of public or private healthcare coverage in addition to VA. As a
result, enrollees rely on VA for approximately one-third of their
healthcare needs. Changes in enrollee reliance occur as a result of
many factors, such as enrollee movement into service-connected
priorities, changing economic conditions, VA's efforts to provide
Veterans access to the services they need, VA's efforts to enhance its
practice of healthcare, the opening of new or expanded facilities, and
the availability of services and/or the cost sharing associated with
services in the private sector.
The VHA Office of Enrollment and Forecasting and the Specialty Care
Delivery Network Model Work Group Co-Chairs (WMC and National Surgery
Office) are incorporating EHCPM data into its staffing model
development, including the Specialty Care Delivery Network Model. VA
will continue to expand its capability to predict Veteran demand for
care and to further enhance the ability of its staffing models to
leverage demand prediction.
This remains a critical activity, and as noted above is being
conducted as a subset of the Specialty Care Services Staffing
workgroup. The team is currently analyzing enrollee demand for all
healthcare within a healthcare market (whether received in a public or
private setting), not just within a framework of demand in the context
of VA facilities. The anticipated completion date is the end of 2018.
Training Human Resource Specialists
Through April 2018, there have been 422 new General Schedule (GS)
201 Human Resources (HR) specialists hired into VA. At the start of FY
2018, VA launched a course called 201 Jumpstart. This self-paced
virtual course helps orient HR professionals to VA, and includes
training on how to best recruit and retain employees. Following the
completion of this course, new HR Specialists enroll in the New Talent
Development Program (NTDP) which is a face-to-face training that
provides comprehensive HR training on two tracks: (1) Staffing/
Classification and (2) Employee Relations/Labor Relations/Performance
Management. After piloting NTDP in the first two quarters of FY 2018,
the program is now expanding to enroll all newly hired HR Specialists,
with annual throughput capacity of 900 employees. To date, 120 HR
Specialists have completed the NTDP, with an additional 34 currently
enrolled.
Mental Health Hiring
VA has committed to achieving a net gain of 1,000 Mental Health
(MH) Providers by the end of this calendar year. As of June 8, 2018, VA
has achieved a net gain of 424 new MH clinicians. As part of this MH
hiring initiative, VA used a new workforce planning approach that has
proven to be a successful proof of concept for early VA manpower
capabilities, including analysis of workforce and mitigation of
regrettable losses. In addition, VA launched the first VA MH Trainee
and Early Career Connection and Recruitment event, to help potential
candidates connect, match, and interview with local VAMCs that are
hiring. Approximately 2,000 matches have been made between participants
and 75 VAMCs. The VA MH Trainee and Early Career Connection and
Recruitment event will run through late July 2018.
Conclusion
VA appreciates Congress's support, which allows us to train future
healthcare professionals to care for Veterans and the Nation as a
whole. Mr. Chairman, this concludes my testimony. My colleague and I
are prepared to answer any questions you, Ranking Member Walz, or other
members of the Committee may have.
Statements For The Record
AMERICAN FEDERATION OF GOVERNMENT EMPLOYEES, AFL-CIO (AFGE)
Chairman Dunn, Ranking Member Brownley, and Members of the
Subcommittee:
The American Federation of Government Employees, AFL-CIO (AFGE) and
its National VA Council (NVAC) appreciate the opportunity to submit a
statement for the record for the June 21, 2018 hearing titled, ``More
Than Just Filling Vacancies: A Closer Look at VA Hiring Authorities,
Recruiting and Retention.'' AFGE and NVAC represent more than 700,000
employees in the federal and D.C. government, including 250,000 front
line employees at the Department of Veterans Affairs (VA) providing
comprehensive benefits, health care, and other critical services for
veterans.
As numerous studies, reports, and anecdotal evidence have shown,
veterans receive the best care for their conditions in a system that is
specifically designed for the treatment of veterans, the VA. In turn,
it is not surprising that the preferred ``CHOICE'' of veterans
regarding where to receive care is also the VA. Because of these
preferences, and the nation's commitment to those and the families of
those who have served, Congress must do all in its power to staff the
VA to a point where capacity meets the VA's exceptional demand, and
where veterans receive the VA care they have earned. If proper staffing
is not accomplished and positions are not filled, the VA will continue
down the path of privatization, and veterans will instead have a
``CHOICE'' made for them by being sent to non-VA care.
AFGE and NVAC welcomes the opportunity to comment on several
components that have an impact on the future of VA staffing, including:
Office of Inspector General Report on Staffing
For years AFGE and NVAC have urged Congress to take a real look at
hiring at the VA. With over 33,000 unfilled positions currently on the
books at the VA, this hearing is timely. It is impossible for us to
keep the promise made to our veterans without adequately funding and
staffing the VA. The VA provides world-class, comprehensive, veteran-
centric care and services that simply are unavailable elsewhere and
that is a system which must be preserved. We hope that the end result
of the hearing today is with an even greater interest in staffing and a
desire to fill all 33,000 vacant VA positions.
Additional data on nonclinical staffing needs: Last week the VA
Office of Inspector General (OIG) released its annual report on
staffing at the VA. Unlike past years, Congress directed the OIG to now
include the top five clinical and non-clinical occupations which are
the most short staffed. To comply, the OIG released data from 140 VA
facilities nationwide and rank ordered the data based on how frequently
the facilities cited an occupation as short staffed.
AFGE and NVAC were pleased to see the OIG provide a more thorough
and complete review of facility staffing deficiencies including
additional data on nonclinical staffing needs. This information will be
useful to all stakeholders as we attempt to identify how to best staff
the VA and fill these vacancies with fulltime federal employees who
will make a career out of serving our veterans.
AFGE and NVAC are pleased to see an increased spotlight on the need
for adequate staffing of nonclinical positions. Staffing levels for VA
police ensure the safety of patients and employees, and staffing the VA
with an appropriate number of custodial workers reduces the risk of
hospital-acquired infections. These are life and death issues.
Given the enormous burden that Choice and other non-VA private care
programs have placed on VA's own support staff who are handling
consults, medical records and requests for assistance from patients
trying to navigate the private care maze, AFGE and NVAC strongly
recommend that additional staffing data be collected to reflect
staffing needs for these support positions as the Mission Act is rolled
out.
Mental health staffing needs: Sadly, once again mental health
topped the list of difficult to fill positions in the OIG report. Of
the 140 facilities surveyed, 98 facilities listed psychiatrist as the
position which is most difficult to fill. This made mental health the
top category of those reported in the surveys. At a time when private
sector entities are hoping to carve out mental health care as a primary
avenue for privatization, this finding is particularly disturbing. The
VA does veteran-centric mental health care better than any comparable
entity in the private sector, and those professionals work every day to
make sure our veterans get the help that they need.
AFGE and NVAC urge Congress to work to increase internal capacity
within the VA's mental health practices instead of supplementing this
care with the private sector. AFGE and NVAC are very troubled by field
reports from our locals who have observed that there appears to be
widespread noncompliance with VA's own mental health staffing ratios.
Chronic short staffing of clinicians providing mental health treatment
to our wounded warriors will directly undermine VA's continued ability
to provide the exemplary specialty mental health care and Primary Care
Mental Health Integration that are a national model.
Direct Hire Authority
The VA has long called for, and the Congress has consistently
provided, direct hiring authority to bypass the regular civil service
process and fill positions within the VA. Less than a year ago, in
August of 2017, the ``VA Choice and Quality Employment Act of 2017''
was enacted into law. This law goes beyond traditional direct hiring
authority, and exclusively grants the VA additional direct authority
when ``there exists a severe shortage of highly qualified candidates''
(Sec. 213). Furthermore, just as recently as last month, the VA MISSION
ACT was signed into law, making two distinct references to how the VA
should use direct hiring authority. Specifically, it says it should be
used as a part of the remediation of closed medical service lines (Sec.
109), as well as for addressing the problems facing underserved
facilities (Sec. 401).
Currently, tens of thousands of vacancies exist throughout the VA,
and short staffing requires some veterans to receive non-VA care
despite their preference to be treated within the VA. While the
aforementioned laws address VA's direct hire authority, we must ask how
the VA is using these hiring tools to address staffing challenges.
Accountability Act
Since the day of its introduction, AFGE and NVAC have vociferously
opposed the ``Department of Veterans Affairs Accountability and
Whistleblower Protection Act of 2017.'' AFGE opposed this law with the
belief that it would lead to a purge of frontline employees at the VA,
including many veterans continuing their service to the nation within
the VA, while failing to address managers who have failed in their
ability to lead staff and serve the mission of the VA. While the VA has
made collection of data related to terminations under the powers
granted by the Accountability Act difficult to say the least, AFGE and
NVAC have worked to compile and analyze data from these terminations.
Through February 2018, 1646 individuals were removed under the
Accountability Act, including 44 physicians, 100 Registered Nurses, 51
Licensed Practical Nurses, 40 Nurses, and eight Physicians Assistants,
while only 18 Supervisors were terminated. With so many veterans
requiring care, it is counterproductive to arbitrarily terminate
medical personnel in short supply, while simultaneously failing to hold
supervisors accountable. AFGE and NVAC are very pleased that a
bipartisan bill, the VA Personnel Equity Act of 2018 (HR 6101) has just
been introduced to restore critical workplace rights that the 2017 law
severely weakened or eliminated. Regarding staffing, passage of this
legislation will enable the VA to restore a more just and fair
workplace that will enable it to be on a more level playing field in
competing with other health care employers,
Transparency
AFGE and NVAC have urged Congress to seriously address VA staffing
in a way that is transparent to patients, workers, and job seekers. We
were pleased to see Congress include new transparency language in the
VA MISSION Act, which is now law. Specifically, Sec. 505 of the new law
requires the VA to submit a report to Congress outlining how many
unfilled positions exist by occupation and by facility. This
information will be posted on a publicly available website so that all
interested parties will have access to the information. This section of
the new law is an important step forward in staffing transparency at
the Department. For entirely too long we have allowed the public to
only see one side of the VA story: wait times. Now the public will be
able to see how many unfilled positions exist at these facilities and
ask questions about why those positions are going unfilled. We were
also pleased to see Sec. 505 include a reporting requirement so that
the Department will have to face Congress and explain what steps it is
taking to fully staff every VA facility across the country. This new
transparency requirement is important, and we ask that Congress make
certain that the VA complies with this section of the new law.
Other comments: Physician Assistant Pay
As the OIG noted in its June 14, 2018 report, VHA has consistently
faced a shortage of physician assistants (PA) in its workforce. Section
212 of the VA Choice and Quality Employment Act of 2017 (VCQEA) added
the requirement that physician assistants employed by VHA receive
competitive pay through the same locality pay setting process already
in place for registered nurses.
AFGE and NVAC have monitored the implementation of this new PA pay
requirement. Our locals in multiple locations report problems with the
types of surveys used. Management at some facilities are using 2016
contract wage surveys and they appear unwilling to consider any other
options. Given that the Medical Center Director has total discretion
over the salary levelswhen converting to the new salary schedule and is
only required to notify the Secretary of his decision, this leaves
little recourse for the PAs adversely affected by the choice of survey,
or their employee representatives to challenge unfair salary schedules.
As a result, despite these new provisions in the law, PAs working
for the VA are paid significantly less than other PAs in the same local
market; some report a $20,000 pay gap. PAs with longstanding tenure
with the VA are facing some of the worst pay gaps due to the VA's
current pay ceilings for PAs.
PAs also report that their years of experience are undervalued
relatives to VA advanced practice registered nurses (APRNs). For APRNs
working at the VA, nursing years of experience are counted as years of
experience towards their APRN salary determination. This practice
results in APRN's receiving higher salaries than PAs with the same or
less APRN experience.
AFGE and NVAC appreciate the opportunity to comment on these
important staffing issues.
WHISTLEBLOWERS OF AMERICA
Mr. Chairman and Ranking Member:
Whistleblowers of America (WoA) was established as a nonprofit in
2017 to provide peer support and advocacy to whistleblowers suffering
the ill-effects of retaliation. Although it receives contacts from
various sectors and communities, whistleblowers from the Department of
Veterans Affairs (VA) is the clear majority. When similar concerns were
raised by VA employees about their retention, reprisal, demotion,
termination, and constructive dismissal WoA wanted to learn more, so we
asked for feedback. We were hearing multiple concerns from employees
(and veterans) about the new Office of Accountability and Whistleblower
Protection (OAWP), WoA wanted to develop a more comprehensive
understanding of interactions people were having with the OAWP. WoA has
included the Findings section upfront and actual comments for VA
whistleblowers in Background.
In previous testimony to this Committee, WoA has cited its concerns
for high turnover rates and vacant positions in the neighborhood of
40,000. WoA believes some of this turnover and difficultness to fill
position is due to the retaliation, discrimination, harassment, and
hostile work environment that VA employees find themselves subject to.
This reputation does not make VA an organization of choice. The Federal
Employees Viewpoints Survey (FEVS) of all government employees shows VA
to be amongst the less favorable places to work. If we want to hire
qualified, competent providers, we must give them a positive work
environment.
Summary of Findings:
Although whistleblowers are bringing forward a variety of different
issues related to disclosing wrongdoing, the retaliation occurs along
similar lines. Whistleblowers report to WoA that they experience
further reprisal in the form of harassment/violence, gaslighting,
mobbing, ostracizing, marginalizing and devaluing, double-binding,
blackballing and counter accusing. \1\ They describe these conditions
as evidence of retaliation in hopes that OAWP will be able to protect
and assist them quickly. However, that is often not the case. The OAWP
is plagued with deficiencies related to timeliness, process and
staffing further effecting outcomes.
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\1\ Garrick Inventory: Whistleblower Retaliation Checklistc. I
developed this checklist with indicators to help assess whistleblower
retaliation.
---------------------------------------------------------------------------
Timeliness - The OAWP, which employees perceive as having been
created to help them, has caused most of them more harm as evident by
some of the comments. Across the board, OAWP does not provide timely
responses. When a whistleblower contacts the OAWP, they are assigned a
case manager who asks them to fill out the VA Form 10177.
Whistleblowers wait several months and are then given ``boilerplate''
answers. They are told that they will hear back, but then they never
do.
Process - Another consistent issue with OAWP is that it appears
limited in its protocol for engagement. Because of the language in the
VA Form 10177, attorneys have advised clients not to sign it because it
creates some conflicts of interest and may be interpreted to waiving
certain rights. However, once signed and a case manager assigned, the
process entails a report to the OAWP Director, but then the information
goes back to the VISN or RO Director, the hospital director and then to
the supervisor, who is usually the person reported in the first place.
Retaliation increases.
This process seems to also involve hospital chiefs of staff sending
letters of investigation to license boards and professional association
that have career ending implications. Doctors are reported to the
National Practitioner Data Bank (NPDB) even when no charges have been
substantiated but once identified to the NPDB a medical career is
virtually over. Living under this threat is causing some practitioners
to leave the VA out of fear. A Readjustment Counseling Services
conference in June 2018 reportedly ended with Vet Center employees
being reminded that Trump has curtailed your due process rights and
that they can be fired at any time.
OAWP engagement seems limited to ``trafficking'' the paperwork and
monitoring the whistleblowers, but not a lot of advocacy or assistance.
They do not appear to have the capability to investigate, mediate, or
arbitrate an outcome. They should also be required to provide case
management updates and disclose an outcome. Although privacy of all
parties must be respected, the whistleblower should at least be able to
receive notice on the section(s) of law reviewed and how it was
applied.
Staffing - The one whistleblower who identified the job series
issue appears to have hit a key element that is challenging engagement
effectiveness. Since the OAWP was created by overtaking the former OAR
- an HR function, the staff tends to have that background. Therefore,
there is a shortage of the right staffing mix of HR specialists,
investigators, mediators/arbitrators and decision makers. The office
would benefit from being authorized to engage independent consultants
to conduct these investigations and issue reports. This would increase
transparency, accountability and confidence in the system.
When employees leave the VA (regardless if they are terminated,
resign or retire), they should be required to participate in an exit
interview process that captures information related to their employment
experience and reasons for leaving. This information should be reported
to Congress annually.
Performance - The OAWP is reporting accountability and disclosures
on their website. \2\ The accountability report (adverse actions)
details demotions, suspensions and terminations while the disclosure
report identifies the types of whistleblower reports made. However,
almost half of those contacting the office were not found to be
whistleblowers. This data point is concerning because it either means
that employees are not being educated in accordance with the NO FEAR
Act or whistleblowers are being unjustly denied. There is also a lack
of data on how they are being assisted as described by the WoA
respondents. The OAWP needs to open the aperture on how it is defining
its whistleblower terms and capturing retaliation (in its many forms)
and be able to account for the assistance provided. It should denote
how many of the adverse actions they took involved any whistleblowers
and who were veterans.
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\2\ https://www.va.gov/accountability/
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There is also very limited accountability for when the OIG makes
recommendations related to disclosures. Those should be better tracked
and reported. There are no mandates to implement an OIG recommendation.
Those can literally, ``sit on the shelf.'' Only the OSC can mandate any
corrective action and rarely do they because they do not have the
resources to take cases to that level of litigation and the MSPB has
not had a full panel of judges to hear cases in years. According to
OSC, about 40% of its cases are VA, so an improved internal VA process
could alleviate this burden and increase effectiveness for all federal
employees. Respondents demonstrate their reliance on OIG and OSC
investigations to support them. Furthermore, managers who were guilty
of the wrongdoing or the retaliation are not held accountable - rarely
are they even identified by the OIG. Most of the time, the OIG
recommendation is for ``further training.'' There should be serious
penalties for retaliation (fines, demotions, loss of retired pay, etc)
to discourage the tactics related to it. Congress could create a fund
that requires those identified as engaging in retaliation to contribute
fines. Whistleblowers who must defend themselves against retaliation
are out-of-pocket - sometimes upward of $100,000 while the wrongdoer is
defended by the government, which wastes taxpayer money for veterans.
This is antithetical to common sense, so this fund could be used to
offset those costs by being used to retain private sector attorneys
chosen by the whistleblower (similar to a risk pool created for
insurance coverage) and reduce the burden on the taxpayer when damages
are awarded. Plus, the lack of serious accountability furthers a
corporate culture that allows retaliation to fester.
Suggested Next Steps:
1.Host a roundtable with whistleblowers to hear firsthand about
retaliation at VA and the career impacts it has had.
2.Conduct a hearing on Whistleblower Retaliation and the
effectiveness of the OAWP
3.Draft legislative requirements for staffing (government and
independent) and performance measures (to include timeliness and
process outcomes) as described above
Background:
WoA contacted 22 current and former VA employees for their feedback
and insights into retaliation at the VA and the effectiveness of OAWP.
Responses came from 13 current and former staff (some who are also
veterans) at VA Central Office, the VA Medical Centers and the VA
Regional Offices from around the country. They are medical doctors and
other clinical providers, claims representatives, lawyers, law
enforcement officers, contracting experts and senior officials. We are
particularly concerned about disabled veterans who are hired and then
terminated during their probationary period, especially after asking
for reasonable accommodations.
The following questions were sent out and their answers are
imbedded below:
What did you ask OAWP to do on your behalf?
My case was presented to OAWP for review because I was
being retaliated against for disclosing fraud, waste, abuse and
substandard care. My law firm on my behalf, requested OAWP to assist
with getting the VA to immediately cease and desist reprisal against
me. After my case was presented to OAWP, the retaliation intensified
and became more frequent.
I was removed in 2014. I think (co-worker \3\) had me
talk to Brandon (OAWP staff) \4\ for some whistleblower Dept in VA that
was new and supposedly for whistleblowers. I called him. Spoke more
than once. He had me submit a form \5\ and then some. I tried to follow
up a couple of times. I never heard back from him.
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\3\ Parenthesis and italics denotes a person was named that is not
a known VA senior official, so their identities are protected.
\4\ Brandon Coleman was the addiction counselor at the VAMC in
Phoenix who made headlines with his whistleblower retaliation case and
was subsequently awarded a high-level position at VACO with the OAWP.
Because of his notoriety, many VA whistleblowers reach out to him
looking for help.
\5\ VA Form 10177
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They conducted a full board investigation of me in June
2017 due to an anonymous complaint sent to OIG in 2015. Why it was sat
on for 2 years is a mystery to all. Board ruled the complaint was not
substantiated. However, they never closed the case with OIG though so
I'm still under law enforcement review until they close it. We have
members of Congress tying to help. OIG says 10N still has the same open
complaint, but they haven't heard from them. I requested documents from
OAWP to which the guy called me to complain and amend. I did. No
response. FOIA appeal. No response. Requested new FOIA based on
additional info. They haven't read it. Will file another FOIA appeal.
I specifically asked the OAWP to investigate my loss of
employment and to review my evidence the VA OIG refused to investigate
on failed temperature monitoring systems at the Denver VA facility. I
was the Manager since June 28, 2012. The only contact I ever received
was from Mr. Brandon Coleman. Mr. Coleman informed me that Mr. Peter
O'Rourke had received all of my information and that they (OAWP) would
soon be contacting me. OAWP never requested any of my evidence. I even
CC'd Dr. Shulkin, OIG Director Mr. Michael Missal, (private consultant)
and sent letters of concern to the White House. Never once have I ever
received a response. I even attempted to report the ``Double Billing of
Windows Operating Systems'' VA purchases from Dell corporation. Nothing
was done nor was I ever contacted. I can prove this is taking place in
less than 10 minutes. This is literally hundreds of millions of dollars
of waste taking place each and every year. These includes fabrications
that VA Leadership provided to the OIG to cover up the abandonment of
the VA Research facility that resulted in the dismantlement of my
Management Position and our local research activities to the Academic
Affiliate (3 HVAC hearing have been held on this topic). Evidence that
supports a much greater level of corruption that the Denver VA has
successfully been allowed to subvert and cover up. The reason I lost my
job.
Investigate the issue I reported of management cancelling
Veteran orders for radiologic exams, fix the problem and protect me
from reprisal.
1. Give me unredacted audits (disclosures) of everyone
who has accessed &/or queried my C-file, 2. make veterans a watchdog
over the C-file by releasing unredacted audits whenever requested and
immediately when requested, 3. make reporting privacy violations easy
and efficient, 4. make those accountable for violating existing laws
The Salt Lake City Fiduciary regarding elder abuse, I
informed them that the SLC fiduciary hub was not helping (a veteran)
who is being financially abused, and that VA officials gave the abuser
permission to sell his home against his wishes. They said there was
nothing that they could do except send a message to have SLC look into
it.
Investigate misconduct and intervene in retaliation. I
filed two separate complaints in August 2017, and again in April 2018.
Investigate misuse of funds by RO senior officials.
I reached out to three arms of that office. HR and
Brandon Coleman. He was useless. I am so dissatisfied and disappointed.
On August 30, 2017; I submitted per their request an
email with my recommendations to improve OAWP. This email was addressed
to the [email protected]. Please be advised that at the time
this email distribution was sent to everyone associated with the OAWP,
which included every one of the former employees of OAR \6\. After
waiting for Brendan Coleman to get settled in to his new position at
OAWP, I submitted my Disclosure to him in his formal capacity as a OAWP
employee. In summary, I asked them to look into the retaliation against
me, allow me to detailed to another facility, request that OIG or OAWP
look into the perjurious statements & manufactured documents made
against me in order to obstruct any legitimate investigation, request
that any denial of my request that justification be provided by Medical
Center Director or higher, And since I had been detailed with nothing
to do for 6 months pending the outcome of Northern Indiana's fact
finding investigation, that OIG or OAWP conduct an investigation into
criminal misconduct by management officials for wasting VA resources &
taxpayer's monies based on allegations that they couldn't even prove.
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\6\ Office of Accountability Review
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I didn't go to OAWP. I went to EEO and MSPB. I was
retaliated against and terminated by the VA in May '15 for reporting
medication mishandling, sterile protocol breaches in surgery (surgeon
operating while bleeding), failure to chart medications in the patient
EMR, failure to encrypt sensitive patient data for 5 months, gender
harassment & discrimination, and a hostile workplace (to name a few)
all by the same physician/surgeon, which escalated into a smear
campaign to retaliate against me by administrators. I was stalked and
devastated financially. My family has been pushed to the brink. I am
unemployed currently and just certified to work in the field of
addiction medicine and aspire to help mitigate the opioid crisis. Still
paying the price for speaking up.
I have had no relief of whistle blower retaliation. I
asked for them to hold those accountable. They assigned an inhouse
investigator to gather some of my documents. I was not allowed to give
him all the documents proving whistleblower retaliation due to being
arrested \7\. I've been barred from the Cincinnati VAMC and several
surrounding VA medical center's. I'm unable to get medical care due to
the whistleblower retaliation. My only concern is that I have an 11-
month-old child and one on the way.
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\7\ I have contacted DepSec Tom Bowman about this case and Brendan
Coleman. VA has charged him with ``harassment and menacing behavior''
after he filed EEOC complaint. He is an OIF disabled Marine Veteran. I
contacted the Veterans Treatment Court, who are supporting him. VA
continues to work on a reassignment for him while still holding charges
against him. I've met with Rep. Brad Wenstrup staff on this case.
---------------------------------------------------------------------------
I asked for assistance from the retaliation to stop and
help to reassign for an investigation.
Did they help you?
NO!
The results of all my work with them was nothing. No one
got back to me. No one.
No Response
I had a private conversation with Peter (O'Rourke) when
he first arrived. Offered help with PR and strategic positioning to
help develop the office further. Offered to assist on detail. Never
heard back. We had a joint call with several WBs and Peter. He said
they'd follow up. Never heard back.
I have contacted the OAWP on repeated occasions since
August 4, 2017. Never, not once have I received any correspondence.
These including overlapping Whistleblower evidence that the VA OIG has
since substantiated to be true. Substantiated evidence that I have
further attempted to report to the OAWP.
Not one bit. They have done nothing whatsoever.
NO
Never heard back on the privacy issue requests
They said they could not in fiduciary cases, even when
there is suspected foul play of government officials at the hub.
No, they have taken no perceivable action.
No, closed my case with no finding when I gave them ample
evidence to have a huge finding related to $1.5 million in payoffs even
though we already had a member of the region counsel confirm our
allegations. It's a fake office and then they leaked my name to Diana
Rubens who then sent harassing emails. You go to them in confidence and
they send what you reported to the person you reported.
There is zero support or outreach to whistleblowers. If
you go to them then you are targeted and attacked. I feel the office is
not about accountability but firing/targeting the dissidents/
whistleblowers. Taxpayers are funding ``monster-like'' tactics with
that office.
On September 4, 2017; I was contacted by Brendan Coleman
asking me to participate in a OAWP listening session conference call on
September 13, 2017. The purpose was twofold, first for Mr. Peter
O'Rourke to hear from me, along with others, what was going on in our
individual retaliation cases. This call also included (Several Others).
The second, was to give my chain of command notice that I had the
interest of the OAWP and provide me a breather from the retaliation. On
December 11, 2017; the Northern Indiana VA issued me a proposed removal
along with over 1,500 pages of documents that were never seen before &
I was given seven days to respond. My attorneys weren't provided copies
of this voluminous `justification' until almost a week later. I was
advised on or about December 14, 2017 by Brendan Coleman that the OAWP
was going to put a `delay' on any action against me. The purpose of
calling it a `delay' rather than a hold, is because of legal
ramifications & to avoid publicity. Which honestly didn't make any
sense. On January 22, 2018; I was offered a 120-day detail to the Puget
Sound VA Health Care System to be the Chief of Facilities Management. I
contacted the OAWP after the management at Northern Indiana VA refused
to release me for the detail. I was contacted by Brendan Coleman and
Peter O'Rourke to provide information regarding the detail. In summary,
in the most general sense ``yes'' they did help me.
I did receive an email from the OAWP. However,
(Consultant) advised me not to respond and forewarned me that they are
an unethical entity. Since I trust his legal advisement, I did not
respond. I did not reach out to them first, so I do not know how they
got information on my case nor do I know the status on their end.
They said they called my HR and told them to reassign me.
(That did not happen.)
How did they help you?
Not applicable.
They did not. They have done nothing.
They have not.
N/A
In September 2017, they tried to put my chain of command
on notice that OAWP was watching. I'm sure it had the effect we hoped.
In December 2017, they did `delay' any adverse personnel actions
against me. And in January 2018, I believe Peter O'Rourke tried to get
the Northern Indiana VA to release me to go on the detail to Puget
Sound.
The retaliation never stopped and only continued to get
worse and my case worker from OAWP said she was a HR employee being
assigned to help with case part time. How can the HR's properly help
when they are the ones helping to retaliate?
How long did it take for them to respond to you? (If at all)
Months
They have not, ever responded.
I was contacted after my initial disclosure, after
supplying the OAWP with over 1600 pages of documentation of both
canceled orders and retaliation paperwork. I NEVER heard from them
again.
I received an email after contacting them several times
that was cryptic. I contacted Brandon Coleman who emailed me a form
that was supposed to have been given to me several months prior. No
response after I submitted the whistleblower form.
I received only initial acknowledgements that they
received the information.
Because I had a relationship with Brendan Coleman before
he started at the OAWP, they were responsive in pumping the breaks on
the proposed termination that took Northern Indiana almost a year of me
doing nothing before handing me a giant box of manufactured nonsense.
They never called me, and when I contact them, they just
said 45 more days...and then I resigned for constructive discharge and
I was assigned new case manager, but they didn't inform me, and the new
CM said she couldn't find any data I sent in.
Did they close your case without sharing information with you?
Yes. I routinely contacted OAWP one time per month for an
update. It required a lot of time and effort to get them to respond.
And even after they did respond, OAWP refused to tell me what, if
anything, they had done for me. Since my employment was eventually
terminated, obviously, OAWP did not help me at all.
I never heard from any individual at the OAWP regarding
any aspect of my reporting to the OAWP (let alone opening a case). I
have copies of every correspondence with OAWP. No reply, no response.
Yes, I have made several attempts to gather more
information, but was told due to privacy issues they are unable to give
me any information.
I have no idea what they did.
Unknown, although their template email response indicates
they will not share information.
They did close my case without informing me. I have no I
idea what the OAWP is doing. The only information that I received that
the VA was still investigating my claims was while listening to the NPR
story about me on April 27, 2018.
I have no idea what they have or have not done, they
don't let me know and Brandon Coleman stopped answering me.
What would you suggest be done to improve the OAWP?
Immediately close the office. Please note, I did not make
that comment to try and be funny. Whistleblowers are under the
impression that by contacting OAWP will help stop the retaliation. I'm
unsure if there is one whistleblower who has submitted a claim to that
office who has actually had the reprisal stopped. In fact, the
contrary. It appears as if VA prefers whistleblowers to report to OAWP
as opposed to OSC. Furthermore, the VA is utilizing the office to
collect information about whistleblowers, so the agency can use the
shared information against the whistleblower. Whistleblowers would be
better off if OAWP did not exist because it gives whistleblowers a
false sense of security where none exists. And obviously, it wastes
taxpayers' money because OAWP is ineffective.
Feedback is...needs major work.
Waste of resources in my opinion and likely more of the
David Shulkin show. He did nothing except create shiny new things to
brag about to the media.
Respond to the Whistleblowers. Not ``Stone walling'' as
VA does best.
As far as I'm concerned, the OAWP is yet another
``Whitewash machine'' that the VA has successfully constructed as a
``False Accounting'' system the does not exist. I hope to talk
Congressman Jeff Miller soon as he may become our new VA Secretary. He
will get the OAWP working as intended.
My view of the process and the concept does of course
come with an understanding that they are a startup organization that
may be struggling to find identity. They cannot organizationally depend
on the Office of General Counsel (OGC) for legal. OGC is tasked with
protecting the agency and defending it in litigation, therefore it is a
conflict. They cannot be transparent with that relationship. I have
looked at job postings for OAWP. They hire for job series 0201, Human
Resource Specialist. That job series shouldn't be the occupational
series for the Investigators in OAWP. Any qualified candidates under
the 0201 series will qualify based on HR experience, not necessarily
investigative technique skills.
Find a different group to manage them. An HONEST group.
Improve communication and actually do something.
The office needs to purge the corrupt investigators that
came from the OAR. I am one of numerous VA employees that have gotten
copies of their reports only after the court forced the issue and found
that the OAWP had intentionally ignored exculpatory evidence to provide
findings that were favorable to the VA as cover in case news reporters
started asking questions.
Don't use VA employees for case workers and just shut
down the VA all together. Give Whistle Blowers other Federal Jobs to be
able to have our retirement. I'm a 10 year AF veteran and lost my 20
year retirement by 5 years. No one will hire me in social work or any
other field.
Did another entity act when the OAWP did not?
OSC completed one investigation and ruled in my favor.
OIG has been trying to help. And has responded timely to
FOIA. GAP is reviewing my case for my defense.
OSC is still investigating this issue.
In all fairness, no one has helped me. VA OIG did not
return communication and OSC wants me to develop my case, so we meet a
threshold for them to ask for an investigation.
VA OIG said they cannot help in fiduciary cases and
referred me to OSC. I am acting as a family member to a veteran in this
instance not as an employee. The Justice Department refers people to VA
OIG on elder abuse fiduciary cases, but VA OIG refers to OSC or back to
the hub.
I am engaged with OSC for the issues I want to see
corrected that affect care.
I honestly believe that OIG Special Agent did try to help
me. Unfortunately, because of how the rules are, only OSC can help me.
After intense lobby by Tom Devine at GAP, the OSC reopened the
investigation into my case. However, the Northern Indiana VA and the
OGC Midwest Region keep delaying providing supporting documentation in
order to move the investigation along. I do want to say that the OGC is
as corrupt as the rest of the VA. The misconduct and obstruction by VA
attorneys is criminal.
I went all the way up the chain and OIG report, and not
one agency or person was able to help at all. Not even EEO at the VISN
level and higher. I continue to be retaliated against.
Thank you for considering this information.
[all]