VA Is Hiring at a Record Rate. Employees Say It's Still Not Enough.

Department is hiring doctors, nurses and aides at record rates while retaining more employees, contributing the largest net gain to its health care workforce in decades. 

The Veterans Health Administration has added nearly 10,000 employees to its rolls in the first five months of fiscal 2023, marking a 2.5% growth. All told it has brought on nearly 23,000 employees in the fiscal year, an increase of 28% compared to the same period in 2022. Its hiring levels in December and January set all-time records, VA’s Undersecretary for Health Shereef Elnahal told reporters on Monday. 

VHA is 44% of the way toward its goal of hiring 52,000 employees in fiscal 2023, far exceeding its expectation—based on seasonal hiring trends—of only getting to 36% toward its objective by this point in the calendar. The department has set particularly aggressive hiring and retention targets this year as it anticipates a wave of new patients enrolling in the system as part of the PACT Act President Biden signed into law last year that makes millions of veterans exposed to burn pits overseas newly eligible for government care. 

“What we're trying to do is prepare for an influx that we expect to occur over the next several months,” Elnahal said, adding the 42% of the 2.8 million veterans who have so far received screenings that have raised concerns about possible toxic exposure has exceeded expectations. “What that will mean is a significant number of veterans benefiting from the legislation, which is a good thing. It puts the onus on the health care system to make sure the capacity is there, which is why we're focused on hiring.” 

Elnahal said VHA is “very likely” to exceed its hiring goal for the year.

As VA is making unprecedented progress, its employees are still expressing widespread concerns about a lack of resources. In a survey of staff represented by the American Federation of Government Employees conducted last year and released on Tuesday by the Veterans Healthcare Policy Institute, a whopping 96% of VHA respondents said their facilities required more frontline clinical staff. Three-quarters of respondents said their facilities need more administrative and support staff, while 77% said they had actually lost resources (budget, staff, beds, etc.) over the last four years. 

VA currently has 76,000 vacancies across the department, according to its own data, though it has typically attributed the bulk of that total to regular turnover. That is despite VA growing its workforce by 113,000 employees, a 35% growth, over the last decade. The vacancy number has grown by 28% since one year prior, leaving VHPI and AFGE officials to suggest their findings—despite being several months old—are still relevant today.

“I don't think enough is being done,” said Suzanne Gordon, a senior policy analyst with VHPI, the veterans-focused think tank that conducted the survey. “I mean, you can be doing something but not doing enough.”

Gordon and VHPI’s report were particularly critical of efforts undertaken during the Trump administration to centralize human resources activities at the regional level. While the Biden administration has criticized those changes, Gordon said VA has done little to unwind the policy and its contributing to a burdensome and too-slow hiring process. Several VA employees also said that while VA is hiring, it is insufficiently training staff to take on their responsibilities. 

Elnahal said February was the first month of the fiscal year that VHA saw its time-to-hire decrease on a month-to-month basis, noting improvements in getting vacancies posted more quickly and standardizing job descriptions. Currently it can take up to two months to post an opening from the time an employee leaves, but Elnahal said VHA is looking to automate that process where it can. 

Still, Linda Ward-Smith, a VA nurse in Las Vegas and president of her local AFGE chapter, said on Tuesday the slow HR processes are “killing us.” It is taking her facility six-to-nine months to onboard an employee, despite receiving ample applications for each opening. VHPI’s survey found 94% of respondents said they had lost an interested candidate due to delays in the HR hiring process. 

While Congress passed and VA is utilizing an array of recruitment and retention incentives—including higher pay caps for nurses—as part of the PACT Act, Ward-Smith said the department’s pay is still not competitive with the private sector in her area. The Biden administration and lawmakers in both parties are pushing to raise the $400,000 pay cap for VA doctors and to create a more market-based compensation system. More than eight in 10 employees said they had lost interested candidates due to salary ceilings, according to the survey, which went out to 90,000 VA workers and was completed by 2,000 of them. 

VHPI’s report also criticized VA for pushing resources toward the private sector as part of the department’s “community care” program. Vacancies go unfilled, the think tank said, creating delays in care that VA uses to justify sending more veterans to the private sector for care. Nearly 78% of employees said their facilities currently have vacant positions for which no recruitment is taking place. 

While the report also raised concerns about burnout and high turnover, Elnahal suggested the department is making significant improvements on that front as well. In January 2022, he said, VHA’s loss rate was 4% of its workforce. This past January, that was down to 2.1%. Elnahal said can continue to see improvements as it ramps up hiring. 

The higher retention is “a combination of our programming and investment and reducing burnout for our clinicians,” he said. “As we staff up, that is inherently something that benefits folks in terms of a better distribution of workload. And so I hope that that is a phenomenon that accelerates, not recedes.”