Staffing growth at VA is not leading to lower wait times in some areas

The Veterans Affairs Department is still struggling with wait times in some areas despite its record-setting hiring last year, though officials are hopeful that new initiatives will help address those problems. 

The Veterans Health Administration is not expecting to net more employees in fiscal 2024 after it added 61,000 in fiscal 2023, when it grew its workforce by 7% and at its fastest rate in 15 years. VHA so far outpaced its goals, Shereef Elnahal, VA’s undersecretary for health, said on Monday, that the agency does not need to focus on growing its numbers this year. Instead, he said, it will prioritize faster hiring and concentrate staffing efforts on a few key specialties. 

VA will establish “access sprints” in the areas of mental health, cardiology and gastroenterology to provide quick, and temporary, boosts in appointments for patients. Despite the record hiring last year, including more than 4,200 mental health clinicians newly brought into the VA system, the department has seen significant increases in demand driven largely by the PACT Act and the aging veteran population. Wait times for cardiology appointments have ticked down only slightly, while mental health wait times have remained stable and those for gastroenterology have increased. 

“Because we very intentionally have enrolled more veterans into the system, the effect on wait times is likely to be variable,” Elnahal said. 

He added some regions have in particular struggled to keep pace with growing demand, particularly in the Southeast and Texas. The access sprints will involve increasing appointment availability through staffing efforts and opening evening and weekend clinics.

It will also require increasing productivity of the workforce, Elnahal said, a goal VA employees have met with skepticism as they have lamented being under-resourced and overworked. Elnahal said the agency has worked with clinicians to understand their concerns and address what they need to see more patients, which VA has done by hiring more staff such as medical support assistants. 

He acknowledged the approach was not without risks. 

“Burnout is always a challenge and it's always something we have to avoid,” Elnahal said. He added VHA is undergoing an “AI sprint” to take work off the plates of clinical staff, such as through autonomous note-taking. 

Still, he acknowledged many of the steps VA takes as part of its access sprints will “not be sustainable” and wait times are likely to continue fluctuating. 

While Elnahal said he is confident VA can absorb the ongoing increase in demand from veterans, he said the department will continue to lean more heavily on the private sector to take VA referrals. He called the Community Care network, streamlined and augmented through the 2018 MISSION Act, a “backstop” that is “so important” to the department. Community Care referrals have climbed by around 16% in recent years and Elnahal said similar, though possibly slightly lower, growth will continue this year. 

He stressed that despite being in a “much better place” this year from a staffing perspective—and not expecting a net workforce increase—VHA will continue to address parts of the country where demand is outpacing capacity. That is of particular concern in rural areas, but Elnahal said the department’s rural hiring plan—created under a provision of the PACT Act—will help address the issue. 

“We have a 10-point plan to increase our total [full-time equivalents] in those areas and make hiring faster and better,” Elnahal said, adding hiring for rural mental health will be the top priority. Unlike in urban areas, he explained, “In rural areas, sometimes we're the only mental health outfit that's available.”