Long hours, too many administrative duties, broken hiring promises, a hostile workplace, lack of equal bargaining rights, and the ongoing open attacks on unions demoralize Department of Veterans Affairs employees on a daily basis.
For years, the VA’s own policies and practices have undermined recruitment and retention at Veterans Health Administration (VHA) facilities and created unnecessary obstacles for the health care personnel who take care of our nation’s veterans.
As the largest federal employee union that also represents 260,000 workers at the VA, AFGE is in a unique position to help improve the VA and the morale of its dedicated employees who have chosen to care for veterans.
Our union submitted our recommendations to the Senate Committee on Veterans’ Affairs, which held a hearing on recruitment, retention, and building a resilient veterans health care workforce.
Here are 10 things the VA can do right now if they want to build a resilient workforce and better serve veterans:
1. Fill remaining vacancies
The VA has been chronically understaffed for years, and COVID-19 has shed light on the scope of the problem. System-wide, the VA has operated with nearly 50,000 positions languishing unfilled. At every opportunity to address this failing, multiple VA Secretaries of both parties have demurred and insisted that the public look the other way. Yet, as soon as a major public health crisis began to grip our nation, the VA swiftly moved to hire over 10,000 people in the course of a month. It is imperative that VA make the same effort to fill the remaining vacancies across the system with permanent, fulltime professionals. Congress must act and insist that the agency continue to prioritize the filling of these positions so that veterans can receive the best care and services possible at the VA.
2. Speed up the hiring process
Too often VHA loses medical professionals to other more attractive employers either before they come on board or shortly after they come on board (and after the VA has invested significant time and resources to credential and orient them). HR personnel take too long to bring applicants on board and do not keep with their commitments as to start date, compensation, and work duties. If labor and management were working together, the VA could more effectively partner with professional schools to attract new recruits in a timely manner and offer more competitive packages to prospective applicants.
3. Bring new hires on board faster
It is widely acknowledged that VHA’s credentialing process for bringing on new medical professionals is cumbersome and slow. The lack of coordination between HR personnel carrying out the credentialing process, coupled with insufficient training and supervision often cause the process to be chaotic and confusing. A good starting point would be to determine how VHA was able to credential and hire so many new employees during the pandemic and replicate lessons learned.
4. Pay better
Frustrations over pay continue to be a leading cause of high attrition at VHA. Pay policies during the COVID-19 pandemic confirm VHA’s longstanding flawed and unfair pay policies. The Secretary delegated all decisions regarding the provision of additional pay during the pandemic to VISN and medical center directors, including which employees were eligible and the amount of additional pay and duration of the payments. The results were unfair, counterproductive, and demoralizing.
Many facilities provided no additional pay to any of their employees even though they also experienced the additional work and risk of treating a surge of patients impacted by COVID-19. In other facilities, the director provided additional pay to physicians, RNs, and other employees based on position and/or whether they were working in a high-risk unit, while denying additional pay to others also facing increased risks such as licensed practical nurses, nursing assistants, and medical technologists.
5. Hire more support staff
VHA does not have enough support personnel such as clerks, nursing assistants, and orderlies to take care of administrative tasks and other support duties that divert providers from patient care and require them to work many additional hours on a regular basis. We urge Congress to investigate whether VHA has appropriate staffing models throughout its medical facilities, especially in primary care clinics, mental health clinics, emergency departments, and other units that regularly treat large numbers of patients.
6. Hire retirees
At the outset of the pandemic, VA stated that it wished to bring back retired medical professionals. This makes sense since they already have most or all of the training and orientation they need. Sadly, we have heard from a number of retirees that VA dropped the ball and did not follow up when they expressed interest. We encourage the VA to again consider developing a program for employing former VHA medical professionals to meet staffing and health care delivery needs during the current pandemic.
7. Expand telehealth
We believe in the use of telework and telemedicine and believe that the VA’s growing and improving telemedicine capabilities can make the VA an attractive workplace for medical professionals, particularly during the COVID-19 pandemic and beyond.
As the COVID-19 pandemic has proven, treatment for many different types of conditions can be conducted easily via telehealth, particularly for treatment of conditions that do not require physical contact, including mental health. This has improved safety for veterans and providers alike by reducing the risk of transmission of COVID-19 and other easily communicable diseases, particularly among higher risk individuals, and without the added inconvenience and expense of travel and PPE.
8. Require the same standards for all care providers, including non-VA contractors
VA needs to require high standards for both internal and external providers. It is demoralizing and distressing for VA providers to see their patients treated through the Community Care Network and other VHA contract care programs, knowing that many of these non-VA providers lack the competencies and veteran-centric medical experience that they and their VA colleagues have. We call on Congress to force the VA to raise the bar on its contractors to make sure they both have and meet the same requirements and standards that VA providers do.
9. Stop misuse of the Accountability Act
One of the greatest obstacles to building a resilient workforce is the continued existence and misuse of the Department of Veterans Affairs Accountability and Whistleblower Protection Act of 2017. This severe, unprecedented reduction in due process and collective bargaining rights has allowed the VA to launch an attack on all civil service protections that was allegedly aimed at mismanagement. Under this statute, shorter timeframes to respond to proposed removals and to file appeals with the Merit System Protection Board, coupled with lower evidentiary standards to review appeals, have resulted in managers terminating employees without an adequate opportunity to respond to management allegations.
It has also encouraged managers to fire employees with good records without an opportunity to improve, who would have faced lesser discipline in the past or would have had opportunities to improve their performance or conduct. The misuse of the law has caused medical professionals to leave the VA and served as a deterrent to recruiting new staff.
10. Stop expanding direct hiring authorities
Proposals to increase VHA direct hiring authorities are often promoted as a shortcut to build the workforce, but these practices are contradictory to merit system principles that the system was built on and ignores the fact that VHA already has direct hiring authority for the majority of its workforce.
We believe hiring should be done under merit-system principles, with veterans’ preference and public notice to guard against cronyism or a federal workforce comprised of only political appointees. Merit systems prevent the return of the spoils systems, in which hiring decisions are based on political connections, not merits.
The VA is also seeking to use direct hiring authorities to place more employees in a category where they don’t have collective bargaining rights and workplace protections.