The Department of Veterans Affairs operates one of the largest health care systems in the nation, providing care to over 9 million veterans at nearly 1,300 facilities.
The VA’s veteran-specific expertise cannot be replicated outside of the VA. Its model for integrated care sets industry standards and should be a model for all care.
In addition, veterans love their local VA’s, which not only provide them the specific treatment they need but also serve as their community and support system.
This top-notch care the VA provides to our country’s heroes cannot be carried out without the hard-working people of the VA. AFGE National VA Council First Vice President Mary Jean “MJ” Burke testified before a congressional hearing last week regarding working conditions, recruitment and retention of doctors, nurses, and other health care professionals at VA facilities across the country. Burke detailed what’s happening at VA facilities and what needs to be done to make the VA a better place to work.
“I consider my decision to work for VA as one of the best decisions I’ve made professionally,” said Burke. “VA must course correct to be able to continue to provide top-notch care to veterans who prefer to seek their care at the VA.”
1. The VA is struggling to keep current employees
According to the VA’s 2023 first quarter vacancy report, VA turnover has been increasing in recent quarters and is now at nearly 10%, compared with 6.1% governmentwide. Although VA reports a net hiring of 7,364 employees through March, its own data still show over 70,000 vacancies.
A recent survey of AFGE membership showed that 96% of respondents believe their facility needs more frontline staff and 77% said that there are vacant positions for which no recruitment is taking place.
2. Noncompetitive pay is one of the reasons the VA can’t keep doctors
The current pay system for physicians, dentists and podiatrists is composed of market pay, performance pay and longevity pay. When the VA rolled out the three-tiered system pay system, it was intended to make pay more competitive with local markets and to incentivize individual professional performance, while also rewarding retention and experience.
However, since this pay system was enacted nearly two decades ago, there have been widespread inconsistencies with processes for setting market pay and performance pay. Market pay data are no longer required to be publicly reported in the Federal Register, so it is difficult to know how “market pay” is set and allocated.
This has resulted in doctors working at facilities in similar markets receiving radically different market pay. Long-serving, experienced, highly credentialed clinicians sometimes receive lower market pay than new employees in the same facility.
Performance pay distribution has also been inconsistent. In some facilities, performance pay functions as a retention bonus or award. However, providers should expect to receive performance pay if they meet the performance goals as a component of their salary. In other facilities, the metrics used to assess performance don’t align with what is in the physician’s control and therefore can be unattainable. For example, a doctor may not get performance pay because it is tied to the number of appointments kept but that number may be affected by the number of no shows, which is not in the doctor’s control and tends to be high at the VA.
Short-sighted strategies to recruit new employees at the expense of existing employees only exacerbate problems with retention as new doctors increasingly see VA as a good place to train but not to stay. VA must develop policies that will attract physicians over the continuum of a career and across the spectrum of specialties and pay levels; otherwise fixes to one set of problems will only create new ones.
3. Staffing shortages have taken its toll on frontline medical workers who have to shoulder unrealistic workload
If VA frontline workers were motivated solely by income, they would choose the higher paying jobs in the private sector. Because VA by law cannot be a pay leader, the agency has historically appealed to doctors, nurses, and other frontline workers drawn to serve its unique patient population while having a good work-life balance.
But the VA’s overuse of data metrics to try to increase productivity has driven hard-to-recruit personnel into the private sector. The combination of clinician shortages that are driving up pay outside the VA while exacerbating VA employee workloads are making the VA a less attractive place to work.
4. Nurse pay is a mystery
The VA is mandated to perform third-party registered nurse locality pay surveys, which are triggered by factors such as turnover rates, resignations due to dissatisfaction with pay, or other criteria set by the facility director.
But it is mostly a big mystery when or if surveys are being conducted. Directors are required to decide within 30 days after receiving the survey data back whether an increase is warranted. If an increase is warranted, it should be implemented within the pay period of that decision.
But VA’s lack of transparency about the underlying information needed to calculate turnover and vacancy rates makes it hard to determine whether the agency is compliant with its legal obligations.
AFGE has often been denied access to pay data, which undermines our ability to monitor whether surveys are being conducted in a timely and appropriate way.
5. Staffing Shortages lead to unpredictable shifts
Shifts and days off have become less predictable due to staffing shortages. Despite their preference to work with veterans, nurses will leave for the private sector where they can get predictable schedules and better pay.
Nursing supervisors often lack the hands-on experience to understand the experiences and needs of front-line nurses. Nurses fear they will be punished with a bad schedule or have requests for days off denied if they speak up.
In addition, private sector nurses have extensive collective bargaining rights that are absent at the VA, including the right to bargain over pay and patient safety issues.
6. HR Smart is not exactly smart
The VA’s transition to HR Smart and a virtual environment has depersonalized the HR process, leaving unions and employees further marginalized from efforts to recruit and retain frontline workers.
Union representatives, for example, are now forced to go to the USA Jobs website to find out what positions are being recruited. The paper organizational charts which showed which positions have been funded or approved are not easy to locate or are nonexistent. As a result, it is difficult to know what the true VA vacancy rate is.
7. Widespread human resource errors make hiring and retaining employees difficult
Prospective employees accept VA job offers based on salaries, duties and schedules outlined in tentative offer letters. But when they report to the job, they are informed by HR or their manager that their salary, job description or schedule differs from the offer made by VA. These new employees may have given notice at a previous job, declined a competing offer, or relocated based on these erroneous offers.
Both new and current employees have also been hit with debt letters when HR discovers that they were paid more than they should have due to a coding or job offer mistake by HR. The employees are informed that not only will they receive a wage or salary reduction, but that the payroll department will claw back the money already paid to them. This has been an ongoing issue and the VA doesn’t have any plan to prevent coding mistakes from happening again. Besides, employees can’t file a grievance over paycheck errors due to restrictions under Title 38 even if it’s clear that VA is at fault.
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