Healthy Hiring: Enabling VA to Recruit and Retain Quality Providers

Statement Of

Carlos Fuentes, Director
National Legislative Service
Veterans of Foreign Wars of the United States

For the Record

Subcomittee on Health
Comittee on Veterans' Affairs
United States House of Representatives

With Respect To

“Healthy Hiring: Enabling VA to Recruit and Retain Quality Providers

WASHINGTON, D.C.                                

Chairman Wenstrup, Ranking Member Brownley and members of the Subcommittee, on behalf of the men and women of the Veterans of Foreign Wars of the United States (VFW) and its Auxiliary, I want to thank you for the opportunity to present the VFW’s views on ways the Department of Veterans Affairs (VA) can improve recruitment and retention of high quality health care professionals. 

When the VFW asked veterans how they would improve the VA health care system in our latest survey of VA health care entitled “Our Care 2017,” the most common suggestion was to hire more health care staff to reduce wait times.  The VFW thanks this subcommittee for recognizing that VA’s ability to hire and retain high quality employees is equally as important as its ability to fire or demote wrongdoers.  Considering that more than 30 percent of VA employees will be eligible for retirement by 2020, it is important that Congress focuses on ways to improve VA’s hiring and retention authorities to ensure veterans have timely access to the care they have earned. 

If VA is not able to quickly hire high quality employees, it will lack the staff needed to accomplish its mission.  In its report, “Hurry Up and Wait,” the VFW highlighted deficiencies in VA Human Resources practices.  The VFW recommended Congress ease federal hiring protocols for VA health care professionals to ensure VA can compete with private industry to hire and retain the best health care providers in a timely manner. 

In their review of VA’s scheduling system and software development as required by the Veterans Access, Choice and Accountability Act of 2014 (VACAA), the Northern Virginia Technology Council (NVTC) reinforced the VFW’s concerns that VA’s hiring process moves too slowly.  NVTC suggested that for VA to be successful, it must aggressively redesign its human resources processes by prioritizing efforts to recruit, train, and retain clerical and support staff.  

That is why the VFW is glad the House of Representatives unanimously passed H.R. 1367, which would improve the authority of the Secretary of Veterans Affairs to hire and retain physicians and other employees.  This important bill would make many needed improvements to the way VA hires and retains high quality employees. 

The VFW would like to thank this subcommittee for incorporating a suggestion from one of this year’s VFW-Student Veterans of America (SVA) fellows into a proposed Executive Management Fellowship Program.  In his proposal, “Connecting America’s Best to Serve America’s Best,” Karthik A. Venkatraj highlighted how a private-public partnership program such as the Executive Management Fellowship –– where VA leaders are detailed to a private sector company and vice versa –– can infuse private sector expertise and disciplines into VA governance and management.  The proposed fellowship would also grant private, non-profit and academic institutions the ability to immerse its leadership in the highest levels of our nation’s public policy to better understand how the public and private sector can learn from each other and work together to improve the lives of America’s veterans. 

The VFW also lauds this subcommittee for taking steps towards improving veterans preference to ensure veterans who served in the Guard and Reserve are afforded the same hiring preferences as their active duty counterparts.  Currently, veterans who served after September 11, 2001, are required to have served at least 180 consecutive days on active duty.  Due to our all-volunteer military and the nature of the wars in Iraq and Afghanistan, the Guard and Reserve have been utilized much more than they have during past conflicts.  However, not all Guard and Reserve service members receive active duty orders for more than 180 days.  Thus, many veterans that deployed into harm’s way in support of the wars in Iraq and Afghanistan are not eligible for veterans hiring preferences.  Changing the eligibility for veterans preference from “180 consecutive days” to “180 cumulative days,” ensures Guardsmen and Reservists are afforded the same opportunity to obtain meaningful civilian employment after military service as their active duty brothers and sisters.

H.R. 1367 also included other ideas the VFW has suggested and supported in the past, such as expedited hiring authority for students enrolled in a VA residency or internship program and recent graduates who are being poached by private sector health care systems because VA’s hiring process is to too long and cumbersome.  It also includes a requirement for VA to conduct and use exit surveys to determine why its medical professionals are leaving.  Doing so would ensure VA is able to address retention issues, which is one of the biggest reasons behind VA staff shortages.  While H.R. 1367 included a number of important provisions to improve VA’s hiring and retention authorities, there are more steps Congress and VA can take. 

VA must conduct periodic demand and capacity analyses in each health care market to properly size its footprint in each community and leverage the capabilities of community care partners. Doing so would enable VA to adjust to changes in the veteran population and develop staffing models based on actual medical need and function level.  The VFW applauds Secretary of Veterans Affairs David J. Shulkin for announcing in a recent House Committee on Veterans’ Affairs hearing that he would ask his staff to conduct demand and capacity analyses.  The VFW urges Congress to ensure Secretary Shulkin has the authority and resources to do so. 
Another program that needs congressional attention and proper resources is the VA Health Professionals Education Assistant Program (HPEAP).  VA operates a number of programs as part of HPEAP to incentivize health care professionals to join VA.  The most popular incentive is the Debt Reduction Program which enables VA to provide certain employees up to $120,000 over five years to repay student debt.  This program serves as an important recruitment and retention tool and has seen a major increase in usage mainly due to increased funding from VACAA.  Thanks to VACAA, VA was able to enroll 696 new participants in this program in 2015 –– a 250 percent increase in new awards compared to 2013. 

However, the infusion of resources from VACAA are set to be exhausted soon and VA will have to rely on its annual appropriations to fund this important program.  Before VACAA, medical facilities were not given the resources needed to properly use this program.  Facilities were only given enough resources to reimburse two or three employees the max amount or provide a small reimbursement to all the medical center’s hard to recruit and retain occupations.  Lack of proper funding would erode this program and diminish its impact on VA’s ability to recruit and retain high quality health care providers.  Congress must ensure the VA Debt Reduction Program continues to be properly funded to ensure it remains a powerful recruitment and retention tool for VA.

A recent VA Office of Inspector General (OIG) report entitled “Audit of Recruitment, Relocation, and Retention Incentives” found that VA –– particularly the Veterans Health Administration (VHA) ––  has misused certain incentives or failed to follow proper steps before using such incentives.  H.R. 1367 would require VA to establish a Human Resources Academy to train Veterans Health Administration human resources professionals on how to best recruit and retain employees.  As indicated by this VAOIG report, such training must also include how to properly use recruitment, relocation and retention incentives.  

Another onboarding process that has needed attention for far too long is VA’s licensing and credentialing process, which is excessively long and should be modified to make certain VA is able hire high quality doctors on a timely basis.  The VFW has heard from countless would-be VA doctors who elected to seek employment elsewhere because the onboarding process for VA was too time consuming and strenuous.  As mentioned above, VFW’s surveys indicate that veterans want more doctors at their VA medical facilities.  Requiring doctors who want to serve veterans to jump through hoops deters them from doing so.  Congress must require VA to streamline its licensing and credentialing process.

Congress must also ensure VA has the authority to quickly hire frontline staff.  Due to the lack of support staff, many VA providers are required to spend time on administrative tasks instead of treating patients or spending more time with their patients.  VA is in the process of streamlining its hiring process for medical scheduling assistants (MSAs) and has set the goal of hiring MSAs within 30 days, which is half the time it takes, on average, to hire support staff today.  The VFW commends VA for its efforts, but it is time Congress expands direct hire authorities to all Veterans Health Administration staff, not just doctors and nurses.  
During our site visits of VA medical facilities, the VFW has noticed one constant struggle facilities face –– hiring and retaining entry level clerks who help with answering phones, greeting patients, scheduling appointments, and other administrative tasks.  During our visits, we often hear providers and facility leadership say that the lack of administrative support staff limits their ability to deliver health care to veterans, particularly when operating in a patient aligned care team (PACT) where team members are often left to backfill the duties of vacant positions. This contributes to attrition of existing employees who are overworked and underpaid because of vacancies that take too long to fill.  Non-clinical VA employees, including frontline staff, are typically hired under title 5, United States Code (U.S.C.) authorities.  Unfortunately, such authorities preclude VA from expeditiously hiring qualified candidates to fill vacancies.

Under section 7802 of title 38, U.S.C., the VA Canteen Service is exempted from title 5, U.S.C., competitive service, general schedule pay rates and classification requirements to ensure it is able to provide veterans reasonably priced merchandise and services essential to their comfort and well-being.  Similar to VA medical facilities, the Canteen Service relies on entry level employees to operate and maintain its services.  However, the VA Canteen Service would not be able to operate its retail stores, cafes, and quality of life programs in VA medical facilities around the country without exemptions from title 5, U.S.C., competitive service requirements. 

The VA Canteen Service has the authority to bypass the USA Jobs process and hire employees through referral and traditional job search engines.  When it finds qualified candidates, the VA Canteen Service hires employees as contractors while they undergo the 30-60 day process to become a federal employee.  This process provides the VA Canteen Service the latitude it needs to ensure its retail stores remain fully staffed despite high turnover rates.  The VFW urges Congress to provide VHA similar authorities to quickly fill high turnover vacancies at VA medical facilities.

VA’s ability to effectively build, lease and maintain its capital infrastructure has a direct impact on delivery of care.  Regardless if VA is able to quickly or efficiently hire health care professionals, VA may still lack the ability to keep pace with increased demand for care due to outdated exams rooms or insufficient space.  That is why the VFW strongly urges this subcommittee to consider and pass legislation to reform VA’s capital leasing process. 

Current congressional rules require the Veterans' Affairs Committees to offset the full ten-year cost of leases in the first year.  This makes authorizing leases nearly impossible.  There are currently 24 major medical leases from fiscal years 2016 and 2017 that Congress has yet to authorize.  Delays in authorization of these leases have a direct impact on VA’s ability to provide timely care to veterans.  Congress must authorize pending leases and reform the authorization process.  

The VFW believes VA must also improve its process for major construction projects.  To ensure VA is able to complete major construction projects on time and on budget, the VFW believes VA must move its construction process entirely to an Integrated Design Bid Build (IDBB) model.  This will allow VA to shorten the overall length of major construction projects by overlapping the three phases of the project.  Additionally, using the IDBB process would allow state of the art medical technology to be in use during its prime years, meaning VA would get more use out of expensive medical equipment.

The largest added benefit of the IDBB process is it saves time over the entire length of the project.  Currently, the three phases of building –– the design, the bidding, and the building –– happen sequentially.  Integrating the three phases allows for some overlap of the different phases and shortens the entire length of the project, sometimes by years.  

The other added benefit of the IDBB is bringing the contractors on board during the design phase of the project, which allows the builders and the designers to interact as a team and helps prevent future conflicts during the building phase.  Teamwork in the design phase alleviates problems up front, which saves time and ultimately money.

In closing, I would like to thank the Subcommittee for advancing accountability and workforce reform legislation, which would have a significant impact on VA’s ability to deliver the timely, high quality, and veteran-centric care our nation’s veterans have earned.  However, those are only the first steps towards building a quality VA workforce.  We look forward to working with this subcommittee to identify and advance meaningful reforms to ensure VA is able to recruit and retain top-performing health care providers. 


Information Required by Rule XI2(g)(4) of the House of Representatives

Pursuant to Rule XI2(g)(4) of the House of Representatives, the VFW has not received any federal grants in Fiscal Year 2017, nor has it received any federal grants in the two previous Fiscal Years. 

The VFW has not received payments or contracts from any foreign governments in the current year or preceding two calendar years.