It’s easy to look at the latest workforce data from the Department of Veterans Affairs and see a series of perhaps confusing narratives.

In its most recent report to Congress on the topic, VA said it had a little more than 49,000 vacancies across the department. The overall size of the VA workforce, however, is larger than it’s ever been.

But for the VA, there’s more nuance behind the 49,000 figure.

Some VA facilities, due to their location, health care market and leadership, have more vacancies than others, and some positions are more difficult to fill in specific locations.

Still, there are some common threads in the data.

According to VA’s Office of Inspector General, 138 of VA’s 140 medical facilities listed frequent vacancies in medical officer occupations in 2018, which included primary care physicians and psychiatrists. At least 108 facilities had nurse shortages that year, the IG noted.

And because the department still lacks a staffing model that tracks its mission needs by facility and then determines the manpower needed to meet that mission, VA can’t be as strategic as it might like to pinpoint its recruitment and retention incentives to specific positions, facilities and locations.

It’s not for lack of trying, Daniel Sitterly, VA’s assistant secretary for human resources and administration, operations, security and preparedness, told the House Veterans Affairs Committee last week.

“Private hospitals use innovative and progressive solutions to address recruitment and retention challenges, and we in the VA must be creative in our approach to human capital,” he said. “We want to be leaders or very fast followers of the best human capital practices in the federal government and in the health care and IT space.”

VA Secretary Robert Wilkie charged Sitterly with creating a departmentwide staffing and manpower model, which has been in the works for the past nine months. Until that staffing model is nearly complete, the department can’t accurately describe just how many vacancies it has, Sitterly said.

VA experimenting with recruitment, retention initiatives

In the meantime, VA has continued to experiment with recruitment and retention incentives to close the department’s skills gaps in increasingly more competitive health care and IT industries. The department spent $50 million on these incentives last year, Sitterly said.

The VA MISSION Act, which the president signed into law last summer, authorized VA to pay a greater portion of student loan debt for its physicians.

Since the cap on student loan repayments went up from $140,000 to 200,000, the department has seen a “significant uptick” in the number of physicians using these incentives, said Jessica Bonjorni, acting assistant deputy undersecretary for health for workforce services at the Veterans Health Administration.

Before the MISSION Act, VA paid, on average, $77,000 toward its physician student loan debt. Today, the average sits much higher at $113,000-to-$115,000, Bonjorni said.

Still, VA sees an opportunity to target its resources more carefully.

“We need to have a more strategic approach to putting together our compensation packages,” Bonjorni said. “Facilities that are in those harder to reach areas understand exactly what kind of package they should put together to offer people to come on board.”

Direct-hire authority, which VA will use for a second consecutive year, has also helped VA hire more IT professionals to its Office of Information and Technology, the department said. A retention bonus for cybersecurity professionals is also paying off.

“We have seen a considerable drop in the turnover [and] the attrition of these information security specialists,” John Oswalt, VA’s deputy chief information officer for IT resource management, said. “For direct-hire authority, we are using that. We are going out with standing open announcements where there is a continual pipeline of folks coming in and applying that we’re able to select from or interview.”

Based on VA OI&T’s available funding, the office is fully staffed, Oswalt told committee members.

VA is also expanding its partnership with the Defense Department to recruit more transitioning servicemembers. It launched a direct marketing campaign to target military IT and health professionals who are leaving active-duty, Bonjorni said.

And according to feedback from VA’s all employee survey, physicians who had their own trainees or residents were likely to stay at the department. Sitterly said VA is reviewing its program to make sure more physicians have opportunities to teach and train residents and other students.

VA Inspector General Michael Missal acknowledged VA has made some progress. The VA OIG has noted “chronic health care professional shortages” since at least 2015.

But Missal, along with the Government Accountability Office, said a constant churn of acting leadership at VA has hindered the department’s attempts to strategically address its workforce challenges.

“Leadership at different facilities is so important,” he said. “That really sets the tone at the facility. People want to work at a place where not only they feel like they’re fulfilling the noble mission at VA but [also] they’re working with people who have the highest integrity.”

Market pay flexibilities, paid family leave

Sitterly said he still sees opportunities where Congress specifically can help resolve VA’s recruitment and retention challenges.

In many cases, VA is plagued by the same human capital challenges that every other agency is facing, GAO said.

But more hiring authorities, Sitterly said, won’t help. VA, along with most other agencies, have roughly 120 hiring authorities already, and the department would like to simplify those options.

“We don’t know those, and so we have to have you all to help us with that,” committee Ranking Member Phil Roe (R-Tenn.) said of the hiring authorities. “I think we could help not only the VA … but we could help a lot of other agencies if we could do just that, but we need your expertise to tell us where the roadblocks are.”

Sitterly suggested Congress could pilot a paid family leave program, modeled after the one that military members currently have, at the VA. The House version of the annual defense authorization bill would give all federal employees up to 12 weeks of paid time off to observe the birth or adoption of a child.

Sitterly also urged Congress to give VA more flexibilities to more quickly set competitive market pay rates for medical centers — or lift the pay caps for those positions altogether.

“Every VA facility is a handmade wooden shoe when it comes to the human capital dynamics in that area,” he said. “For instance in San Francisco, a neurosurgeon can get paid downtown close to a million dollars. We can only pay them up to the aggregate $400,000. I can never compete with that. When you get to more rural areas in America, the average salary is less than it is nationwide, and I can’t compete because when I do the survey of market data, they’re already getting lower pay. So I can’t raise that pay above market rates.”

“We need to address this issue,” Rep. Kathleen Rice (D-N.Y.) said. “I agree with you; the federal government is not going to be able to compensate people at the level that people get in the private sector. If it means us acting to raise those caps, if that’s where the authorization comes from, that’s what we have to do. This is not just a morale issue, although it certainly affects the morale of the employees. Are veterans getting the health care that they deserve? And the answer is in some instances no, and it should never be because we’re not paying people enough money to get them to come.”

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