Each year the VA's Office of Inspector General looks at whether the agency has what are known as severe occupational staffing shortages. It's had mixed results ...
Each year the Department of Veterans Affairs Office of Inspector General looks at VA staffing. In particular, whether crucial medical staff job slots are filled, or if VA has what are known as severe occupational staffing shortages. It’s had mixed results recently. For what it found in the latest report, the Deputy Assistant IG for Healthcare Inspections Julie Kroviak talked with the Federal Drive with Tom Temin.
Tom Temin: You looked across the VA facilities, it’s fair to say the study is done place by place and adds up to a cross. So the results are mixed across VA facilities, correct?
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Julie Kroviak: Yeah, we try to tell a story individual and specific to each facility but giving a national glimpse to what’s going on with staffing in VHA.
Tom Temin: And what is the source of the data for evaluating staffing?
Julie Kroviak: So we actually survey, we send surveys out to each individual facility. We have a contact that we distribute a survey to, and they fill it out based on their discussions with leadership and the needs that they have defined.
Tom Temin: And just as an aside question, before we get into the results, is there any way that personnel data systems could be harnessed to sort of generate these reports automatically?
Julie Kroviak: I would think it’d be more appropriate to have some discussions to understand what current trends are. So yes, they have their own databases that suggest where they’re “hurting and in need,” but it does require some discussion at the leadership level to rank.
Tom Temin: Alright, so the genesis of this entire series of investigations was I think, in 2014. And then later in 2017, VA was found to have tens of thousands of openings, I think, and having trouble filling them. This goes back several secretaries. What did you find this year? Give us the macro numbers on unfilled medical positions, and then maybe we’ll talk about some of the locations.
Julie Kroviak: Yeah, just to be clear, we’re talking about different things than vacancies. So what a facility might define as a critical staffing shortage might be quite different than what they have listed as a vacancy. So the criteria to define something as a severe shortage is in the Code of Federal Regulations. And so the facility uses that criteria when describing where their shortages are. So just to put at home, you could have 100 vacancies in pharmacy and still not ranked that as a critical shortage.
Tom Temin: Right, but shortages are the result of some level of vacancies, though, correct?
Julie Kroviak: Potentially, that goes to our staffing model issue. But you’re right, it wouldn’t shock us to see where you’ve got 50 vacancies is also listed as a shortage. And you’ll find across the board for the occupational shortages, you’re looking at doctors and nurses on the clinical side for sure, which is no shock. We’ve seen that. The disappointment this year is that the trend of going down on shortages reversed and this year, we’re reporting that they have increased shortages across the board for all facilities that we surveyed.
Tom Temin: And shortage means severe shortage as defined in the regulations?
Julie Kroviak: As defined by the criteria set in the Code of Federal Regulations.
Tom Temin: And what is the definition?
Julie Kroviak: So they have a whole bunch of criteria, but what they really rank is the nationwide recognized shortage specific to a geographical area, specific skills and the availability of qualified candidates.
Tom Temin: Right. So therefore, the vacancies could be explainable by a shortage of candidates out there in the marketplace. It kind of looks at the holistic picture, then, not simply the open slots in the job roster.
Julie Kroviak: Correct.
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Tom Temin: All right. What did you find?
Julie Kroviak: The interesting thing about the 2017 law, it gave us some authority to look into nonclinical positions as well. And what we’re seeing for nonclinical is an impressive shortage of janitorial staff. And clearly, that’s a huge issue for facilities providing medical care, and I suspect COVID weighed into that. There are increasing demands on the sets of workers. They’re lower on the pay scale. So you see a lot of turnover and unfortunately, a lot of competition amongst communities where there’s a higher paying Community Hospital potentially to grab those from the department.
Tom Temin: Janitorial then, you could classify as perhaps lower skilled, but really critical to making sure that a facility operates correctly.
Julie Kroviak: Oh, absolutely. And I really am more worried about the lower pay. In terms of scale, every time a facility takes on any type of worker they invest in training and janitorial, especially in a hospital setting, they require a significant amount of training and retraining to make sure things are up to code and ready to serve patients.
Tom Temin: That’s interesting. So the lack of janitorial staff, do you look into the causes of it, or what do the facilities say is the issue there?
Julie Kroviak: Yeah, the facilities will repeatedly describe that as competition and high turnover, and the high turnover is like they relate it to that competition factor.
Tom Temin: Right competition for janitorial jobs in other domains than medicine might be less demanding or the same –
Julie Kroviak: Potentially seen as safer during a pandemic.
Tom Temin: Or they could go to a private health care facility and get paid better for the same work and skill.
Julie Kroviak: Exactly, exactly. And that’s a common battle VA’s been fighting.
Tom Temin: Yeah, I was talking with someone the other night and they said if trash pickup stopped in Washington, D.C. or any of the big suburbs in three days, we would look like a third-world country with the trash piled up. That’s kind of what’s going on.
Julie Kroviak: Completely, absolutely. I mean, when you have patients and their families thinking, oh the hospitals, the doctors and the nurses, yeah except when you walk in and it’s filthy dirty, and you don’t want to get your care there for very good reason.
Tom Temin: We’re speaking with Julie Kroviak, deputy assistant inspector general for Healthcare Inspections at the Veterans Affairs Department. And we’ll return to that but what about the Title 38 doctors, nurses, practitioners severe shortages?
Julie Kroviak: Yeah, so again, it hits psychology and psychiatry, pretty hard. Rcognized shortages, again, unfortunately, not unique to VHA. But we were not surprised at all to see those rank pretty high or very high on the list of clinical shortages. And VA is working hard. They have retention bonuses, they’re doing everything they can to effectively recruit, but they are again facing that same battlefield that the rest of the nation’s health care system is facing.
Tom Temin: And you do show macro figures of the numbers of severe shortages across the country. What is the number this year versus the last couple of years?
Julie Kroviak: We saw a jump in terms of shortages across all occupational staffing shortages up to 2,600. And last year we saw 2,100, roughly. So that was a bump across all the staff. And the number of occupational series listed this year jumped to 285. And that was 256 last year. And again, those had been tracking down for the past five years. So this bump up is an unpleasant but not terribly surprising in light of what’s going on in health care.
Tom Temin: And all that psychology and psychiatry shortage, same issue, competition and pay?
Julie Kroviak: Absolutely. And you know, they have a harder time recruiting in the rural areas, they have an advantage with their telehealth systems in place. But they are still struggling to meet the demands for especially their high risk veterans, which unfortunately happen to kind of hang out in these rural areas that are most definitely in need.
Tom Temin: Then what were your recommendations for VA?
Julie Kroviak: We made no recommendations, actually. This is meant to be a data-driven report to really inform stakeholders, but also the department of what their local leaders are describing as their biggest needs. But based on the situation and in the climate and health care. Now, it’s really meant to be more informative. We obviously, encourage their use of the tools to recruit and retain but recognize there are just a lot of barriers to hiring and retaining qualified staff.
Tom Temin: When the question comes up of personnel in other domains, say cybersecurity or this agency or that agency, OPM often comes back and says, well, we’ve got 125 possible job flexibilities within the federal hiring system., the Merit Systems that you can use, and nobody uses them. Is that true for VHA? Do they have flexibilities and authorities, perhaps they’re not exercising enough?
Julie Kroviak: Well, they are exercising direct hire, which is critical for them to use especially, and they’ve had that flexibility for the clinical staff. But now in that we can actually recommend using those tools for nonclinical staff to support hospital functions. That’s a pretty powerful tool to bypass a lot of the burdens of hiring in the federal government.
Tom Temin: But I imagine even though there’s no recommendations, this report must get the attention of the highest levels of VA leadership, because lord knows they’ve got a lot of flies buzzing around, they’ve got to swat out but you can’t get customer experience, you can’t get the care levels better without the people to do it.
Julie Kroviak: Absolutely. They use this as a very important tool in making many of their decisions as we use it as a tool to inform our stakeholders. If we have a hotline about a specific facility, and the issue relates to ER nurse staffing. The first thing I’m going to do is go to this report database and understand well, what did that facility say about nurses in the ER in terms of their needs? And is it matching with the allegations we’re getting? Can we draw connections to support better and more meaningful recommendations?
Tom Temin: Is there any single major facility that looks really good in terms of how it compares to the average here?
Julie Kroviak: Unfortunately, no, I mean, we’re seeing the same needs to find especially on that clinical setting where we report on psychology, psychiatry, and nurses, that they’re struggling, and it’s an unfortunate but again, not surprising occurrence.
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