The Veterans Health Administration is looking to raise  workforce productivity, after a record year of hiring, and increase the number of health care appointments available to patients.

“We now have the end-strength to be able to increase productivity across the system, and provide more care out of the direct care system,” VA Under Secretary for Health Shereef Elnahal told reporters in a briefing on Monday.

VHA hired more than 61,000 employees last year, far exceeding some of its workforce goals for fiscal 2023.

“Because of that, the goal this year is not going to be to increase total employees on board except for very critical staffing areas like mental health,” Elnahal said. “But pretty much for every other category of staff that we have, we think we have what we need to meet that demand. It’s on us to increase productivity commensurate with our staffing level, to make sure that we are able to provide accessible care.”

But to keep up with “unprecedented growth” in demand for VA health care under the PACT Act,  VHA is running “access sprints” to increase appointment availability across three areas of care — cardiology, mental health and gastroenterology.

Elnahal said VHA is expanding access to appointments in these areas by offering night and weekend clinics, and by increasing the number of veterans that each VA provider sees for appointments.

“Across the board, we’ve seen increases in the number of appointments delivered,” Elnahal said.

Elnahal said VHA saw “pretty consistent increases week-to-week” for mental health care appointments in December 2023 and January 2024.

However, wait times for mental health care appointments, depending on the location, have either held steady at about 21-22 days, or increased.

“What that means is at the same rate that we’ve been able to deliver more appointments is the same rate that even more demand for care and mental health has also increased,” Elnahal said.

VHA, he added, is looking at ways to boost employee productivity, while also avoiding burnout among its ranks.

“The reason that we’re calling them sprints is because we’re not sure what within that discrete effort will be sustainable in the future,” he said. “Some things won’t be sustainable, because we’re basically just putting more appointments into the same clinics. And in some cases, we’ve been able to increase staff. In some cases, we’ve had level staff. And so, our question becomes what’s sustainable for the end, frontline worker who has to bear that increased load, and we’re still figuring that out.”

VHA saw record hiring of mental health clinicians in FY 2023.

The agency hired more than 4,200 mental health clinicians from outside the VA health care system. Those include more than 670 psychologists, more than 350 psychiatrists and more than 1,400 mental health social workers.

“Overall, the American health care system does not have enough mental health clinicians, which is why we’re trying to do a lot of work in building that pipeline,” Elnahal said.

VHA under the PACT Act is specifically prioritizing mental health staffing in rural areas.

“We know that in particular, mental health hiring has to be a priority,” Elnahal said. “In an urban area, you often have many options for that community care backstop. In rural areas, sometimes we’re the only mental health outfit that’s available.”

The VA is seeing higher-than-expected enrollments in health care under the PACT Act.

Under the PACT Act, more than 100,000 new veterans have enrolled in VA health care since the legislation was signed in August 2022.

That’s out of the more than 500,000 total health care enrollments during that same period.

“In general, being present in the community and letting veterans know across the country that VA is an option for them, I think, has led to an overall increase in enrollments over and above what we would have expected,” Elnahal said.

Meanwhile, Elnahal said VHA is seeing “asymmetric growth” in the places where veterans are enrolling in VA health care across the country.

VHA is seeing record numbers of new enrollees in the Southeastern U.S. — including in parts of North Carolina, South Carolina, Georgia and most of Florida.

The agency is also seeing significant enrollment in Chicago, Texas, New Mexico, Arizona, San Diego and Southern California more broadly.

Elnahal said VHA is trying to increase capacity by standing up new VA clinics and hiring more staff.

“These are the areas where we are seeing the most veteran growth and as a result, it’s where we’ve concentrated our hiring efforts and determined where we’ve needed more [full-time equivalents],” Elnahal said.

Under an accelerated eligibility timeline, VHA expects that nearly 21,000 additional veterans will enroll in VA health care under the PACT Act in fiscal 2024.

“We’re not talking about huge increases in veteran enrollment, because there are already so many doors that veterans can already enter. But that’s part of the reason why we decided to accelerate that eligibility, because we think we can handle that capacity,” Elnahal said.

Over the next five years, VHA expects nearly 55,000 new veterans will enroll in VA medical care under the PACT Act.

Over the next 10 years, it expects more than 84,500 veterans will enroll in VA health care under the PACT Act.

“The enrollment numbers go up, because we know that veterans who were engaged in these theatres of deployment, these theatres of war, will likely have an escalating need for health care as they age,” Elnahal said.

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