VA: Competition With Private Sector Is An Obstacle To Hiring More Medical Staff

Feb 1, 2017
Originally published on January 31, 2017 10:45 pm

The Veterans Administration got $2.5 billion to add more doctors, nurses and other staff. An NPR investigation finds that total staff didn't rise much more than it might have without that money. We examine reasons why it's hard to bring new medical personnel into the VA, including a cumbersome hiring process.

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The VA has been under pressure for the last two years to get health care to veterans faster. One possible solution - hire more doctors, nurses and staff. Congress gave the VA $2.5 billion to do that. NPR and member stations have been following that money and found it did not make a dent in wait times.

Today on MORNING EDITION, we heard about how the doctors and nurses who did get hired did not go to the places with the longest wait times. And now we're going to look into whether the VA hired as many staff as it might have for the money.

So joining us now are NPR's Quil Lawrence, who covers veterans, and Patricia Murphy, a reporter at KUOW in Seattle, which is one of the cities where we've been digging into this problem. Hi, to you both.

QUIL LAWRENCE, BYLINE: Hello.

PATRICIA MURPHY, BYLINE: Hello.

SHAPIRO: Quil, begin by reminding us of the problem that the VA was trying to solve here.

LAWRENCE: So back in 2014, there was a big scandal over how long veterans were waiting for care at VA clinics across the country. And underneath a lot of other things, there was just a basic math problem. The number of vets coming to the VA had jumped. The number of doctors and nurses working there hadn't kept up. So Congress passed a law called the Veterans Choice and Accountability Act, and part of it included $2.5 billion for new medical staff.

SHAPIRO: How many staffers would you expect $2.5 billion to hire?

LAWRENCE: You know, we got a lot of different answers to that question. The choice money was used to hire about 12,000 medical staff, but that includes people who aren't doctors and nurses, like schedulers. What we found overall was that staffing just didn't go up that much. And we spoke with the head of Veterans Health, Dr. David Shulkin, last fall about this. And I should add, since we spoke to him, he's been nominated by President Trump to be the next head of the VA. Anyhow, he said that the Choice money was critical but that even with it, they had only gained about 3,000 doctors and nurses over two years.

DAVID SHULKIN: The net gain of clinicians - about 2,200 nurses and 828 physicians.

LAWRENCE: That's the net gain?

SHULKIN: That's the net gain.

LAWRENCE: That's - so that's a shockingly lower number.

SHULKIN: Yes. But not only have we added more doctors and nurses, but we have also seen a dramatic increase in efficiency, which has allowed us to see more patients and to address the wait-time issue.

SHAPIRO: We should add that Dr. Shulkin, who we're hearing from there, is going to go up for confirmation hearing in the Senate this week.

You try to figure out why it's so hard for the VA to add doctors and nurses to its medical staff. And let's bring in reporter Patricia Murphy who worked on the story. Patricia, what did you find when you looked at this question in Seattle?

MURPHY: Well, we found really three reasons that explained why so few medical staff were hired. One of the first is simple supply and demand. So even with $2.5 billion to spend, right now there's a nationwide shortage of qualified doctors and nurses and specialists, especially in rural areas. And I spoke to Benjamin Brunjes at the University of Washington about this.

BENJAMIN BRUNJES: You're competing with private hospitals - right? - private hospitals and nonprofit hospitals. So, as a physician coming out of med school or finishing an internship or residency, the VA in terms of comparative attractiveness maybe lower on the list.

SHAPIRO: And I can imagine that the VA waiting-times scandal that Quil mentioned probably didn't help make the VA more attractive to new doctors.

MURPHY: No, not at all. And since that scandal two years ago, applications at the VA are down 78 percent. And we should note, of course, the VA says it's trying to make salaries more competitive with the private sector.

SHAPIRO: So if competition with the private sector is the first reason the VA might not have gotten more staff after spending $2.5 billion on hiring, what other reasons are there?

MURPHY: Well, the second reason is this government hiring process, which is just really convoluted. About 13 percent of potential hires even drop out of the process. Between us, Quil and I talked to more than half a dozen people with similar stories about how long it takes, about how they're not able to afford to wait around even after they've been hired for the VA to complete the paperwork.

And one of those people was Almetta Pitts. And she interned at the VA while she was pursuing her master's in social work here in Seattle. After graduation, she began this intense application process because she wanted to continue the work she started there helping vets confront their trauma. And this was back in 2010.

ALMETTA PITTS: It took about six months. So I had to think about ways to just put my money together to be able to - really be able to pursue this job.

MURPHY: And after a series of interviews, Pitts was actually notified she'd been hired.

PITTS: I received my acceptance letter, and it did inform me that I would start in that September. And I was like, oh, my gosh. I'm so excited. But I was like, wow, it's, like, May. It takes so long. And you're just like, maybe I could definitely move on, or do something else? Like, what do I do? I work for Starbucks (laughter). And I'm grateful. I'm grateful for Starbucks, as well. But I'm just saying, like, what do I do? I have an apartment. I have student loan that's, you know, needs to take care of (laughter). So it's those things that you're just not prepared for. And so I had to make the decision to move back home.

SHAPIRO: So she actually had to give up her apartment and move in with her mother to take this job that began four months after she was offered it?

MURPHY: Yeah, she did. And after 13 months of working for the VA, she was laid off.

SHAPIRO: Oh, wow.

MURPHY: At the time, human resources offered to help her find another job at a VA out of state. And this was a job that she loved. She really thought she was making a difference, but she decided that she just had to move on.

SHAPIRO: OK. So two big reasons why the $2.5 billion dollars did not add more medical staff - a shortage of doctors and nurses, a cumbersome VA hiring process. Quil, what's another explanation?

LAWRENCE: Well, the last reason doesn't really have so much to do with the hiring challenges of the market. We looked at VA data, and we found the VA basically hired the same number of people with the VA Choice money - the $2.5 billion - as they were expected to without it based on the recent hiring trend. So Congress gave them this money to really plus up the staff. It seems like the VA spent the Choice money on hiring first and then spend its regular hiring budget on other things - other needs.

SHAPIRO: So you're saying when you look at the line, you would've expected to see a spike when they spent this $2.5 billion. There was no spike, which suggests instead of using $2.5 billion dollars plus the regular hiring budget, they only used the $2.5 billion dollars and spent the regular hiring budget on other stuff. Can they do that?

LAWRENCE: Yeah. I ran this by one of the best VA watchers I know, Phil Carter. He's an Iraq vet. He works at the Center for New American Security.

PHIL CARTER: It makes complete sense for a self-interested bureaucracy to hire with that money first. I think VA hired staff with this money with all intention of easing access challenges and improving quality. But I don't see malice here so much as the basic inefficacy of American bureaucracy.

LAWRENCE: Now, Republicans on the Hill did see, if not, malice some sort of a shell game. They were ripping mad when we showed them our conclusions. A vets committee spokesman called it just a plain money grab - a way for the VA to free up more of its other budget from congressional restrictions.

SHAPIRO: NPR's Quil Lawrence, thanks a lot.

LAWRENCE: Thank you, Ari.

SHAPIRO: And Patricia Murphy of member station KUOW in Seattle, thanks for joining us.

MURPHY: Thanks. Transcript provided by NPR, Copyright NPR.