Member Survey Results Are In
NAVAPD recently sent out a survey to our membership so that we could get an idea of what is most challenging in VA healthcare. We were pleased with the number of responses received and surprised with some of the responses, although most responses boiled down into some common themes across the enterprise.
Membership background:
Most respondents were board certified specialists from medical centers in major urban areas who have been with the VA for, on average, more than 15 years and who plan to retire within the next 5 or so years.
Over 67% of respondents had prior military service, service on average more than 15 years and achieving the rank of Colonel.
Also interestingly, more than 80% of respondents said they had worked in private practice or non-VA health care centers and their motivation for joining the VA was to give back to veterans where they can focus on delivering high quality are without worrying about resources.
More than 70% said they would like to remain with VA for the duration of their careers but those who are planning to leave VA cite the reasons of burnout, workload, and the pay cap as the top three reasons for leaving.
NAVAPD then asked about the change from our current CPRS EHR to the new Cerner-Oracle electronic health record. We wanted to know the concerns and challenges using this system from those working in sites where it has been deployed and those working in sites of imminent deployment.
Everyone at those sites agreed that there is inadequate training, that training must be worked around patient care and be face to face with a training and not time wasting TMS courses
That the new EHR is inefficient, cumbersome, not intuitive, and too complex to use and that because of these issues patient safety is at risk.
The respondents feel the product is inferior to other products available on the market and that Congress needs to cut its losses and invest in making CPRS more modern.
Most feel the “interoperability” that is being requested is of no use to VA clinicians.
NAVAPD asked about the current pay structure. Each year NAVAPD sends a letter to the Office of Workforce Management regarding the pay structure, and we are pleased to report that several of our recommendations have been implemented to improve pay for our member physicians and dentists.
The main concern our respondents have regarding pay is that once a physician or dentist reaches step 10 of the pay scale, there is no room for advancement in pay and they stagnate at that level.
The respondents also believe this is the main reason VA cannot recruit and retain physicians and dentists.
NAVAPD is continuing to recommend the removal of the pay cap and improvement in the market pay calculations. We have seen that the PACT Act has increased eligibility across the enterprise, causing an influx of veterans to VA. NAVAPD echoes your concern that with the difficulty in recruitment and retention due to pay, and the current hiring freeze status, this is a recipe for burnout and loss of providers.
NAVAPD recognizes that to prevent burnout and to deal with the current and future projected workload, VA needs to do everything in their power to retain their talented workforce and recruit new physicians and dentists.
Because of the increased workload, NAVAPD asked about the state of community care.
Nearly all respondents stated they spend on average 6 to 8 hours a week putting in community care consults, following up on the results and documentation and that all of this administrative work falls on the shoulders of physicians and dentists.
NAVAPD agrees this is a waste of resources and that a lot of these administrative burdens should be syphoned off to non-clinicians.
The respondents reported that the community care consult process is too burdensome, inefficient, requires too many clicks, and often, delays care and disrupts the continuity of care.
NAVAPD believes that money spent on community care should be redirected into hiring new physicians and dentists. Multiple third-party, non-VA studies have shown that VA provides superior care, more timely care, and more effective care to veterans when compared to the private sector.
For VA to recruit and retain physicians and dentists, hiring managers rely on Human Resources. NAVAPD asked our members their perception of “HR Modernization”.
Nearly 80% responded that HR modernization is not working and that to hire new clinicians takes more than 6 months, even if someone is transferring from another VA.
Centralizing HR at the VISN level has led to a myriad of problems, including not having a direct contact person, lack of communication, lack of transparency processing, lack of accountability.
This all has led many selected candidates refusing the position or taking another position where they were hired more quickly and leaving VA hiring managers back at step one.
NAVAPD proposed and will continue to push for transparency and accountability in the HR process, and a strict hiring time frame of 30-45 days from the day the candidate is selected. We also propose penalties should this time frame not be met since delays in hiring cause delays in delivery of healthcare.
NAVAPD then asked about the use of telehealth and does this technology improve healthcare and healthcare outcomes.
Nearly 60% of the respondents use telehealth modalities such as VVC and CVT.
All respondents agreed this technology has improved the delivery of healthcare and healthcare outcomes.
Surprisingly, nearly 95% have reported frequent and/or daily issues with the technology including calls dropping, internet connectivity issues, equipment failure and other IT issues.
NAVAPD believes the use of telehealth across the enterprise is a positive step. It allows veterans to stay home for routine services instead of making a long drive to a medical center. It makes the clinician more efficient but only when IT and equipment issues are mitigated.
The NAVAPD Board wants to thank all who participated in the survey. NAVAPD will continue to work on these issues with our Congressional partners. We invite you to join our town hall where you can speak directly to the House and Senate VA committee staffers.