Round Table Discussion On VA Workforce Issues
On March 16, 2023, NAVAPD President, Dr. Joseph Abate was invited by Senator Tester to participate as a panelist in a round table discussion on VA workforce issues. The round table was held virtually with 7 panelists and representatives from 10 different Senator’s offices. The panelists included one representative each from NAVAPD, NoVA, DAV, AFGE, NFFE, PVA and AOA.
NAVAPD’s opening remarks are included below:
Good afternoon. My name is Dr. Joseph Abate. I am the Supervisory Dentist at the William “Bill” Kling Outpatient clinic of the Miami VA Healthcare System. I am also the President of the National Association of VA Physicians and Dentists. NAVAPD’s core mission is preserve, protect, strengthen, and ensure the delivery of high-quality health care to our nation’s veterans that is unsurpassed anywhere in the world.
To do that, the VA needs to be able to recruit and retain physicians and dentists. Salaries as they are set now are not competitive with the private sector nor with other large hospital organizations. This severe pay disparity makes recruiting extremely difficult across the enterprise. Retention is a problem as many physicians and dentists use the VA as a “stepping-stone” as they find better paying jobs at other organizations. This leaves VA with a deficit of providers. This deficit was outlined in a recent OIG report. With the passage of the PACT Act, opening the door for more veterans to claim disabilities due to toxic exposures, the VA will need more physicians and dentists to provide care. Overhauling the pay structure making VA competitive is needed immediately. NAVAPD has provided biannual recommendations to the Steering Committee on Workforce Management to correct the pay disparities across all tiers of the pay system, and it seems our recommendations get ignored.
Money for continuing education provides an incentive for physicians and dentists to join VA. However, the language for continuing education must be changed. As it is written it states that monies for continuing education are available to “board certified physicians and dentists”. With this wording, most medical centers deny continuing education money to all general dentists. General dentists make up 95% of the VA Dentist workforce. There is no board certification in general dentistry. A simple change in the language would allow general dentists to avail themselves of this money providing an incentive for them join VA.
HR Modernization is a disaster and does not work. There are severe delays in hiring, leading to applicants withdrawing because they can no longer wait on VA. Most that withdraw site this delay as a reason they looked for and chose employment elsewhere. This severe delay in onboarding occurs even when a hire is transferring from another VA facility. There is no excuse for this type of delay which contributes to the recruitment challenge VA already has. Another major issue applicants’ site for withdrawing, is that VA will not offer a firm salary until very late in the onboarding process. Once the applicant sees how small their salary will be when compared to other organizations, they withdraw their application, and hiring managers must start the process all over. This delays care to the veteran as we are not able to quickly fill vacant positions. There is no reason that VA cannot provide a firm salary offer at the beginning of the process. There needs to be accountability in HR to onboard applicants quickly. NAVAPD recommends a firm deadline of 30 days be imposed on HR to bring onboard a new hire or a transfer.
Healthcare and the delivery of high-quality healthcare is not a factory job. Individuals, circumstances, situations, and needs are unique. VA must stop thinking of the delivery of healthcare as if it were any other factory, piece meal job, or quota type job where the more people seen in a day or hour means you are doing a good job. You can manage what you measure, but what you measure must be meaningful and impactful. Measuring irrelevant details does not make better medicine. Offering competitive salaries, offering continuing education money to all physicians and dentists, restructuring the tier system, eliminating backlogs and obstacles to hiring, and imposing strict time frames for onboarding will go a long way to making VA the employer of choice for physicians and dentists.
Thank you for your time.
After the opening remarks the facilitator introduced the representatives from the offices of the Senators who then asked the panelists specific questions regarding workforce issues.
The majority of the discussion centered around a bill being proposed in Congress called S10 The VA CAREERS Act of 2023. This is bipartisan legislation that has at its aim the improvement of the VA’s ability to recruit and retain physicians, dentists, podiatrists, optometrists, and chiropractors. Some of the provisions of the proposed bill include changing the pay system to a market driven system competitive with the private sector, provisions for educational debt repayment, provisions that VA must return hospital directors to their home hospital after being detailed for 90 days or hire another director, more oversight and accountability by VA, and several other provisions and changes in language to the existing bill it amends.
Also discussed was low morale and burnout among physicians, dentists and nurses and the recent OIG report outlining the attrition of physicians in VA. It was pointed out to the Senatorial staff that Title IX of the PACT Act has given additional hiring authorities to VA which have not been fully communicated to front line staff making recruitment a challenge. NAVAPD discussed the pros and cons of hiring non-United States trained physicians, dentists and nurses and emphasis was placed on unfamiliarity with American military service and the unique needs and specialized care needed by American veterans.
NAVAPD stressed that for VA to be able to recruit and retain high quality talent, competitive salaries must be offered, the tier system restructured and improved. NAVAPD pointed out that a strictly market driven system is not the best approach as it would disincentivize physicians and dentists from working in rural communities where the need may be the greatest. The representatives from AFGE and NFFE echoed these same concerns.
From the course of the discussion and the questions asked by the Senatorial staff, it appears the Senate is acutely aware of the challenges facing the VA physician and dentists workforce, and has as its intention to make improvements so that physicians, dentists, podiatrists, optometrists and chiropractors are recruited into VA and retained by VA. The information provided will be used at a Congressional Hearing this week where the Secretary of the VA has been asked to provide testimony on how VA will improve working conditions for physicians and dentists and how they will be accountable to meeting recruitment metrics.
NAVAPD was pleased we were asked to be included in this discussion on workforce issues. We will be hosting a townhall with House and Senate VA Committee staffers on Monday March 27, 2023. We look forward to continuing this discussion with the staffers as NAVAPD strives to make working conditions better for physicians and dentists.