On Monday March 27, 2023, NAVAPD held a town hall meeting that was open to all members. We had as our special guests, staffers from the Senate and House VA committees on Health and Information Technology, as well as many of our members.  The event kicked off with introductory remarks made by NAVAPD President, Dr. Joseph Abate. Each staffer then introduced themselves, the offices they are affiliated with and what Bill or Measure they are working on that directly impacts VA’s Physicians and Dentists.

A discussion was held regarding the new S10 Bill, the VA CAREERS Act which was introduced into the Senate on January 23, 2023. This Bill was first introduced by Senator Jon Tester (D-MT) and Senator Boozman (R-AR) and has bipartisan support. Co-Sponsors of the Bill include Senator King (I-ME), Senator Capito (R-WV), Senator Coons (D-DE), and Senator Klobuchar (D-MN).  Of all the co-sponsors, Senator Boozman is a former optometrist.  The VA CAREERS Act is the first VA Bill in the Senate for this session of Congress.  

The aim of the Bill is to improve recruitment and retention of clinicians in VA, particularly in rural areas.  As stated on Senator Tester’s website,

“The VA Clinician Appreciation, Recruitment, Education, Expansion, and Retention Support (CAREERS) Act would provide VA with more tools to compete for highly qualified medical personnel, support training for current and future VA clinicians to ensure veterans receive the highest quality of care and provide more oversight and public transparency on VA’s efforts to address vacancies. This legislation would also better prepare VA manage care for the thousands of veterans newly eligible under the Senator’s Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act.”

There are several portions of the bill that directly impact, and are of importance to NAVAPD’s members. 

Section 201 of the bill will change the pay system for physicians, dentists, podiatrists and adds optometrists to the physician and dentist pay system. There will be a modernization of the pay system for physicians, dentists, podiatrists, and optometrists which will benefit rural and other hard to hire markets.  The focus of the change of the pay system will be away from the base pay, locality pay, performance pay system to a more market driven pay system where VA will be required to conduct market assessment reviews every 2 years and adjust pay to be in line with market demands. VA will still be required to consider experience, longevity and performance in setting pay for physicians, dentists, podiatrists, and optometrists. VA will also be required to report these market assessment reviews to Congress and report on how pay has been adjusted. 

This section of the bill has a provision that will remove the current $400,000 pay cap and provides that VA will be given discretion to waive pay caps for hard to fill specialty positions. This will also greatly benefit the rural and smaller markets in being able to recruit and retain specialty clinicians. 

The VA CAREERS Act specifies that there will be a fix to the issue with Annual Leave accrued during the pandemic where clinicians have been unable to use this built-up annual leave. The Office of Personnel Management increased the window where this leave can be taken but Congress wanted providers to be able to take the built-up leave beyond the window that OPM authorized (and VA would be required to come up with a plan to allow those affected providers to take that leave) or the provider would have to be given the option of a lump sum buy out of that leave.

Continuing Education Reimbursement is also going to be fixed in the Bill. There will be an expansion of continuing education reimbursement to support staff, such as nursing staff, and the bill will remove the “board certification” requirement for physicians and dentists to obtain money from VA to be used for continuing education. Of note: there is a similar provision in the House Bill, but the House would have increased the amount of money a physician or dentist could request for continuing education from the current $1000, to $2000. However, S10, keeps the rate at the current $1000.

Part of the recruitment benefits under the Bill would require VA to pay for licensure exams costs for future clinicians who are participating in the VA scholarship program.  One of the hiring authorities VA currently has allows VA to offer up to $40,000 educational debt repayment for a graduate from a VA sponsored Residency program, if that clinician serves in VA for a minimum of 12 months after graduation from the residency program. This provision was part of the VA MISSION Act of 2018 and to date only 45 participants have made use of this program.  VA has requested in the CAREERS Act that this number be increased to 300 participants. If used nationally, this would only add 2 clinicians per VA medical center. NAVAPD has requested that this number be increased to 1500 participants which would add an average of an additional 10 clinicians per medical center.

Regarding the Cerner-Oracle electronic health record, Congress is acutely aware of the issues facing the sites where the product has already been deployed. Recently, a VA physician has been put in charge of the program, and the Senators from Washington and Ohio are pushing to halt the project and suggesting that VA stop it all together and figure out a different solution.  Congress is also considering requiring an independent third-party assessment of the product and its problems and if the third-party assessment supports abandoning the Cerner-Oracle system, Congress would support that as well.

NAVAPD appreciates the work put into the new bill and is thrilled that the suggestions we have made over the past year or so have been incorporated into the bill. NAVAPD fully supports the changes being made to the provisions for continuing education, recruitment, retention, educational debt repayment, and the electronic health record.  NAVAPD also values the time that we were given by the Senate and House staff, and the insight they were able to provide on the S10 Bill.

NAVAPD encourages you to learn more about the VA CAREERS Act and to contact your Senators and Representatives if you have any concerns about any of the provisions in the bill. A link to the bill can be found on Congress.gov.