Federal Employees News Digest
Rising VA healthcare job vacancies—and outsourcing—spur union alarm
- By Nathan Abse
- Mar 04, 2019
The number of unfilled positions at the Department of Veterans Affairs continues to increase—recently hitting 49,000 according to VA data, with 4,000 vacancies added just since August.
The vast majority of the empty slots are at the Veterans Health Administration, which manages the department’s massive healthcare operations. A chorus of public employee unions and veterans’ organizations are pushing back—against the vacancies, and what they see as a key cause: growing reliance on outsourcing to private contractors and away from the VA’s own healthcare facilities.
“Last month the VA announced new criteria for privatized care that will be simultaneously slower and inferior to the integrated and specialized care offered by the VA,” the American Federation of Government Employees, the top union of VA employees, said in a recent press release. “Understaffing the VA is a slow-motion replacement of [the department’s] in-house care with private care that is demonstrably unable to deal with veterans’ unique needs.”
The secretary of the department, Robert Wilkie, has been foursquare behind the intensified shift to outsourcing. The program has its roots in the Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014, passed during a wave of highly-publicized failings at a number of VA facilities. The outsourcing scheme has undergone significant changes over time—including the changes in eligibility criteria that sparked AFGE’s recent complaints.
The union and other program critics—as they have previously, in recent years—are calling out the VA on the large number of vacancies, which they say in turn cause capacity deficits that push vets into the care of otherwise unneeded private contractors.
“It is unconscionable that Secretary Wilkie is starving the VA by leaving almost 49,000 positions unfilled– 42,790 of which are at the Veterans Health Administration,” said J. David Cox, president of AFGE. “As the Secretary recently said, the ‘VA is seeing more patients than ever before, more quickly than ever before, and Veterans are more satisfied with their care [by VA employees] than they have been previously’ –which comes as the VHA has jumped from having 35,000 unfilled vacancies in October 2017 to nearly 43,000 today.”
“With the outstanding work being done by VA medical centers across the country, why would anybody try to undermine them with short staffing or shifting funding to the private sector?” Cox added.
A number of veterans’ groups have slammed Choice Act for poor implementation—and have criticized waste, lack of oversight and the entire pro-private contractor focus of the program. The Vietnam Veterans of America, for example, has called it a “shadow healthcare delivery system”—one Congress cannot properly oversee. Another, VoteVets, has published numerous veterans’ “horror stories” about the program.
Indeed, a GAO report just last year identified serious problems with the program, and concluded that “it’s unclear if the Choice Program improved the timeliness of veterans’ care.” A ProPublica journalistic investigation, among others, has buttressed the GAO’s criticisms—uncovering billions of dollars in waste and other issues.
Of course, some individuals report good experiences with the outsourcing program—and take the view that—in facing the program’s problems—supplementing VA healthcare with private care should be improved, not abandoned.
Sgt. Nelida Yanez, retired, is a user of VA healthcare living in California. She enlisted in 1977, and served across the U.S. and in South Korea, among other postings. Yanez told FEND she has had good experiences with Choice providers.
“I have been sent to several facilities outside system, outside of the VA and military doctors—and I believe these have been efficient—they see us more quickly,” she said. “If I have to see a VA doctor, the wait time for the appointment can be very long.”
“Also, the VA [in some areas] is limited—the closest VA facility to me is in Long Beach, about a 30-minute drive from where I live in Santa Ana.” Her private provider, she said, is close by.
But Yanez is not opposed to the VA keeping more healthcare in-house. She said the government should fund medical school scholarships to staff up the VA healthcare system. But for now, she says where she lives the VA’s presence is sparse and overburdened.
And while many national veterans’ groups have slammed the outsourcing program, some groups remain open—just as Yanez does—to the promise of a balance between the Choice program and the existing VA facilities.
Richard D. Kingsberry, Lt. Col., U.S. Army, Ret., told FEND that although privatization is not the sole fix to the VA’s ills, it might be part of the solution. Kingsberry is the National Commander of the National Association for Black Veterans.
“From my perspective, representing NABVETS, I think that the VA needs to look closely at the data it has on the program,” Kingsberry told FEND. “I don’t think one way is going to work throughout the United States—as in, some privatizing may work in Muskogee, but not in Milwaukee—you see?”
“Some veterans are getting services and appointments in a more timely manner with the Choice program, in areas where they were not getting that before Choice was available to them—this actually happens,” he said. “The VA should use their data to say, ‘OK, here’s where
we know Choice is working,’ then decision makers at VA will have a basis for actual decisions—guiding them to use the Choice program here, but not there.”
“There are areas where the existing VA [facilities] are stronger, and others where using Choice might be a solution,” he said.
“Finally, the VA itself can also use more funding,” he added. “As the veteran population needing services grows, the need to keep up with servicing these vets has also increased.
“The VA, with adequate funding, can improve with demand,” he concluded. “We see the fear is that there will be a move toward ‘privatization-only’—and privatization is clearly not the sole answer. It’s one option, but is it always the best option for veterans? Probably not.”
Union: Increase in-house funding
Still, AFGE—the largest organization representing VA healthcare workers—remains adamant. The biggest issue is that VA is simply underfunded, and understaffed. The VA needs to stop “funneling” money away to private hands, which numerous analyses have shown to be wasteful—and less efficient than the VA’s—the union notes.
First, the department needs to do “a thorough analysis of the impact of privatization on the quality and cost of care,” AFGE National Veterans Affairs Council President Alma Lee says. Lee is the union voice for some 250,000 workers at the VA.
Next, the union sees “alternative approaches that will improve care—namely increased funding and a commitment to achieving full-staffing inside the VA,” instead of a greater role for Choice.
“While the administration is setting us up to fail so they can dismantle veterans’ preferred health care provider, there are thankfully allies in Congress who are working to ensure we can hire and retain the medical professionals we so desperately need,” Lee said in a release.
Last month, H.R. 1133, the VA Employee Fairness Act, was introduced to restore equal workplace rights to VA Title 38 health care professionals, strengthening the hand of the department’s own employees—and representing pushback against more privatization.
“Veterans are provided the best quality and timely care when the VA workforce can thrive,” said Rep. Mark Takano (D-Calif.), the bill’s lead sponsor. “With more than 40,000 employee vacancies in the VHA alone, it is crucial to ensure that doctors, nurses, and other medical professional are equipped with the best tools to retain and recruit the best talent to serve veterans — this bill will help make that possible.”
A companion bill has been introduced in the Senate.