Federal Employees News Digest

Veterans push VA to fill job vacancies, amid clamor and protest

The Department of Veterans Affairs is a 330,000-plus employee, $175 billion organization. The VA’s largest unit, the Veterans’ Health Administration, runs a far-flung system of over 1,200 veterans’ health facilities serving millions of patients. VA healthcare is generally rated very highly. But three years ago, long waits for care and neglect were discovered at the VA’s Phoenix healthcare facility—and subsequently elsewhere—resulting in congressional hearings, tough media coverage and the departure of some from the agency. The VA has said these problems are being addressed. Still, tens of thousands of job vacancies hamper the agency’s functioning. Critics blame the vacancies—mostly in VHA healthcare jobs—on a nationwide shortage of qualified candidates, agency pay limitations, and bad press resulting from misconduct probes. The American Federation of Government Employees—whose members have held substantial protests at various sites in recent months—faults Congress and the VA over the vacancy issue—alleging leaders have facilitated the shunting of too many patients to private health providers. The VA, in turn, insists the vacancy problem is improving. In related news, this year, a controversial new law could assist in the removal of bad apples at the VA—and facilitate hiring. There is also a new whistleblower office. Nathan Abse explored these issues in an interview with Joe Chenelly, executive director of the 250,000-strong group AMVETS, also known as American Veterans.

Q & A with Joe Chenelly

Some vets who use VA health facilities complain the tens of thousands of healthcare vacancies have led to overworked staff and gaps in care—with AFGE putting vacancies at 49,000, the VA significantly less. Can you comment?

Chenelly: Certainly. The fact is that the agency lacks staff in many places. So, we are working with the VA’s central office and at the local level—along with employee unions—to get these jobs filled. There are many reasons for the vacancies. A big one is there are not enough mental and other health care providers. Then there are the VA’s recruiting—and retention—problems.

With legislation passed this year, the VA appears to have new, faster firing capabilities—and mildly improved hiring capabilities. Could these help lift the vacancy crisis—especially in places like Denver, with its 600 unfilled VA healthcare job vacancies?

Chenelly: Yes, we think so—some. Some of that could be helpful. But it will take a while to take effect. Another problem is the issue here is not just in the hiring process—which is slow, or in dismissing people. It’s that VA pay is still too uncompetitive. Another big issue is the perception the American public still has of the agency and its employees. So, we are working to let VA folks know we appreciate them and their dedication to veterans—and we are spreading the word.

As you noted, a countrywide shortage of medical practitioners is one cause of vacancies, right?

Chenelly: That’s absolutely the case. One thing we are doing to fix this is to press for ways to help veterans that want to pursue medical professions. In fact, already a huge percentage of our doctors in this country educated to work and care for vets have gone through the VA at some point in their training. The VA needs to be able to capture more people motivated to do this, to help them with their medical education—and in recruiting and hiring them.

The many-months-long process of hiring people into healthcare at the VA, that’s another cause for vacant VA healthcare positions, correct?

Chenelly: The slow process of hiring people is not just a big problem at the VA and in healthcare areas of the VA. It’s a problem for just about any agency in the federal government. Job applications get caught up in red tape. The process is notoriously very slow. There have been various proposals to streamline things. I understand the VA needs to be careful, to make sure they hire the right kind of people—and especially to prevent hiring people who might harm patients. But the hiring process, as things stand, takes so long that it’s ridiculous. It’s a major reason why so many medical people—doctors and nurses—don’t even try to get into the VA. In fact the entire H.R. side of the government is broken. We can all see it, especially these past eight months, throughout Washington. Because of slow hiring and the vacancy situation, those already in federal jobs are often overburdened.

So, we have noted a shortage of health professionals, long hiring times and the red tape behind it as issues hurting recruiting? Any others--maybe the VA scandal starting in Phoenix in 2014?

Chenelly: Yes, Phoenix. That was about real problems. There was a lack of trust between the local office and the national office, at the Veterans Health Administration—it was a huge part of what happened. Then there was the bad publicity that followed. You have to remember, the VA has the largest coordinated healthcare system in the country, and one of the largest in the world. Every time a local VA hospital problem got some media, it became a national news story. Unfortunately, as things developed, it didn’t take long for VA employees to be painted as villains—like people who didn’t care about veterans, and were sometimes killing veterans.

Given those problems, what are some solutions to the large number of vacancies?

Chenelly: We need Congress to look at compensation at the VA, to make the VA more competitive with the private sector—especially for nurses. In addition to compensation as a solution, we are also looking into telehealth solutions. Hopefully, that can help to get more health providers into the VA system. As for hiring more nurses, some areas of the country just have a huge shortage of them. In these areas, the VA’s hiring effort has to be very competitive—and, for now, VA almost always loses out on hiring them—again, for many reasons, but a lot of it is about pay. Another angle is that if the VA could hire and plus up nurses from areas where there are more of them, that could help staffing everywhere. We have seen the VA start to do this. But, for now, those problems remain—and what I see as a concerted effort to smear the VA’s reputation—actually, for some years. It’s been very detrimental.

So, legitimate criticisms of the VA have morphed into a smear campaign—one that encourages privatizing VA care, right? That begs the question—can we use the private sector much at all, for veterans, without destroying the VA?

Chenelly: Let me say this: About 30 percent of all veterans who are receiving care through the VA system are already receiving [some] care from outside of it. That’s about one-third of veterans. I think that’s a fairly high share. I worry that if it goes much higher, private care could erode—or further erode, I should say—the VA healthcare system, which really needs investment. Having said that, in any situation where a veteran cannot get the care they need in a timely way, then they need to use a defined network outside of the VA system, definitely.  But, remember, one-third of vets already do that, and I am for that. And we at AMVETS have worked on helping with the funding for that. I am simply trying to emphasize that if we are going to invest in veterans’ healthcare, we need to invest in the VA system itself. We need to do this to end the continuing big problem with access—which we have struggled with for several years. If instead we don’t invest in VA to fix the problem with access, while we continue to allow approved physicians outside of the system to be open for vets, then we will continue to push veterans out of the VA system, [ruining it.] There’s no doubt here. And I don’t think there is any veterans’ organization that wants veterans’ healthcare to be privatized.

The scandal following Phoenix in 2014 has not helped reduce vacancies—just a huge effects on recruiting and morale, right?

Chenelly: Yes, it has. It has had additional effects—two big ones I see. The first one was on patients, not employees. The crisis got local media attention trained on problems at local VA facilities and stories into national news—and those unfortunately discouraged patients. Literally, some said, “You know what? I’m not going to go to the VA for care anymore. I don’t trust the VA, because this news channel or that newspaper in effect is telling me the VA is trying to hurt or kill me.” Some of that message was intentional—at least the effect of peeling some patients away from the VA and toward private solutions was. A second issue emerged, this one on [recruiting and morale.] VA healthcare employees have had to work very long hours, while not making as much money as their private sector counterparts. Bad publicity about work and pay—along with the media sometimes effectively painting the VA employee as a villain—it’s been bad for morale. The question we face now is: How does the VA get away from all this?

You raise a good question here: How does the VA get past the ill effects of scandal—and the continuing problem of vacancies and bad publicity?

Chenelly: First, the VA needs to let people know the good things the agency and its people are doing. And, second, the VA needs to win back the trust of the public and the veterans—by actually making more progress on filling those vacancies—and getting rid of its access problem. Meanwhile, the VA must continue to provide the high level of care that agency does generally provide.

Until the Phoenix crisis, the VA had been perceived as improving, by most accounts, for some years. How can you make sure the VA’s image—and the care itself—don’t start to slide again?

Chenelly: The key to preventing any real slide in care is to build up the improvements we discussed here. You cannot fire your way to success, that’s for sure. The presidential campaign cycle last year was not helpful to us on this. During his campaign, the current president spoke brashly, suggesting everyone in the VA system basically needed to get axed. That was not right. On the other hand, the new president did pick a secretary who understood this well—someone who had been the undersecretary running the healthcare side of the VA for the previous 18 months. So, as I’ve said, now the best way is to stay the course. There are a lot of things going in the right direction right now. These will help maintain stability in the organization. There is a sort of unified, one-party government right now, effectively—and so far, in a way, this at least means there has been progress on legislation in the first part of this year—legislation that had been slowed by partisan politics. So, that’s good. The recent improvements Congress passed were stuck on the table for a long time. We’re finally at a good place on legislation—not perfect, but getting somewhere. Now, we will have to see about implementing.

What are the two or three most important aspects of “staying the course” that you want the White House and the VA to stick with—some priorities leading to a better VA? 

Chenelly: First of all, I want the VA to keep working on rebuilding trust with veterans. For example, the VA now has on its website exact wait times at VA facilities all over the country. The VA is also the only federal agency listing, on a weekly basis, disciplinary actions. They’re no longer brushing so much stuff under the rug. There is collaboration with veterans at the VA. They are listening to vets—to us. Just yesterday we had a breakfast with the undersecretary of the VA. Two days ago we had a three-hour meeting with the undersecretary for veterans’ health. Next week, we will meet with the undersecretary for veterans benefits. So, there is a collaborative approach and transparency. That’s two aspects of the course we need to stay on.

What is AMVETS doing to advance those priorities?

Chenelly: Our organization has millions of paid members—and they hire us, so to speak, to be their voice. We are constantly out there with our veterans, holding town halls and seeing what they are seeing out there, and bringing back to Washington, to the VA, the news of what they need.

 

What is your take on dealing with the current White House, and how are things going?  

Chenelly: Although the White House and the VA shouldn’t be so separate, to my mind, in fact they are, for sure. In any case, the folks who run the VA are not new to this. As I said, VA Secretary David Shulkin was already running the VA’s health division and knows very well the issues. As soon as President Trump was elected, [we and others were asked] what kind of person the VA needed as secretary. We replied that you have a pretty good secretary already—Bob McDonald, President Obama’s last VA Secretary and former head of Proctor & Gamble. But, they needed a new secretary, and from our point of view, the next best thing was the undersecretary [David Shulkin]. We continued to push that we needed face time with the president and his staff. And we have met [with them] five times now, as I recall. There are all the nuances of things he said on the campaign trail. Though he was passionate—and let us know he cared about veterans—some of those things weren’t right. So, we have since let him know the facts. I think the president is pleased that the things he was talking about, many of them, were already in the works. Now we need his continued support on those. Dr. Poonam Alaigh, the VHA [acting] undersecretary for health, also needs help in keeping on in the right direction and getting the right resources

If you could, tell us about the VA and its budget situation, for employees and the veterans?

Chenelly: OK. Well, first, there was a bit of a learning curve with a new administration—it came the hard way, in the first budget they proposed months ago. I am hoping next year’s budget proposal from the administration is better—more collaborative, where this year’s was not at first. There were cuts proposed that we and our members could not tolerate. So, we had to show our grass roots strength, flex our muscles a little bit. Now, to me, of course more money overall is need. But my first concern right now is that the money the VA gets already goes into the right accounts, where needed. Care should not be getting pushed toward the private sector. We absolutely need to be investing in VA infrastructure, so that capacity and care standards remain high. We need to continue to maintain and improve a strong VA health care system.

Regarding the vacancies, and other issues upsetting to staff and veterans, can AFGE-led protests be helpful?

Chenelly: The VA has a lot of vacancies—and its recruiting and retention process is a problem. Our members are aware of it, and we work to inform those that aren’t aware—and to tell them where to direct their voice on this matter. The bottom line is that the veterans are a very involved community, and they are very likely to reach out to their lawmakers. They have a sense of civic duty and they will reach out to tell lawmakers about their concerns.

Where do you, at AMVETS, see room for improvement in the budget for the VA?

Chenelly: Every year, we in the veterans’ organizations put together a comprehensive budget document—our ideas on the budget. We give it to the committees in both sides of Congress, the White House and to the VA. And I can tell you, one item that is underfunded every year is the infrastructure side—investment in the facilities, as well as some R&D and some IT. Middle management is overfunded. And a huge part of what’s underfunded is actual healthcare employees in the VA’s hospitals and facilities. As you have said in the news in this article—it’s the vacancies, that we don’t have enough people who actually spend time with veterans.

For clarification, why shouldn’t our leaders try more privatized healthcare for vets?

Chenelly: Because we know that the VA healthcare system is the right system. It’s a public trust, it’s a public institution, and we need to continue to maintain it and improve that. The majority of veterans do like the care that they receive with the VA. By and large that care is more comprehensive than the care they receive in the private sector. I myself am a veteran, and I myself receive healthcare from the VA and from outside the VA. And I can say personally that the VA’s care is more comprehensive.

Is there any era’s veterans who might have greater unmet needs in the VA system?

Chenelly: The whole VA system needs more investment. It needs more doctors and nurses to fill those many vacancies, for all veterans. But, interestingly, the Vietnam-war era veterans probably have some of the most pressing, most emerging needs. Much of the last fifteen years has been directed toward the post-9/11 veterans. (And by the way, I am one of those—I was in Iraq and Afghanistan.) The Vietnam vets, on the other hand, all too often are being forgotten in our legislative process, when our legislators are working out resources.  Overall, we have veterans from every era, and the VA needs more staff and more improvements for all of them.

Is there anything we might not have covered here—regarding the VA’s problems?  

Chenelly: As a vet, I am glad you in the media are addressing this topic—the vacancies, and the access to care situation as a veterans’ issue—because most media are not covering this, though they should be. Again, the fact is that although the VA still provides great care, many VA facilities just do not have the doctors and nurses and other providers they were approved to get. It has to be said, there has been an effort at accountability—a lot of new accountability, which we support. Despite this progress, it comes back to the vacancies and compensation.

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