69–006 

114TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 2d Session 114–811 

DEPARTMENT OF VETERANS AFFAIRS EMERGENCY 

MEDICAL STAFFING RECRUITMENT AND RETENTION ACT 

NOVEMBER 14, 2016.—Committed to the Committee of the Whole House on the 

State of the Union and ordered to be printed 

Mr. MILLER of Florida, from the Committee on Veterans’ Affairs, 

submitted the following 

R E P O R T 

[To accompany H.R. 4150] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Veterans’ Affairs, to whom was referred the 

bill (H.R. 4150) to amend title 38, United States Code, to allow the 

Secretary of Veterans Affairs to modify the hours of employment of 

physicians and physician assistants employed on a full-time basis 

by the Department of Veterans Affairs, having considered the 

same, report favorably thereon with an amendment and recommend that the bill as amended do pass. 

CONTENTS 

Page 

Amendment .............................................................................................................. 2 

Purpose and Summary ............................................................................................ 2 

Background and Need for Legislation. ................................................................... 2 

Hearings ................................................................................................................... 3 

Subcommittee Consideration .................................................................................. 4 

Committee Consideration ........................................................................................ 4 

Committee Votes ...................................................................................................... 4 

Committee Oversight Findings ............................................................................... 5 

Statement of General Performance Goals and Objectives .................................... 5 

New Budget Authority, Entitlement Authority, and Tax Expenditures ............. 5 

Earmarks and Tax and Tariff Benefits .................................................................. 5 

Committee Cost Estimate ....................................................................................... 5 

Congressional Budget Office Estimate ................................................................... 5 

Federal Mandates Statement ................................................................................. 6 

Advisory Committee Statement .............................................................................. 6 

Constitutional Authority Statement ...................................................................... 6 

Applicability to Legislative Branch ........................................................................ 6 

Statement on Duplication of Federal Programs .................................................... 7 

Disclosure of Directed Rulemaking ........................................................................ 7 

Section-by-Section Analysis of the Legislation ...................................................... 7 

Changes in Existing Law Made by the Bill as Reported ...................................... 7 


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1The Complexities of Physician Supply and Demand: Projections from 2014 to 2025. https:// 

www.aamc.org/download/458082/data/2016_complexities_of_supply_and_demand_projections.pdf. 2Subcommittee on Health and Subcommittee on Economic Opportunity Joint Legislative 

Hearing on draft legislation to improve the authority of the Secretary of Veterans Affairs to hire 

and retain physicians and other employees of the Department of Veterans Affairs, March 16, 

2016. https://veterans.house.gov/hearings/legislative-hearing-draft-legislation-improve-authoritysecretary-veterans-affairs-hire-0. 

AMENDMENT

The amendment is as follows: 

Strike all after the enacting clause and insert the following: 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Department of Veterans Affairs Emergency Medical 

Staffing Recruitment and Retention Act’’. 

SEC. 2. MODIFICATION OF HOURS OF EMPLOYMENT FOR PHYSICIANS AND PHYSICIAN ASSISTANTS EMPLOYED BY THE DEPARTMENT OF VETERANS AFFAIRS. 

Section 7423(a) of title 38, United States Code, is amended— 

(1) by striking ‘‘(a) The hours’’ and inserting ‘‘(a)(1) Except as provided in 

paragraph (2), the hours’’; and 

(2) by adding at the end the following new paragraph: 

‘‘(2) The Secretary may modify the hours of employment for a physician or physician assistant appointed in the Administration under any provision of this chapter 

on a full-time basis to be more than or less than 80 hours in a biweekly pay period 

if the total hours of employment for such employee in a calendar year does not exceed 2,080 hours. No physician or physician assistant may accrue overtime by reason of modified hours of employment authorized under this paragraph.’’. 

PURPOSE AND SUMMARY

H.R. 4150, the ‘‘Department of Veterans Affairs Emergency Medical Staffing Recruitment and Retention Act,’’ was introduced by 

Representative Raul Ruiz of California on December 1, 2016. H.R. 

4150, as amended, would (1) authorize the Department of Veterans 

Affairs (VA) to modify the hours of employment for a full-time VA 

physician or physician assistant (PA) to be more than or less than 

80 hours in a biweekly pay period if the total of such employee’s 

hours of employment in a calendar year does not exceed 2,080 

hours and (2) stipulate that no physician or PA may accrue overtime as a result of modified hours of employment pursuant to this 

authority. 

BACKGROUND AND NEED FOR LEGISLATION

According to the 2016 report from the Association of American 

Medical Colleges, the United States is facing a coming physician 

shortfall as ‘‘[p]hysician demand continues to grow faster than supply leading to a projected total physician shortfall of between 

61,700 and 94,700 physicians by 2025.’’ 1 The Veterans Health Administration (VHA) is not immune to the expected provider shortage. On March 16, 2016, VA officials testified before the Subcommittee on Health that VHA had 43,000 current vacancies, nearly 4,000 of which are physician vacancies.2 VHA’s ability to effectively manage these vacancies is hampered by continued struggles 

to recruit and retain quality health care providers and make efficient use of the existing VHA workforce. Accordingly, in the final 

report of the Commission on Care, which was issued in June 2016, 

the Commissioners noted that VHA employs ‘‘policies that fail to 

optimize the talents and efficiency of all health professionals [and] 

detract from the effectiveness of VHA health care,’’ and that ‘‘roVerDate Sep 11 2014 01:30 Nov 21, 2016 Jkt 069006 PO 00000 Frm 00002 Fmt 6659 Sfmt 6602 E:\HR\OC\HR811.XXX HR811

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3 Commission on Care Final Report. https://commissiononcare.sites.usa.gov/files/2016/07/Commission-on-Care_Final-Report_063016_FOR-WEB.pdf. 4 Career Information: Emergency Medicine. http://meded.ucsf.edu/ume/career-informationemergency-medicine. 5Full Committee Legislative Hearing on H.R. 3216, H.R. 4150, H.R. 4764, H.R. 5047, H.R. 

5083, H.R. 5162, H.R. 5166, H.R. 5392, H.R. 5407, H.R. 5416, H.R.5420, and H.R. 5428, June 

23, 2016. https://veterans.house.gov/hearings/legislative-hearing-hr-3216-hr-4150-hr-4764-hr5047-hr-5083-hr-5162-hr-5166-hr-5392-hr-5407. 

bust structured programs to recruit, retain, develop, and advance 

high potential staff are essential.’’ 3

Currently, VHA’s ability to maximize its providers’ time is hampered by a rigid, 40-hour work week pay schedule that is at odds 

with private sector industry standards. Typically, emergency department providers work flexible schedules to accommodate the 

variant, irregular hours that their work demands. As the University of California, San Francisco School of Medicine explains, ‘‘EM 

[emergency medicine] physicians should expect to work a mix of 

day, evening, night, weekend, and holiday shifts,’’ where ‘‘every 

shift is different,’’ and ‘‘work shifts range from 6–12 hours plus 

time to sign-out and finish clinical tasks.’’ 4 However, VHA’s standing 80-hour pay period does not provide emergency room providers 

sufficient flexibility to work fluid hours similar to their private sector counterparts, putting VA emergency room staffing practices at 

odds with industry standards. In VA’s fiscal year 2017 budget submission, the Department issued a legislative proposal—which this 

bill is based on—that would address this issue. According to the 

Department, this would, ‘‘allow VA to arrange flexible physician 

and physician assistant work schedules to allow for the staffing 

and full implementation of a hospitalist physician system and to 

accommodate the unusual work schedule requirements for Emergency Medicine (EM) Physicians.’’ 5

The Committee is dedicated to ensuring timely access to quality 

care for veteran patients. Providing appropriate tools to enhance 

the recruitment and retention of a high quality VA workforce is essential to achieving that priority. As such, Section 2 of the bill 

would allow VA to determine a physician or physician assistant’s 

full-time status based on the hours they are expected to work in 

a year—2,080—rather than the hours they work during a bi-weekly 

pay period—80. Section 2 of the bill would also stipulate that no 

physician or PA may accrue overtime by reason of the modified 

work hours authorized in this legislation unless the hours worked 

exceed the normal scheduled hours. The Committee believes this 

change will enable VHA to maximize the Department’s current 

workforce and, therefore, increase access to care for veteran patients. 

HEARINGS

On June 23, 2016, the Full Committee held a legislative hearing 

on various bills introduced in the 114th Congress, including H.R. 

4150. The following witnesses testified: 

The Honorable Doug Lamborn of Colorado, U.S. House of 

Representatives; the Honorable Dina Titus of Nevada, U.S. 

House of Representatives; the Honorable Raul Ruiz of California, U.S. House of Representatives; the Honorable Beto 

O’Rourke of Texas, U.S. House of Representatives; the HonorVerDate Sep 11 2014 01:30 Nov 21, 2016 Jkt 069006 PO 00000 Frm 00003 Fmt 6659 Sfmt 6602 E:\HR\OC\HR811.XXX HR811

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able Ron DeSantis of Florida, U.S. House of Representatives; 

the Honorable Ted Yoho of Florida, U.S. House of Representatives; the Honorable Jody Hice of Georgia, U.S. House of Representatives; the Honorable Dan Newhouse of Washington, 

U.S. House of Representatives; the Honorable David Young of 

Iowa, U.S. House of Representatives; the Honorable Sloan Gibson, Deputy Secretary, U.S. Department of Veterans Affairs, 

accompanied by Laura Eskenazi, the Executive in Charge and 

Vice Chairman of the Board of Veterans Appeals, David 

McLenachen, the Deputy Under Secretary for Disability Assistance for the Veterans Benefits Administration, and Dr. 

Maureen McCarthy, the Assistant Deputy Under Secretary for 

Health Patient Care Services for the Veterans Health Administration; Raymond Kelley, Director, National Legislative Service, Veterans of Foreign Wars of the United States; Paul 

Varela, the Assistant National Legislative Director, Disabled 

American Veterans; Carl Blake, Associate Executive Director 

of Government Relations, Paralyzed Veterans of America; 

Louis J. Celli, Jr., Director, National Veterans Affairs and Rehabilitation Division, The American Legion; and, Rick 

Weidman, Executive Director for Policy and Government Affairs, Vietnam Veterans of America. 

Statements for the record were submitted by: 

American Battle Monuments Commission; AMVETS; Court 

of Appeals for Veterans Claims; Iraq and Afghanistan Veterans 

of America; Military Officers Association of America; Military 

Veterans Advocacy, Inc.; National Organization of Veterans 

Advocates; National Veterans Legal Services Program; 

P.A.W.S. Foundation; Stetson University College of Law’s Veterans Law Institute; and, U.S. Department of Labor. 

There were no Subcommittee hearings held on H.R. 4150, as 

amended. 

SUBCOMMITTEE CONSIDERATION

There was no Subcommittee markup of H.R. 4150, as amended. 

COMMITTEE CONSIDERATION

On September 21, 2016, the Full Committee met in open markup 

session, a quorum being present, and ordered H.R. 4150, as amended, favorably reported to the House of Representatives by voice 

vote. During consideration of the bill, the following amendment in 

the nature of a substitute was considered and agreed to by voice 

vote: 

An Amendment in the Nature of a Substitute to H.R. 4150 

offered by Representative Raul Ruiz of California. 

COMMITTEE VOTES

In compliance with clause 3(b) of rule XIII of the Rules of the 

House of Representatives, there were no recorded votes taken on 

amendments or in connection with ordering H.R. 4150, as amended, reported to the House. A motion by Representative Mark 

Takano of California to report H.R. 4150, as amended, favorably to 

the House of Representatives was agreed to by voice vote. 


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COMMITTEE OVERSIGHT FINDINGS

In compliance with clause 3(c)(1) of rule XIII and clause (2)(b)(1) 

of rule X of the Rules of the House of Representatives, the Committee’s oversight findings and recommendations are reflected in the 

descriptive portions of this report. 

STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

In accordance with clause 3(c)(4) of rule XIII of the Rules of the 

House of Representatives, the Committee’s performance goals and 

objectives are to modify hours of employment for certain VHA employees in order to increase access to care for veteran patients. 

NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX

EXPENDITURES

In compliance with clause 3(c)(2) of rule XIII of the Rules of the 

House of Representatives, the Committee adopts as its own the estimate of new budget authority, entitlement authority, or tax expenditures or revenues contained in the cost estimate prepared by 

the Director of the Congressional Budget Office pursuant to section 

402 of the Congressional Budget Act of 1974. 

EARMARKS AND TAX AND TARIFF BENEFITS

H.R. 4150, as amended, does not contain any Congressional earmarks, limited tax benefits, or limited tariff benefits as defined in 

clause 9 of rule XXI of the Rules of the House of Representatives. 

COMMITTEE COST ESTIMATE

The Committee adopts as its own the cost estimate on H.R. 4150, 

as amended, prepared by the Director of the Congressional Budget 

Office pursuant to section 402 of the Congressional Budget Act of 

1974. 

CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

Pursuant to clause 3(c)(3) of rule XIII of the Rules of the House 

of Representatives, the following is the cost estimate for H.R. 4150, 

as amended, provided by the Congressional Budget Office pursuant 

to section 402 of the Congressional Budget Act of 1974: 

U.S. CONGRESS, CONGRESSIONAL BUDGET OFFICE, Washington, DC, October 12, 2016. 

Hon. JEFF MILLER, 

Chairman, Committee on Veterans’ Affairs, 

House of Representatives, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for H.R. 4150, the Department of 

Veterans Affairs Emergency Medical Staffing Recruitment and Retention Act. 

If you wish further details on this estimate, we will be pleased 

to provide them. The CBO staff contact is Ann E. Futrell. 

Sincerely, 

KEITH HALL. 


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Enclosure. 

H.R. 4150—Department of Veterans Affairs Emergency Medical 

Staffing Recruitment and Retention Act 

H.R. 4150 would allow the Department of Veterans Affairs (VA) 

to offer alternative work schedules (above or below 80 hours on a 

biweekly basis) to physicians or physician assistants (PAs) who 

work for VA on a full-time basis, provided that the total work 

hours in a calendar year do not exceed 2,080. Physicians and PAs 

would not be eligible for overtime pay for the hours worked in accordance with an alternative work schedule. VA reports that implementing this bill would not affect the amount of compensation paid 

to those employees. 

CBO estimates that implementing this bill would cost less than 

$500,000 over the 2017–2021 period to prepare the necessary regulations; that spending would be subject to the availability of appropriated funds. 

Enacting the legislation would not affect direct spending or revenues; therefore, pay-as-you-go procedures do not apply. 

CBO estimates that enacting H.R. 4150 would not increase net 

direct spending or on-budget deficits in any of the four consecutive 

10-year periods beginning in 2027. 

H.R. 4150 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act would not 

affect the budgets of state, local, or tribal governments. 

The CBO staff contact for this estimate is Ann E. Futrell. The 

estimate was approved by H. Samuel Papenfuss, Deputy Assistant 

Director for Budget Analysis. 

FEDERAL MANDATES STATEMENT

The Committee adopts as its own the estimate of Federal mandates regarding H.R. 4150, as amended, prepared by the Director 

of the Congressional Budget Office pursuant to section 423 of the 

Unfunded Mandates Reform Act. 

ADVISORY COMMITTEE STATEMENT

No advisory committees within the meaning of section 5(b) of the 

Federal Advisory Committee Act would be created by H.R. 4150, as 

amended. 

STATEMENT OF CONSTITUTIONAL AUTHORITY

Pursuant to Article I, section 8 of the United States Constitution, 

H.R. 4150, as amended, is authorized by Congress’ power to ‘‘provide for the common Defense and general Welfare of the United 

States.’’ 

APPLICABILITY TO LEGISLATIVE BRANCH

The Committee finds that H.R. 4150, as amended, does not relate 

to the terms and conditions of employment or access to public services or accommodations within the meaning of section 102(b)(3) of 

the Congressional Accountability Act. 


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STATEMENT ON DUPLICATION OF FEDERAL PROGRAMS

Pursuant to section 3(g) of H. Res. 5, 114th Cong. (2015), the 

Committee finds that no provision of H.R. 4150, as amended, establishes or reauthorizes a program of the Federal Government known 

to be duplicative of another Federal program, a program that was 

included in any report from the Government Accountability Office 

to Congress pursuant to section 21 of Public Law 111–139, or a 

program related to a program identified in the most recent Catalog 

of Federal Domestic Assistance. 

DISCLOSURE OF DIRECTED RULEMAKING

Pursuant to section 3(i) of H. Res. 5, 114th Cong. (2015), the 

Committee estimates that H.R. 4150, as amended, contains no directed rule making that would require the Secretary to prescribe 

regulations. 

SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title 

Section 1 of the bill would provide the short title for H.R. 4150, 

as amended, as the ‘‘Department of Veterans Affairs Emergency 

Medical Staffing Recruitment and Retention Act.’’ 

Section 2. Modification of hours of employment for physicians and 

physician assistants employed by the Department of Veterans 

Affairs 

Section 2 of the bill would amend section 7423(a) of title 38 

U.S.C. by striking ‘‘(a) the hours’’ and inserting ‘‘(a)(1) Except as 

provided in paragraph (2), the hours’’ and adding at the end a 

paragraph authorizing VA to modify the hours of employment for 

a full-time physician or physician assistant to be more or less than 

eighty hours in a biweekly pay period, so long as that employee’s 

total hours do not exceed 2,080 in a single calendar year and stipulate that no physician or physician assistant may accrue overtime 

due to modified hours of employment authorized under this paragraph. 

CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

In compliance with clause 3(e) of rule XIII of the Rules of the 

House of Representatives, changes in existing law made by the bill, 

as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets, new matter is printed in italic, 

existing law in which no change is proposed is shown in roman): 

CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

In compliance with clause 3(e) of rule XIII of the Rules of the 

House of Representatives, changes in existing law made by the bill, 

as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets, new matter is printed in italics, 

and existing law in which no change is proposed is shown in 

roman): 


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TITLE 38, UNITED STATES CODE 

* * * * * * * 

PART V—BOARDS, ADMINISTRATIONS, AND 

SERVICES 

* * * * * * * 

CHAPTER 74—VETERANS HEALTH ADMINISTRATION - 

PERSONNEL 

* * * * * * * 

SUBCHAPTER II—COLLECTIVE BARGAINING AND 

PERSONNEL ADMINISTRATION 

* * * * * * * 

§ 7423. Personnel administration: full-time employees 

ø(a) The hours¿ (a)(1) Except as provided in paragraph (2), the 

hours of employment in carrying out responsibilities under this 

title of any employee who is appointed in the Administration under 

any provision of this chapter on a full-time basis in a position listed 

in section 7421(b) of this title (other than an intern or resident appointed pursuant to section 7406 of this title) and who accepts responsibilities for carrying out professional services for remuneration other than those assigned under this title shall consist of not 

less than 80 hours in a biweekly pay period (as that term is used 

in section 5504 of title 5). 

(2) The Secretary may modify the hours of employment for a physician or physician assistant appointed in the Administration under 

any provision of this chapter on a full-time basis to be more than 

or less than 80 hours in a biweekly pay period if the total hours of 

employment for such employee in a calendar year does not exceed 

2,080 hours. No physician or physician assistant may accrue overtime by reason of modified hours of employment authorized under 

this paragraph. 

(b) A person covered by subsection (a) may not do any of the following: 

(1) Teach or provide consultative services at any affiliated institution if such teaching or consultation will, because of its nature or duration, conflict with such person’s responsibilities 

under this title. 

(2) Accept payment under any insurance or assistance program established under title XVIII or XIX of the Social Security Act or under chapter 55 of title 10 for professional services 

rendered by such person while carrying out such person’s responsibilities under this title. 

(3) Accept from any source, with respect to any travel performed by such person in the course of carrying out such person’s responsibilities under this title, any payment or per diem 

for such travel, other than as provided for in section 4111 of 

title 5. 

(4) Request or permit any individual or organization to pay, 

on such person’s behalf for insurance insuring such person 


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against malpractice claims arising in the course of carrying out 

such person’s responsibilities under this title or for such person’s dues or similar fees for membership in medical or dental 

societies or related professional associations, except where such 

payments constitute a part of such person’s remuneration for 

the performance of professional responsibilities permitted 

under this section, other than those carried out under this 

title. 

(5) Perform, in the course of carrying out such person’s responsibilities under this title, professional services for the purpose of generating money for any fund or account which is 

maintained by an affiliated institution for the benefit of such 

institution, or for such person’s personal benefit, or both. 

(c) In the case of any fund or account described in subsection 

(b)(5) that was established before September 1, 1973— 

(1) the affiliated institution shall submit semiannually an accounting to the Secretary and to the Comptroller General of 

the United States with respect to such fund or account and 

shall maintain such fund or account subject to full public disclosure and audit by the Secretary and the Comptroller General for a period of three years or for such longer period as the 

Secretary shall prescribe, and 

(2) no person in a position specified in paragraph (1)(B) may 

receive any cash from amounts deposited in such fund or account derived from services performed before that date. 

(d) As used in this section: 

(1) The term ‘‘affiliated institution’’ means a medical school 

or other institution of higher learning with which the Secretary 

has a contract or agreement as referred to in section 7313 of 

this title for the training or education of health personnel. 

(2) The term ‘‘remuneration’’ means the receipt of any 

amount of monetary benefit from any non-Department source 

in payment for carrying out any professional responsibilities. 

(e)(1) The Secretary shall establish a leave transfer program for 

the benefit of health-care professionals in positions listed in section 

7401(1) of this title. The Secretary may also establish a leave bank 

program for the benefit of such health-care professionals. 

(2) To the maximum extent feasible— 

(A) the leave transfer program shall provide the same or 

similar requirements and conditions as are provided for the 

program established by the Director of the Office of Personnel 

Management under subchapter III of chapter 63 of title 5; and 

(B) any leave bank program established pursuant to paragraph (1) shall be consistent with the requirements and conditions provided for agency leave bank programs in subchapter 

IV of such chapter. 

(3) Participation by a health-care professional in the leave transfer program established pursuant to paragraph (1), and in any 

leave bank program established pursuant to such paragraph, shall 

be voluntary. The Secretary may not require any health-care professional to participate in such a program. 

(4)(A) The Secretary and the Director of the Office of Personnel 

Management may enter into an agreement that permits healthcare professionals referred to in paragraph (1) to participate in the 

leave transfer program established by the Director of the Office of 


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Personnel Management under subchapter III of chapter 63 of title 

5 or in any leave bank program established for other employees of 

the Department pursuant to subchapter IV of chapter 63 of title 5, 

or both. 

(B) Participation of such health-care professionals in a leave 

transfer program or a leave bank program pursuant to an agreement entered into under subparagraph (A) shall be subject to such 

requirements and conditions as may be prescribed in such agreement. 

(5) The Secretary is not required to establish a leave transfer 

program for any personnel permitted to participate in a leave 

transfer program pursuant to an agreement referred to in paragraph (4). 

(f) The Secretary may purchase promotional items of nominal 

value for use in the recruitment of individuals for employment 

under this chapter. The Secretary shall prescribe guidelines for the 

administration of the preceding sentence. 

* * * * * * * 

Æ 


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