Page 1 GAO-16-666R VHA Clinical Employee Retention

441 G St. N.W.

Washington, DC 20548

July 29, 2016

The Honorable Richard Blumenthal

Ranking Member

Committee on Veterans’ Affairs

United States Senate

Veterans Health Administration: Personnel Data Show Losses Increased for Clinical 

Occupations from Fiscal Year 2011 through 2015, Driven by Voluntary Resignations and 

Retirements

Dear Senator Blumenthal:

The Department of Veterans Affairs’ (VA) Veterans Health Administration (VHA) provided health

care to about 6.7 million veterans through its 167 VA medical centers (VAMC) and more than 

1,000 outpatient facilities in fiscal year 2015.

1 VHA has faced a growing demand by veterans for 

its health care services, a trend that is expected to continue. For example, the total number of 

annual outpatient medical appointments VHA provided increased by 17.1 million visits (or about 

20 percent) from fiscal year 2011 through 2015.

In 2015, VHA had about 195,900 clinical employees in 45 types of occupations.2 To meet the 

growing demand for care, VHA has implemented a number of targeted hiring initiatives, such as 

a mental health hiring initiative, which brought on about 5,300 staff nationwide from 2012 to 

2013.

Despite its hiring efforts, we and others have expressed concerns about VHA’s ability to ensure 

that it has the appropriate clinical workforce to meet the current and future needs of veterans,

due to factors such as national shortages and increased competition for clinical employees in 

hard-to-fill occupations.3 VHA officials also have expressed concern with its own hiring 

 1

Outpatient facilities include community-based outpatient clinics and health care centers. Community-based 

outpatient clinics are located in areas surrounding VAMCs and provide primary care and some specialty care 

services that do not require a hospital stay. Health care centers are large multi-specialty outpatient clinics that provide 

surgical services.

2

The 195,000 clinical employees are employed specifically in the VHA occupations covered by 38 U.S.C § 7401—a 

specific section of law that provides VHA with the authority to hire clinical employees. This number does not include 

employees of the veteran canteen service, or the VHA central office, health care providers who provided services 

through contracts, or medical residents or trainees that were intermittently employed or in non-pay status. This 

number does include some types of trainees, such as interns and post-doctoral fellows.

3

See Government Accountability Office (GAO), VA Primary Care: Improved Oversight Needed to Better Ensure 

Timely Access and Efficient Delivery of Care, GAO-16-83 (Washington, D.C.: October 8, 2015); VA Mental Health: 

Clearer Guidance on Access Policies and Wait-Time Data Needed, GAO-16-24 (Washington, D.C.: October 28, 

2015); VA Health Care: Oversight Improvements Needed for Nurse Recruitment and Retention Initiatives, GAO-15-

794 (Washington, D.C.: September 30, 2015); VA Health Care: Actions Needed to Ensure Adequate and Qualified 

Nurse Staffing, GAO-15-61 (Washington, D.C.: October 16, 2014); VA Office of the Inspector General, Veterans 

Health Administration: Audit of Physician Staffing Levels for Specialty Care Services, 11-01827-36 (Washington, 
Page 2 GAO-16-666R VHA Clinical Employee Retention

capabilities since 2014 when a well-publicized series of events called into question the ability of 

veterans to gain timely access to care from VHA.4

The Veterans Access, Choice, and Accountability Act of 2014 (Veterans Choice Act) required 

the VA Office of Inspector General (OIG) to identify and report annually on the five VHA clinical 

occupations with the largest staffing shortages.5 In January 2015, the VA OIG reported that 

these were physicians, registered nurses, physician assistants, psychologists, and physical 

therapists.

6 (See Enclosure I, Table 2 for a description of these five occupations.) For the 

purposes of this report, we refer to these as the five shortage occupations.

You asked us to review issues related to retention of clinical employees at VHA. This report 

examines

1) how VHA collects and uses information on employees’ decisions to leave clinical 

occupations, and 

2) what trends, if any, exist over the last 5 years in the number of, and reasons for, VHA 

employee losses from the five shortage occupations. 

To examine how VHA collects and uses information on employees’ decisions to leave clinical 

occupations, we reviewed relevant VHA documentation that described its processes for 

collecting and using information on departing employees’ decisions to leave, including 

information on VHA’s human resources (HR) processes, data systems, and exit survey. We also 

interviewed VHA officials knowledgeable about how information from departing employees is 

collected and used, including officials from VHA’s Offices of Workforce Management and 

Consulting, Healthcare Leadership Talent Institute, and Healthcare Talent Management.

To examine what trends, if any, exist over the last 5 years in the number of, and reasons for,

VHA employee losses from the five shortage occupations, we analyzed 5 years of trend data—

from fiscal years 2011 through 2015—from VHA’s HR data systems and exit survey for the five 

shortage occupations. To provide additional insights, we also identified the 10 clinical 

occupations that had the highest loss rates—the percentage of employee losses relative to the 

total number of employees in that occupation—in fiscal year 2015 and analyzed the number and 

reasons for VHA employee losses from these occupations using the same data.

7 (See 

 D.C.: December 27, 2012), and VA Office of the Inspector General, OIG Determination of Veterans Health 

Administration’s Occupational Staffing Shortages, 15-00430-103 (Washington, D.C.: January 30, 2015).

4

In 2014, news outlets began reporting about extended wait-times for veteran appointments at VHA medical facilities. 

Subsequent investigations by us, the VA OIG, and others substantiated allegations of extended wait-times and we 

found that VHA employees responsible for scheduling appointments at certain facilities engaged in inappropriate 

practices to make wait-times appear more favorable.

5

Pub. L. No. 113-146, § 301, 128 Stat. 1754, 1784 (2014) (codified at 38 U.S.C. § 7412).

6

The VA OIG reviewed VHA data on occupational attrition rates and vacancies, and facilities’ rankings of occupations 

for which they have a critical need. The VA OIG then weighted these rankings based on additional factors, such as 

the total number of facilities that ranked an occupation as a critical need. 

7

When we conducted this analysis, we found that the occupation of therapeutic medical physicist had a loss rate of 

about 8.7 percent, which placed it within the 10 occupations with the highest loss rate for fiscal year 2015. However, 

VHA did not have data for 4 of the 5 years included in our review because data for this position were not separately 

captured prior to fiscal year 2015. As such, we excluded this occupation from our analysis and, instead, included 

practical nurse, which had the next highest loss rate.
Page 3 GAO-16-666R VHA Clinical Employee Retention

Enclosure I, Table 3 for a description of these 10 occupations.) We assessed the reliability of 

these data in several ways, including reviewing each data source for reasonableness and 

consistency with other published reports that used the same data, conducting internal checks 

for missing or erroneous data, and interviewing VHA officials knowledgeable about its reliability. 

Based on these activities, we determined that the data we used were sufficiently reliable for the 

purposes of this report. We also reviewed our prior work and work of the VA OIG that described 

staffing shortages and issues with the retention of clinical employees. Additionally, we 

interviewed knowledgeable VHA officials about these trends.

We conducted this performance audit from January 2016 to July 2016 in accordance with 

generally accepted government auditing standards. Those standards require that we plan and 

perform the audit to obtain sufficient, appropriate evidence to provide a reasonable basis for our 

findings and conclusions based on our audit objectives. We believe that the evidence obtained 

provides a reasonable basis for our findings and conclusions based on our audit objectives.

Results in Brief

We found that VHA collects data on the reasons clinical employees leave the agency and uses 

that data for planning purposes. VHA collects personnel data on the number of and reasons for 

clinical employee losses, including voluntary resignations, retirements, or removals due to 

adverse actions, in its HR databases and through a voluntary exit survey. VHA uses this 

information to evaluate its workforce needs and inform its recruitment and retention efforts.

We also found that VHA losses for the five shortage occupations incrementally increased from 

about 5,900 employees in fiscal year 2011 to about 7,700 in fiscal year 2015. Voluntary 

resignations and retirements were the primary drivers of VHA’s losses for these occupations, 

with resignations accounting for about 54 percent, and retirements 36 percent of losses 

annually, though reasons differed for some occupations. We found a similar trend for all clinical 

occupations across VHA overall. VHA’s exit survey indicated that advancement issues or

dissatisfaction with certain aspects of the work were commonly cited as the primary reasons

respondents in the five shortage occupations left VHA.

VHA Collects and Uses Personnel Data and an Exit Survey to Develop Workforce Plans 

and Inform Retention Efforts

VHA collects information on the reasons employees leave VHA clinical occupations—loss 

type—through personnel actions recorded on employees’ official personnel files and entered 

into VHA’s HR databases.8 These databases provide information on the number of employees 

who leave each year, and loss type, such as voluntary resignation (quitting), transfer to another 

government agency, voluntary retirement, or removal due to adverse actions.

VHA also collects self-reported information on the reasons employees leave clinical occupations 

through an optional exit survey offered to voluntarily departing employees prior to their 

departure. This survey asks departing employees to identify the most important reasons for their 

decisions to leave VA, their plans after leaving VA, and their level of satisfaction with various 

aspects of their jobs. Overall, an average of 30 percent of all clinical employees who left 

 8

Personnel files include the Standard Form 50 which constitutes the official documentation of federal employment. 

VHA HR employees enter information from this and other forms into VHA’s Personnel and Accounting Integrated 

Data (PAID) and WebHR data systems. Through these forms, VHA collects the OPM-approved categories for the 

types of reasons employees leave (e.g. voluntary resignation), referred to as loss type.
Page 4 GAO-16-666R VHA Clinical Employee Retention

voluntarily completed VHA’s exit survey over the past 5 years, though the response rate varied 

by occupation. VHA HR officials told us that a 30 percent response rate is typical for exit 

surveys. In comparison, for example, according to the Office of Personnel and Management, its

2015 senior executive service exit survey also had a response rate of about 30 percent.9

Further, according to VHA officials, some VHA program offices and medical centers may collect 

additional information through other surveys or exit interviews. For example, many VA facilities 

administer a survey to departing registered nurses to better understand their job satisfaction and 

identify opportunities to improve retention of registered nurses. Both the decision to use such 

additional surveys or exit interviews and the manner in which they are administered varies; data 

from these surveys are generally not aggregated at the VHA level.

According to HR officials, VHA uses the information it collects through personnel actions and 

the exit survey in its workforce planning processes as well as its recruitment and retention 

efforts. For example:

• VHA’s National Healthcare Recruitment Service regularly uses data collected through 

personnel actions to focus its recruitment efforts on occupations that are hard to fill and 

have high turnover rates and to help determine which professional events recruitment 

staff should attend to solicit interest by potential job candidates. Exit survey data are

used to gain an understanding of recruitment challenges, such as pay levels, and help 

guide recruitment and retention activities at the local level.

• VHA’s Workforce Planning Team uses data from personnel actions and the exit survey 

in the VHA Workforce and Succession Strategic Plan to identify trends in the number 

and reasons for employee losses. This report is used by senior and local leaders to 

make management decisions related to retaining the workforce, such as using retention 

incentives for specific occupations. 

• VHA’s Workforce Education Program uses data from personnel actions and the exit 

survey to make decisions about VHA’s scholarship program—one of VHA’s employee 

retention tools—and the number of scholarship awards for specific occupations.10

According to VHA officials, the personnel and exit survey data are made available to leadership 

within VHA, its Veterans Integrated Service Networks, and its medical centers through Webbased tools, such as the HR Dashboard.11 VHA leaders at all levels may use this information to 

 9

The “federal senior executive service occupations” category includes most managerial, supervisory, and policy 

positions responsible for directing the work of an organizational unit or exercising important policy-making, policydetermining, or other executive functions, among other things. 

10VHA has a number of scholarship programs that are used to help retain clinical employees. According to VHA 

officials, scholarship programs include, for example: the Health Professionals Scholarship Program, which awards 

scholarships to students who are receiving education or training in health care disciplines for which recruitment and 

retention of qualified personnel is difficult, and the Employee Incentive Scholarship Program, which authorizes VA to 

award scholarships to current employees pursuing degrees or training in health care disciplines for which recruitment 

and retention of qualified personnel is challenging.

11VHA is divided into geographic based networks known as Veterans Integrated Service Networks (VISN). Each 

geographical area has a VISN director who is responsible for making decisions and allocating regional resources.

VHA HR Dashboard is an internal website that provides access to HR data.
Page 5 GAO-16-666R VHA Clinical Employee Retention

make decisions about allocating resources for retention programs, such as additional training 

opportunities.

VHA Losses for the Five Shortage Occupations Increased from Fiscal Year 2011 through 

2015, Driven by Voluntary Resignations and Retirements

VHA’s Losses for the Five Shortage Occupations Increased Annually, and Loss Rates Varied by

Year and Occupation

The number of employees that VHA lost from the five shortage occupations increased each 

year, from about 5,900 employees in fiscal year 2011 to about 7,700 in fiscal year 2015, which 

accounted for about 50 percent of VHA’s total losses across all clinical occupations during this 

period. We found a similar trend for all clinical occupations across VHA—losses increased 

annually during this period. (See table 1).

Table 1: Number of Employees, Losses, and Loss Rate for the Five Shortage and All Clinical Occupations at 

VHA, Fiscal Year 2011 through 2015

2011 2012 2013 2014 2015

Five Shortage Occupations

Total number of employees lost 5,897 6,332 6,726 7,254 7,734

Average number of employees 80,420 81,892 85,299 89,460 94,109

Loss rate (percent) 7.3 7.7 7.9 8.1 8.2

All Clinical Occupations

Total number of employees lost 11,843 12,588 13,523 14,788 15,901

Average number of employees 162,809 167,344 177,315 185,962 195,914

Loss rate (percent) 7.3 7.5 7.6 8.0 8.1

Source: GAO analysis of Veterans Health Administration (VHA) Personnel Data. | GAO-16-666R

From fiscal year 2011 through 2015, occupation loss rates for each of the five shortage 

occupations varied annually, though most saw an overall increase during this period (see fig. 1).

Physician assistants consistently had the highest loss rate among the five shortage 

occupations. The loss rate for physician assistants increased from 9.3 to 10.9 percent during 

this period. The loss rate for physical therapists decreased from fiscal year 2011 to 2012 (from 

8.3 to 6.4 percent), but then increased to 8.0 percent in fiscal year 2015. (See Enclosure II for a 

breakdown of the loss rates—including the number of losses, the number of employees, and the 

individual loss rates per year for each of the five shortage occupations—from fiscal year 2011 

through 2015.)
Page 6 GAO-16-666R VHA Clinical Employee Retention

Figure 1: Loss Rates for Each of the Five Shortage Occupations, Fiscal Year 2011 through 2015

In addition to our review of VHA’s five shortage occupations, we also identified the 10 clinical 

occupations within VHA with the highest loss rates as of fiscal year 2015. The loss rates for 

these 10 occupations also varied (ranging from 5.3 percent to 10.9 percent each year from fiscal 

year 2011 through 2015). We found that two of the five shortage occupations—physician 

assistants and physicians—were among this group of the 10 highest loss-rate occupations each 

year from fiscal year 2011 through 2015. Additionally, two other occupations—medical support 

assistants and nursing assistants—were also consistently among this group of the 10 highest

loss-rate occupations each year during this period.

12 The six remaining occupations were 

technical positions that were generally small in overall number, such as medical supply aides 

and technicians. According to VHA HR officials, employees in these occupations generally do 

not require specialized education or licensing; thus, they tend to be more easily replaced than 

those in the five shortage occupations. (See Enclosure III for a breakdown of these loss rates

for each of the 10 clinical occupations with the highest loss rates, including the number of 

losses, the number of employees, and the individual loss rates per year from fiscal year 2011 

through 2015.)

Voluntary Resignations and Retirements Were the Primary Drivers of VHA Losses, though 

Reasons Differed for Some Occupations

 12Medical support assistants schedule veterans’ appointments and thus play a critical role in ensuring veterans’ 

access to care and nursing assistants attend to basic patient needs and support other nursing staff.
Page 7 GAO-16-666R VHA Clinical Employee Retention

According to VHA’s personnel data, voluntary resignations and retirements accounted for about 

90 percent of VHA’s losses from the five shortage occupations annually from fiscal year 2011 

through fiscal year 2015.13 The percent of losses due to voluntary resignations from the five 

shortage occupations averaged 54 percent during this period and retirements averaged 36 

percent. However, for some occupations, voluntary resignations and retirements accounted for 

a smaller proportion of employee losses. For example, for physical therapists and psychologists,

the resignation rate averaged about 44 percent and retirement averaged about 19 percent 

during the 5-year period. In these occupations, other reasons—primarily expiration of their 

appointments—averaged about 35 and 33 percent of losses, respectively. According to VHA 

officials, expirations of appointments occur when a nonpermanent, time-limited appointment 

ends due to the expiration of the work or the funds available for the position. For physical 

therapists and psychologists, the use of trainees, such as interns or post-doctoral fellows, 

accounted for the majority of losses due to expirations of appointments. Removals accounted 

for a small proportion (5 percent or less, on average) of losses in each of these five occupations 

(see fig. 2).

14 (See Enclosure IV for a breakdown of the reasons employees from the five 

shortage occupations left each year from fiscal year 2011 through 2015.)

Figure 2: Reasons Employees Left the Five Shortage Occupations, Five-Year Average for Fiscal Year 2011 

through 2015

Notes: Resignations include employees who quit and voluntarily transferred to other government agencies. 

Retirement includes voluntary retirements and retirements due to disability or special situations, such as voluntary 

early retirement. Removals include terminations that occurred during a probationary period, and removals due to 

adverse actions. Other reasons employees may depart VHA include death, separations due to a reduction in force 

(layoffs) or an employee entering into a uniformed service, and expirations of nonpermanent, time-limited 

appointments, including trainees, such as interns or post-doctoral fellows.

Totals may exceed 100 percent due to rounding.

 13Resignations include employees who quit and voluntarily transferred to other government agencies. Retirement 

includes voluntary retirements and retirements due to disability or special situations, such as voluntary early 

retirement.

14Removals include terminations that occurred during a probationary period and removals due to adverse actions.
Page 8 GAO-16-666R VHA Clinical Employee Retention

Voluntary resignations and retirements accounted for 84 percent of VHA’s losses from the 10 

occupations with the highest loss rates annually from fiscal year 2011 through fiscal year 2015. 

The percentage of losses due to voluntary resignations from these 10 occupations averaged 

about 55 percent during this period and retirements averaged 30 percent. (See Enclosure V for 

a breakdown of the reasons employees from the 10 occupations with the highest loss rates left 

the agency each year from fiscal year 2011 through 2015.)

The following summarizes the reasons for leaving VHA cited by exit survey respondents in the 

five shortage occupations: 15

• 28 percent said that advancement and 21 percent said that dissatisfaction with certain 

aspects of the work, such as concerns about management and obstacles to getting the 

work done, was the primary reason they were leaving. Other than retirement, these were 

the most commonly cited reasons.16

• 71 percent said that a single event generally did not cause them to think about leaving, 

while 28 percent reported that it did.

• 65 percent were generally satisfied with their jobs over the past year, while 25 percent 

reported that they were not. 

• 50 percent indicated that they were generally satisfied with the quality of senior 

management, while 31 percent were not. 

• 69 percent said that their supervisors did not try to change their minds about leaving, 

while 30 percent reported that they did. 

• 73 percent felt that their immediate supervisors treated them fairly at work, while 15 

percent reported that they did not.

• 67 percent felt that they were treated with respect at work, while 19 percent reported 

they were not.

• 50 percent reported that one or more benefits would have encouraged them to stay, 

such as alternative or part-time schedules (25 percent) or student loan repayment or 

tuition assistance (12 percent), among others.17

(See Enclosure VI for more details from the exit survey responses from the five shortage 

occupations.)

 15VHA’s exit survey is offered to employees who voluntarily resign or retire. The response rate for the five shortage 

occupations averaged about 30 percent over the past 5 years. For each question, some respondents may have opted 

not to respond or provided a response other than what is summarized here. Percentages are approximate.

16We grouped like responses together to create these categories. For example, we aggregated the number of 

responses for ‘”advancement – lack of opportunity within VHA” and “advancement – unique opportunity elsewhere”

into a single category, ‘advancement.’

17Exit survey respondents were instructed to either select all benefits that may have encouraged them to stay or to 

select ‘no benefits would have helped.’ Of the 9,623 employees from the five shortage occupations who completed an 

exit survey from fiscal year 2011 through 2015, about 60 percent (5,830) reported that no benefits would have helped 

encourage them to stay. Because respondents who did not select ‘no benefit would have helped’ could select more 

than one response, the responses by the different benefit categories are not mutually exclusive.
Page 9 GAO-16-666R VHA Clinical Employee Retention

VHA’s exit survey results were similar for respondents from the 10 occupations with the highest 

loss rates to those in the five shortage occupations. For example, respondents from these 10 

occupations also said that advancement issues (34 percent) and dissatisfaction with certain 

aspects of the work (20 percent) were among their primary reasons for leaving. Additionally, the 

majority said that a single event generally did not cause them to think about leaving (71 percent) 

and about 47 percent reported that one or more benefits would have encouraged them to stay, 

such as an alternative or part-time schedule (22 percent) or student loan repayment or tuition 

assistance (12 percent), among others. (See Enclosure VII for more details from the exit survey 

responses from the 10 occupations with the highest loss rates.) 

Agency Comments and Our Evaluation

We are not making recommendations in this report. We provided a draft of this report to VA for 

review and comment. VA provided written comments, which are reprinted in enclosure VIII. In 

their comments, VA provided historical context for loss rate trends. For example, they noted that 

loss rates decreased during the economic downturn of 2008 to 2009 and that current loss rates 

represent a return to the rates seen in fiscal years 2006 to 2007. VA also noted that VHA’s 

workforce challenges mirror those of the health care industry, including the growing national 

shortage of physicians and nurses and increased competition for health care professionals in 

hard-to-fill occupations. Additionally, VA suggested we use other, non-VA data sources to 

provide additional context, however that was outside the scope of this report. VA also provided 

technical comments which we incorporated as appropriate. 

We are sending copies of this report to the appropriate congressional committees and the 

Secretary of Veterans Affairs. In addition, the report is available at no charge on the GAO 

website at http://www.gao.gov. 

If you or your staff have any questions about this report, please contact me at (202) 512-7114 or 

draperd@gao.gov. Contact points for our Offices of Congressional Relations and Public Affairs 

may be found on the last page of this report. GAO staff who made major contributions to this 

report include Lori Achman (Assistant Director), Jennie Apter, LaKendra Beard, Fred Caison, 

Sarah Harvey, Kelli Jones, Vikki Porter, and Jennifer Whitworth.

Sincerely yours,

Debra A. Draper

Director, Health Care

Enclosures – 8
Page 10 GAO-16-666R VHA Clinical Employee Retention

Enclosure I: VHA Clinical Occupation Descriptions

The following tables describe the responsibilities and specialized education 

requirements for the five shortage occupations and the 10 occupations with the highest 

loss rates.

Table 2: Responsibilities and Specialized Education Requirements of the Five Shortage Occupations

Occupation Responsibilities Specialized Education and 

Licensing Requirements 

Physician Administer, supervise, or perform 

professional and scientific work in one or 

more fields of medicine through the practice 

of medicine or direct patient service, 

research and experimental work, or 

determining disability evaluations and 

ratings. Physicians are required to hold 

current licenses to practice medicine or 

surgery.

Complete medical school and have a 

license to practice. The majority of 

physicians are also board certified—a 

testing and certification process that 

deems the physician qualified to provide 

particular types of health care services.

Registered nurse Provides care to patients, administers 

medications, documents patients’ medical 

conditions including admissions and 

discharges, analyzes test results, 

establishes treatment plans, and operates 

medical equipment. 

Complete a nursing education program, 

pass a nurse licensing examination, and 

have a license to practice. 

Physician assistant Takes medical histories, examining and 

treating patients, ordering and analyzing lab 

tests and x-rays, prescribing medication, and 

treating minor injuries.

Graduate from an accredited physician 

assistant program, pass a national 

certifying exam, and have a license to 

practice.

Psychologist Evaluates, diagnoses, and treats mental and 

emotional disorders, using psychological 

tests, interviews, and psychotherapy. Some 

states grant prescribing privileges to medical 

psychologists holding a post-doctoral 

master's degree or equivalent in clinical 

psychopharmacology.

Obtain a professional doctoral degree in 

psychology and (typically) complete a 

period of post-doctoral practice under the 

supervision of a licensed psychologist, 

and have a license to practice.

Physical therapist Provide services that help restore function, 

improve mobility, relieve pain, and limit 

physical disability. Treat disability, injury, and 

disease by use of light, heat, cold, water, 

electricity, massage, and therapeutic 

exercises. Perform tests of range of motion, 

strength, and ability to perform activities of 

daily living. Instruct patients in muscle reeducation and in the use of prosthetic 

devices.

Obtain a graduate degree from an 

accredited physical therapist program and 

take a national licensure exam. Licensing 

requirements vary among the states. 

Source: GAO analysis of Veterans Health Administration and Office of Personnel Management. | GAO 16-666R
Page 11 GAO-16-666R VHA Clinical Employee Retention

Table 3: Responsibilities and Specialized Education Requirements for the 10 Occupations with the Highest 

Loss Rates

Occupation Responsibilities Specialized Education and 

Licensing Requirements 

Physician assistant Takes medical histories, examining and treating patients, 

ordering and analyzing lab tests and x-rays, prescribing 

medication, and treating minor injuries.

Graduate from an accredited 

physician assistant program, 

pass a national certifying exam, 

and have a license to practice.

Medical support 

assistant 

Supervises, leads, or performs administrative support work 

in connection with the care and treatment of patients in 

wards, clinics, or other medical units. The work includes

scheduling veteran appointments and serving as a 

receptionist, record keeping, and providing support to the 

medical staff. 

None. 

Medical supply 

aide and technician 

Provides wards, clinics, operating rooms, and other hospital 

facilities with medical supplies, instrument sets, and 

equipment. 

None. 

Optometrist Applies professional optometric knowledge and skills in 

examining and analyzing the eye for diseases and defects 

and prescribing correctional lenses or exercises.

Graduate from an accredited 

optometry school, pass a 

national examination, and 

obtain a license from a 

regulatory board of optometry. 

Nursing assistant Attends to basic patient needs such as providing personal 

care to patients (e.g., assistance with bathing, dressing, 

and personal hygiene), carries out non-specialized duties 

(e.g., measure blood pressure), and supports other nursing 

staff. 

Has registered as a nursing 

assistant with their state health 

department, and passed a 

written competency examination 

upon completion of a stateapproved training program, 

generally lasting 3 to 12 weeks.

Medical records 

technician 

Encompasses a range of technical support positions which 

supervise or perform work in connection with processing 

medical records. It also includes the analysis, coding, 

compilation, or extraction of medical records data.

None. 

Health technician 

(optometry) 

Assists ophthalmologists in treating outpatients, 

preoperative and postoperative patients, general 

appointments and newly consulted patients. This position 

has four major components: technical functions, optician 

functions, photography functions, and clinic management 

functions.

None.

Physician Administer, supervise, or perform professional and 

scientific work in one or more fields of medicine through the 

practice of medicine or direct patient service, research and 

experimental work, or determining disability evaluations 

and ratings. Physicians are required to hold current license 

to practice medicine or surgery.

Completed medical school, and 

have a license to practice. The 

majority of physicians are also 

board certified—a testing and 

certification process that deems 

the physician qualified to 

provide particular types of 

health care services.

Medical records 

administration

Manage, preserve, analyze, and develop policies and 

procedures on the use of diagnostic and therapeutic 

medical records.

None.

Practical nurse Takes patient vital signs, provides basic care, and 

administers medications, but generally does not provide 

certain complex patient care services such as patient 

assessments or administration of intravenous medications.

Obtained a high school diploma 

or its equivalent and passed a 

licensing examination upon 

completion of a state-approved 

program available at technical 

schools and community 

colleges, typically lasting 1 year.

Source: GAO analysis of Veterans Health Administration, Office of Personnel Management, Bureau of Labor Statistics, and medical information websites. | GAO 16-666R
Page 12 GAO-16-666R VHA Clinical Employee Retention

Enclosure II: VHA Clinical Occupation Loss Rate Data for the Five Shortage 

Occupations

The following tables describe the loss rate data, including the number of losses and employees, 

for the five shortage occupations.

Table 4: Number of Losses for the Five Shortage Occupations, Fiscal Year 2011 through 2015

2011 2012 2013 2014 2015

5-year 

average

Physician 1,671 1,768 1,735 1,979 2,071 1,845

Registered nurse 3,652 4,025 4,358 4,560 4,879 4,295

Physician assistant 175 187 179 206 225 194

Psychologist 274 254 336 362 407 327

Physical therapist 125 98 118 147 152 128

Total 5,897 6,332 6,726 7,254 7,734 6,789

Source: GAO analysis of Veterans Health Administration (VHA) Personnel Data. | GAO-16-666R

Table 5: Number of Employees in the Five Shortage Occupations, Fiscal Year 2011 through 2015

2011 2012 2013 2014 2015

5-year 

average

Physician 20,297 20,692 21,446 22,423 23,500 21,672

Registered nurse 53,071 53,949 55,904 58,603 61,702 56,646

Physician assistant 1,877 1,880 1,899 1,977 2,067 1,940

Psychologist 3,675 3,829 4,425 4,709 4,947 4,317

Physical therapist 1,502 1,541 1,625 1,749 1,893 1,662

Total 80,420 81,892 85,229 89,460 94,109 86,237

Source: GAO analysis of Veterans Health Administration (VHA) Personnel Data. | GAO-16-666R
Page 13 GAO-16-666R VHA Clinical Employee Retention

Table 6: Loss Rate for the Five Shortage Occupations, Fiscal Year 2011 through 2015

2011 2012 2013 2014 2015

5-year 

average

Physician 8.2 8.5 8.1 8.8 8.8 8.5 

Registered nurse 6.9 7.5 7.8 7.8 7.9 7.6 

Physician assistant 9.3 10.0 9.4 10.4 10.9 10.0 

Psychologist 7.5 6.6 7.6 7.7 8.2 7.6 

Physical therapist 8.3 6.4 7.3 8.4 8.0 7.7 

Total 7.3 7.7 7.9 8.1 8.2 7.9

Source: GAO analysis of Veterans Health Administration (VHA) Personnel Data. | GAO-16-666R
Page 14 GAO-16-666R VHA Clinical Employee Retention

Enclosure III: VHA Clinical Occupation Loss Rate Data for the 10 Occupations 

with the Highest Loss Rates

The following tables describe the loss rate data, including the number of losses and employees, 

for the 10 occupations with the highest loss rates.

Table 7: Number of Losses for the 10 Occupations with the Highest Loss Rates, Fiscal Year 2011 through 

2015

2011 2012 2013 2014 2015

5-year 

average

Physician assistant 175 187 179 206 225 194

Medical support 

assistanta 969 1,088 1,403 1,658 1,929 1,409

Medical supply aide 

and technician 221 225 213 205 245 222

Optometrist 47 56 67 86 87 69

Nursing assistant 929 886 938 982 1,056 958

Medical records 

technician 156 152 197 182 230 183

Health technician 

(Optometry) 12 9 16 17 20 15

Physician 1,671 1,768 1,735 1,979 2,071 1,845

Practical nurse 1,033 1,110 1,162 1,114 1,256 1,135

Medical records 

administration 29 29 29 39 38 33

Total 5,242 5,510 5,939 6,468 7,157 6,063

Source: GAO analysis of Veterans Health Administration (VHA) Personnel Data. | GAO-16-666R

a

Medical support assistants schedule veterans’ appointments.
Page 15 GAO-16-666R VHA Clinical Employee Retention

Table 8: Number of Employees for the 10 Occupations with the Highest Loss Rates, Fiscal Year 2011 through 

2015

2011 2012 2013 2014 2015

5-year 

average

Physician assistant 1,877 1,880 1,899 1,977 2,067 1,940

Medical support 

assistanta

10,308 12,004 15,183 16,397 18,453 14,469

Medical supply aide 

and technician 2,416 2,444 2,469 2,462 2,447 2,447

Optometrist 692 716 763 826 884 776

Nursing assistant 10,054 10,173 10,606 11,003 11,278 10,623

Medical records 

technician 2,268 2,269 2,310 2,385 2,469 2,340

Health technician 

(optometry) 161 168 182 200 215 185

Physician 20,297 20,692 21,446 22,423 23,500 21,672

Practical nurse 13,251 13,394 13,789 14,126 14,486 13,809

Medical records 

administration 461 471 476 469 438 463

Total 61,784 64,212 69,123 72,267 76,237 68,724

Source: GAO analysis of Veterans Health Administration (VHA) Personnel Data. | GAO-16-666R

a

Medical support assistants schedule veterans’ appointments.
Page 16 GAO-16-666R VHA Clinical Employee Retention

Table 9: Loss Rate for the 10 Occupations with the Highest Loss Rates, Fiscal Year 2011 through 2015

2011 2012 2013 2014 2015

5-year 

average

Physician assistant 9.3 10.0 9.4 10.4 10.9 10.0 

Medical support 

assistanta 9.4 9.1 9.2 10.1 10.5 9.7 

Medical supply aide 

and technician 9.2 9.2 8.6 8.3 10.0 9.1 

Optometrist 6.8 7.8 8.8 10.4 9.9 8.8 

Nursing assistant 9.2 8.7 8.8 8.9 9.4 9.0 

Medical records 

technician 6.9 6.7 8.5 7.6 9.3 7.8 

Health technician 

(optometry) 7.5 5.3 8.8 8.5 9.3 8.0 

Physician 8.2 8.5 8.1 8.8 8.8 8.5 

Practical nurse 7.8 8.3 8.4 7.9 8.7 8.2 

Medical records 

administration 6.3 6.2 6.1 8.3 8.7 7.1

Total 8.5 8.6 8.6 9.0 9.4 8.8

Source: GAO analysis of Veterans Health Administration (VHA) Personnel Data. | GAO-16-666R

a

Medical support assistants schedule veterans’ appointments.
Page 17 GAO-16-666R VHA Clinical Employee Retention

Enclosure IV: Reasons for VHA Clinical Employee Losses for the Five Shortage 

Occupations

The following tables describe the reasons clinical employees from the five shortage occupations

left VHA.

Table 10: Reasons Employees Left the Five Shortage Occupations, Fiscal Year 2011 through 2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Physician

Resignation 1,122 67.1 1,172 66.3 1,097 63.2 1,256 63.5 1,273 61.5 1,184 64.2

Retirement 397 23.8 411 23.2 481 27.7 564 28.5 633 30.6 497 27.0

Removal 65 3.9 80 4.5 68 3.9 63 3.2 72 3.5 70 3.8

Other 87 5.2 105 5.9 89 5.1 96 4.9 93 4.5 94 5.1

Total 1,671 100.0 1,768 100.0 1,735 100.0 1,979 100.0 2,071 100.0 1,845 100.0

Registered nurse

Resignation 1,867 51.1 1,972 49.0 2,182 50.1 2,316 50.8 2,532 51.9 2,174 50.6 

Retirement 1,514 41.5 1,749 43.5 1,863 42.7 1,937 42.5 2,018 41.4 1,816 42.3 

Removal 200 5.5 198 4.9 207 4.7 201 4.4 203 4.2 202 4.7 

Other 71 1.9 106 2.6 106 2.4 106 2.3 126 2.6 103 2.4 

Total 3,652 100.0 4,025 100.0 4,358 100.0 4,560 100.0 4,879 100.0 4,295 100.0 

Physician assistant 

Resignation 97 55.4 95 50.8 100 55.9 108 52.4 102 45.3 100 51.6 

Retirement 60 34.3 72 38.5 61 34.1 72 35.0 64 28.4 66 33.8 

Removal 9 5.1 6 3.2 5 2.8 9 4.4 11 4.9 8 4.1 

Other 9 5.1 14 7.5 13 7.3 17 8.3 48 21.3 20 10.4 

Total 175 100.0 187 100.0 179 100.0 206 100.0 225 100.0 194 100.0 

Psychologist 

Resignation 118 43.1 109 42.9 145 43.2 144 39.8 210 51.6 145 44.5 

Retirement 59 21.5 49 19.3 53 15.8 76 21.0 82 20.1 64 19.5 

Removal 11 4.0 13 5.1 8 2.4 17 4.7 9 2.2 12 3.6 

Other 86 31.4 83 32.7 130 38.7 125 34.5 106 26.0 106 32.5 

Total 274 100.0 254 100.0 336 100.0 362 100.0 407 100.0 327 100.0 

Physical therapist

Resignation 58 46.4 43 43.9 58 49.2 55 37.4 68 44.7 56 44.1 

Retirement 29 23.2 18 18.4 22 18.6 28 19.0 24 15.8 24 18.9 

Removal 4 3.2 2 2.0 2 1.7 6 4.1 1 0.7 3 2.3 

Other 34 27.2 35 35.7 36 30.5 58 39.5 59 38.8 44 34.7 

Total 125 100.0 98 100.0 118 100.0 147 100.0 152 100.0 128 100.0 

Source: GAO analysis of Veterans Health Administration (VHA) Personnel Data. | GAO-16-666R

Notes: Resignations include employees who quit and those who voluntarily transferred to other government agencies. 

Retirement includes voluntary retirements and retirements due to disability or special situations, such as voluntary 

early retirement. Removals include terminations that occurred during a probationary period, and removals due to 

adverse actions. Other includes death and expirations of nonpermanent, time-limited appointments.
Page 18 GAO-16-666R VHA Clinical Employee Retention

The sum of averages may not sum to total due to rounding.

Table 11: Number and Percent of Physicians Who Left VHA, by Reason, Fiscal Year 2011 through 2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Resignation 1,122 67.1 1,172 66.3 1,097 63.2 1,256 63.5 1,273 61.5 1,184 64.2

Quit 1,098 65.7 1,150 65.0 1,076 62.0 1,239 62.6 1,244 60.1 1,161 63.0

Transfer to 

another 

government 

agency

24 1.4 22 1.2 21 1.2 17 0.9 29 1.4 23 1.2

Retirement 397 23.8 411 23.2 481 27.7 564 28.5 633 30.6 497 27.0

Disabled 13 0.8 14 0.8 12 0.7 17 0.9 12 0.6 14 0.7

Speciala 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Voluntary 384 23.0 397 22.5 469 27.0 547 27.6 621 30.0 484 26.2

Removal 65 3.9 80 4.5 68 3.9 63 3.2 72 3.5 70 3.8

Termination 

during 

probation

22 1.3 16 0.9 22 1.3 21 1.1 25 1.2 21 1.1

Adverse 

actions

43 2.6 64 3.6 46 2.7 42 2.1 47 2.3 48 2.6

Other 87 5.2 105 5.9 89 5.1 96 4.9 93 4.5 94 5.1

Death 27 1.6 33 1.9 29 1.7 19 1.0 22 1.1 26 1.4

Separationb 0 0.0 0 0.0 0 0.0 0 0.0 1 0.0 0 0.0

Expiration of 

appointmentc

60 3.6 72 4.1 60 3.5 77 3.9 70 3.4 68 3.7

Total 1,671 100.0 1,768 100.0 1,735 100.0 1,979 100.0 2,071 100.0 1,845 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Personnel Data. | GAO-16-666R

Notes: The sum of averages may not sum to total due to rounding.

a

Special retirements include non-regular retirements, such as voluntary early retirements. b

Separations occur when there is a reduction in force (layoffs) or when employees leave to enter uniformed service. c

Expiration of appointments occur when nonpermanent, time-limited appointments end due to the expiration of work 

or funds.
Page 19 GAO-16-666R VHA Clinical Employee Retention

Table 12: Number and Percent of Registered Nurses Who Left VHA, by Reason, Fiscal Year 2011 through 

2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Resignation 1,867 51.1 1,972 49.0 2,182 50.1 2,316 50.8 2,532 51.9 2,174 50.6

Quit 1,820 49.8 1,923 47.8 2,135 49.0 2,264 49.6 2,465 50.5 2,121 49.4

Transfer to 

another 

government 

agency

47 1.3 49 1.2 47 1.1 52 1.1 67 1.4 52 1.2

Retirement 1,514 41.5 1,749 43.5 1,863 42.7 1,937 42.5 2,018 41.4 1,816 42.3

Disabled 98 2.7 109 2.7 69 1.6 91 2.0 111 2.3 96 2.2

Speciala 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Voluntary 1,416 38.8 1,640 40.7 1,794 41.2 1,846 40.5 1,907 39.1 1,721 40.1

Removal 200 5.5 198 4.9 207 4.7 201 4.4 203 4.2 202 4.7

Termination 

during 

probation

61 1.7 56 1.4 66 1.5 60 1.3 65 1.3 62 1.4

Adverse 

actions

139 3.8 142 3.5 141 3.2 141 3.1 138 2.8 140 3.3

Other 71 1.9 106 2.6 106 2.4 106 2.3 126 2.6 103 2.4

Death 48 1.3 63 1.6 63 1.4 65 1.4 68 1.4 61 1.4

Separationb 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Expiration of 

appointmentc

23 0.6 43 1.1 43 1.0 41 0.9 58 1.2 42 1.0

Total 3,652 100.0 4,025 100.0 4,358 100.0 4,560 100.0 4,879 100.0 4,295 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Personnel Data. | GAO-16-666R

Notes: The sum of averages may not sum to total due to rounding.

a

Special retirements include non-regular retirements, such as voluntary early retirements. b

Separations occur when there is a reduction in force (layoffs) or when employees leave to enter uniformed service.

c

Expiration of appointments occur when nonpermanent, time-limited appointments end due to the expiration of work 

or funds.
Page 20 GAO-16-666R VHA Clinical Employee Retention

Table 13: Number and Percent of Physician Assistants Who Left VHA, by Reason, Fiscal Year 2011 through 

2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Resignation 97 55.4 95 50.8 100 55.9 108 52.4 102 45.3 100 51.6

Quit 93 53.1 90 48.1 97 54.2 102 49.5 100 44.4 96 49.6

Transfer to 

another 

government 

agency

4 2.3 5 2.7 3 1.7 6 2.9 2 0.9 4 2.1

Retirement 60 34.3 72 38.5 61 34.1 72 35.0 64 28.4 66 33.8

Disabled 5 2.9 8 4.3 0 0.0 2 1.0 5 2.2 4 2.1

Speciala 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Voluntary 55 31.4 64 34.2 61 34.1 70 34.0 59 26.2 62 31.8

Removal 9 5.1 6 3.2 5 2.8 9 4.4 11 4.9 8 4.1

Termination 

during 

probation

1 0.6 1 0.5 0 0.0 1 0.5 1 0.4 1 0.4

Adverse 

actions

8 4.6 5 2.7 5 2.8 8 3.9 10 4.4 7 3.7

Other 9 5.1 14 7.5 13 7.3 17 8.3 48 21.3 20 10.4

Death 1 0.6 2 1.1 3 1.7 2 1.0 5 2.2 3 1.3

Separationb 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Expiration of 

appointmentc

8 4.6 12 6.4 10 5.6 15 7.3 43 19.1 18 9.1

Total 175 100.0 187 100.0 179 100.0 206 100.0 225 100.0 194 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Personnel Data. | GAO-16-666R

Notes: The sum of averages may not sum to total due to rounding.

a

Special retirements include non-regular retirements, such as voluntary early retirements. b

Separations occur when there is a reduction in force (layoffs) or when employees leave to enter uniformed service.

c

Expiration of appointments occur when nonpermanent, time-limited appointments end due to the expiration of work 

or funds.
Page 21 GAO-16-666R VHA Clinical Employee Retention

Table 14: Number and Percent of Physical Therapists Who Left VHA, by Reason, Fiscal Year 2011 through 

2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Resignation 58 46.4 43 43.9 58 49.2 55 37.4 68 44.7 56 44.1

Quit 55 44.0 41 41.8 57 48.3 55 37.4 64 42.1 54 42.5

Transfer to 

another 

government 

agency

3 2.4 2 2.0 1 0.8 0 0.0 4 2.6 2 1.6

Retirement 29 23.2 18 18.4 22 18.6 28 19.0 24 15.8 24 18.9

Disabled 3 2.4 1 1.0 1 0.8 0 0.0 0 0.0 1 0.8

Speciala 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Voluntary 26 20.8 17 17.3 21 17.8 28 19.0 24 15.8 23 18.1

Removal 4 3.2 2 2.0 2 1.7 6 4.1 1 0.7 3 2.3

Termination 

during 

probation

1 0.8 1 1.0 2 1.7 2 1.4 1 0.7 1 1.1

Adverse 

actions

3 2.4 1 1.0 0 0.0 4 2.7 0 0.0 2 1.3

Other 34 27.2 35 35.7 36 30.5 58 39.5 59 38.8 44 34.7

Death 2 1.6 0 0.0 0 0.0 0 0.0 0 0.0 0 0.3

Separationb 1 0.8 0 0.0 0 0.0 0 0.0 0 0.0 0 0.2

Expiration of 

appointmentc

31 24.8 35 35.7 36 30.5 58 39.5 59 38.8 44 34.2

Total 125 100.0 98 100.0 118 100.0 147 100.0 152 100.0 128 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Personnel Data. | GAO-16-666R

Notes: The sum of averages may not sum to total due to rounding.

a

Special retirements include non-regular retirements, such as voluntary early retirements. b

Separations occur when there is a reduction in force (layoffs) or when employees leave to enter uniformed service. c

Expiration of appointments occur when nonpermanent, time-limited appointments end due to the expiration of work 

or funds.
Page 22 GAO-16-666R VHA Clinical Employee Retention

Table 15: Number and Percent of Psychologists Who Left VHA, by Reason, Fiscal Year 2011 through 2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Resignation 118 43.1 109 42.9 145 43.2 144 39.8 210 51.6 145 44.5

Quit 104 38.0 95 37.4 131 39.0 135 37.3 197 48.4 132 40.5

Transfer to 

another 

government 

agency

14 5.1 14 5.5 14 4.2 9 2.5 13 3.2 13 3.9

Retirement 59 21.5 49 19.3 53 15.8 76 21.0 82 20.1 64 19.5

Disabled 3 1.1 2 0.8 3 0.9 3 0.8 2 0.5 3 0.8

Speciala 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Voluntary 56 20.4 47 18.5 50 14.9 73 20.2 80 19.7 61 18.7

Removal 11 4.0 13 5.1 8 2.4 17 4.7 9 2.2 12 3.6

Termination 

during 

probation

4 1.5 8 3.1 3 0.9 2 0.6 0 0.0 3 1.0

Adverse 

actions

7 2.6 5 2.0 5 1.5 15 4.1 9 2.2 8 2.5

Other 86 31.4 83 32.7 130 38.7 125 34.5 106 26.0 106 32.5

Death 4 1.5 3 1.2 4 1.2 6 1.7 2 0.5 4 1.2

Separationb 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Expiration of 

appointmentc

82 29.9 80 31.5 126 37.5 119 32.9 104 25.6 102 31.3

Total 274 100.0 254 100.0 336 100.0 362 100.0 407 100.0 327 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Personnel Data. | GAO-16-666R

Notes: The sum of averages may not sum to total due to rounding.

a

Special retirements include non-regular retirements, such as voluntary early retirements. b

Separations occur when there is a reduction in force (layoffs) or when employees leave to enter uniformed service.

c

Expiration of appointments occur when nonpermanent, time-limited appointments end due to the expiration of work 

or funds.
Page 23 GAO-16-666R VHA Clinical Employee Retention

Enclosure V: Reasons for VHA Clinical Employee Losses for the 10 Occupations 

with the Highest Loss Rates

The following tables describe the reasons clinical employees from the 10 occupations with the 

highest loss rates left VHA.

Table 16: Reasons Employees Left the 10 Occupations with the Highest Loss Rates, Fiscal Year 2011 through 

2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Physician assistant

Resignations 97 55.4 95 50.8 100 55.9 108 52.4 102 45.3 100 51.6 

Retirements 60 34.3 72 38.5 61 34.1 72 35.0 64 28.4 66 33.8 

Removals 9 5.1 6 3.2 5 2.8 9 4.4 11 4.9 8 4.1 

Other 9 5.1 14 7.5 13 7.3 17 8.3 48 21.3 20 10.4 

Total 175 100.0 187 100.0 179 100.0 206 100.0 225 100.0 194 100.0 

Medical support assistanta

Resignations 452 46.6 577 53.0 726 51.7 912 55.0 1,141 59.1 762 54.0 

Retirements 263 27.1 298 27.4 436 31.1 492 29.7 527 27.3 403 28.6 

Removals 152 15.7 135 12.4 150 10.7 182 11.0 204 10.6 165 11.7 

Other 102 10.5 78 7.2 91 6.5 72 4.3 57 3.0 80 5.7 

Total 969 100.0 1,088 100.0 1,403 100.0 1,658 100.0 1,929 100.0 1,409 100.0 

Medical supply aide and technician

Resignations 85 38.5 93 41.3 81 38.0 91 44.4 122 49.8 94 42.6 

Retirements 80 36.2 69 30.7 70 32.9 75 36.6 66 26.9 72 32.5 

Removals 41 18.6 52 23.1 48 22.5 33 16.1 43 17.6 43 19.6 

Other 15 6.8 11 4.9 14 6.6 6 2.9 14 5.7 12 5.4 

Total 221 100.0 225 100.0 213 100.0 205 100.0 245 100.0 222 100.0 

Optometrist

Resignations 14 29.8 17 30.4 19 28.4 28 32.6 25 28.7 21 30.0 

Retirements 6 12.8 7 12.5 8 11.9 11 12.8 11 12.6 9 12.5 

Removals 3 6.4 0 0.0 4 6.0 6 7.0 0 0.0 3 3.8 

Other 24 51.1 32 57.1 36 53.7 41 47.7 51 58.6 37 53.6 

Total 47 100.0 56 100.0 67 100.0 86 100.0 87 100.0 69 100.0 

Nursing assistant

Resignations 358 38.5 366 41.3 425 45.3 454 46.2 522 49.4 425 44.4 

Retirements 292 31.4 279 31.5 269 28.7 263 26.8 283 26.8 277 28.9 

Removals 212 22.8 199 22.5 218 23.2 224 22.8 206 19.5 212 22.1 

Other 67 7.2 42 4.7 26 2.8 41 4.2 45 4.3 44 4.6 

Total 929 100.0 886 100.0 938 100.0 982 100.0 1,056 100.0 958 100.0 

Medical records technician

Resignations 72 46.2 65 42.8 84 42.6 84 46.2 115 50.0 84 45.8 

Retirements 68 43.6 77 50.7 88 44.7 77 42.3 98 42.6 82 44.5 

Removals 11 7.1 6 3.9 18 9.1 13 7.1 10 4.3 12 6.3 

Other 5 3.2 4 2.6 7 3.6 8 4.4 7 3.0 6 3.4 

Total 156 100.0 152 100.0 197 100.0 182 100.0 230 100.0 183 100.0 

Health technician (optometry)

Resignations 7 58.3 5 55.6 5 31.3 10 58.8 12 60.0 8 52.7 

Retirements 4 33.3 3 33.3 9 56.3 5 29.4 5 25.0 5 35.1 

Removals 1 8.3 1 11.1 2 12.5 2 11.8 2 10.0 2 10.8 

Other 0 0.0 0 0.0 0 0.0 0 0.0 1 5.0 0 1.4 

Total 12 100.0 9 100.0 16 100.0 17 100.0 20 100.0 15 100.0 

Physician

Resignations 1,122 67.1 1,172 66.3 1,097 63.2 1,256 63.5 1,273 61.5 1,184 64.2 

Retirements 397 23.8 411 23.2 481 27.7 564 28.5 633 30.6 497 27.0 

Removals 65 3.9 80 4.5 68 3.9 63 3.2 72 3.5 70 3.8 

Other 87 5.2 105 5.9 89 5.1 96 4.9 93 4.5 94 5.1 
Page 24 GAO-16-666R VHA Clinical Employee Retention

Total 1,671 100.0 1,768 100.0 1,735 100.0 1,979 100.0 2,071 100.0 1,845 100.0 

Practical Nurse

Resignations 564 54.6 585 52.7 649 55.9 590 53.0 729 58.0 623 54.9 

Retirements 326 31.6 384 34.6 364 31.3 376 33.8 407 32.4 371 32.7 

Removals 123 11.9 116 10.5 128 11.0 126 11.3 98 7.8 118 10.4 

Other 20 1.9 25 2.3 21 1.8 22 2.0 22 1.8 22 1.9 

Total 1,033 100.0 1,110 100.0 1,162 100.0 1,114 100.0 1,256 100.0 1,135 100.0 

Medical records administration

Resignations 9 31.0 10 34.5 16 55.2 17 43.6 17 44.7 14 42.1 

Retirements 17 58.6 17 58.6 13 44.8 20 51.3 21 55.3 18 53.7 

Removals 1 3.4 0 0.0 0 0.0 2 5.1 0 0.0 1 1.8 

Other 2 6.9 2 6.9 0 0.0 0 0.0 0 0.0 1 2.4 

Total 29 100.0 29 100.0 29 100.0 39 100.0 38 100.0 33 100.0 

Source: GAO analysis of Veterans Health Administration (VHA) Personnel Data. | GAO-16-666R

Notes: Resignations include employees who quit and those who voluntarily transferred to other government agencies. 

Retirement includes voluntary retirements and retirements due to disability or special situations, such as voluntary 

early retirement. Removals include terminations that occurred during a probationary period, and removals due to 

adverse actions. Other includes death and expirations of nonpermanent, time-limited appointments.

The sum of averages may not sum to total due to rounding.

a

Medical support assistants schedule veterans’ appointments.
Page 25 GAO-16-666R VHA Clinical Employee Retention

Table 17: Number and Percent of Physician Assistants Who Left VHA, by Reason, Fiscal Year 2011 through 

2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Resignation 97 55.4 95 50.8 100 55.9 108 52.4 102 45.3 100 51.6

Quit 93 53.1 90 48.1 97 54.2 102 49.5 100 44.4 96 49.6

Transfer to 

another 

government 

agency

4 2.3 5 2.7 3 1.7 6 2.9 2 0.9 4 2.1

Retirement 60 34.3 72 38.5 61 34.1 72 35.0 64 28.4 66 33.8

Disabled 5 2.9 8 4.3 0 0.0 2 1.0 5 2.2 4 2.1

Speciala 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Voluntary 55 31.4 64 34.2 61 34.1 70 34.0 59 26.2 62 31.8

Removal 9 5.1 6 3.2 5 2.8 9 4.4 11 4.9 8 4.1

Termination 

during 

probation

1 0.6 1 0.5 0 0.0 1 0.5 1 0.4 1 0.4

Adverse 

actions

8 4.6 5 2.7 5 2.8 8 3.9 10 4.4 7 3.7

Other 9 5.1 14 7.5 13 7.3 17 8.3 48 21.3 20 10.4

Death 1 0.6 2 1.1 3 1.7 2 1.0 5 2.2 3 1.3

Separationb 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Expiration of 

appointmentc

8 4.6 12 6.4 10 5.6 15 7.3 43 19.1 18 9.1

Total 175 100.0 187 100.0 179 100.0 206 100.0 225 100.0 194 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Personnel Data. | GAO-16-666R

Notes: The sum of averages may not sum to total due to rounding.

a

Special retirements include non-regular retirements, such as voluntary early retirements. b

Separations occur when there is a reduction in force (layoffs) or when employees leave to enter uniformed service.

c

Expiration of appointments occur when nonpermanent, time-limited appointments end due to the expiration of work 

or funds.
Page 26 GAO-16-666R VHA Clinical Employee Retention

Table 18: Number and Percent of Medical Support Assistantsa Who Left VHA, by Reason, Fiscal Year 2011 

through 2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Resignation 452 46.6 577 53.0 726 51.7 912 55.0 1,141 59.1 762 54.0

Quit 381 39.3 470 43.2 645 46.0 766 46.2 922 47.8 637 45.2

Transfer to 

another 

government 

agency

71 7.3 107 9.8 81 5.8 146 8.8 219 11.4 125 8.9

Retirement 263 27.1 298 27.4 436 31.1 492 29.7 527 27.3 403 28.6

Disabled 38 3.9 54 5.0 63 4.5 77 4.6 100 5.2 66 4.7

Specialb 0 0.0 1 0.1 0 0.0 0 0.0 0 0.0 0 0.0

Voluntary 225 23.2 243 22.3 373 26.6 415 25.0 428 22.1 337 23.9

Removal 152 15.7 135 12.4 150 10.7 182 11.0 204 10.6 165 11.7

Termination 

during 

probation

80 8.3 63 5.8 73 5.2 100 6.0 126 6.5 88 6.3

Adverse 

actions

72 7.4 72 6.6 77 5.5 82 4.9 77 4.0 76 5.4

Other 102 10.5 78 7.2 91 6.5 72 4.3 57 3.0 80 5.7

Death 22 2.3 28 2.6 44 3.1 34 2.1 30 1.6 32 2.2

Separationc 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Expiration of 

appointmentd

80 8.3 50 4.6 47 3.3 38 2.3 27 1.4 48 3.4

Total 969 100.0 1,088 100.0 1,403 100.0 1,658 100.0 1,929 100.0 1,409 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Personnel Data. | GAO-16-666R

Notes: The sum of averages may not sum to total due to rounding.

a

Medical support assistants schedule veterans’ appointments.

b

Special retirements include non-regular retirements, such as voluntary early retirements. c

Separations occur when there is a reduction in force (layoffs) or when employees leave to enter uniformed service.

d

Expiration of appointments occur when nonpermanent, time-limited appointments end due to the expiration of work 

or funds.
Page 27 GAO-16-666R VHA Clinical Employee Retention

Table 19: Number and Percent of Medical Supply Aides and Technicians Who Left VHA, by Reason, Fiscal 

Year 2011 through 2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Resignation 85 38.5 93 41.3 81 38.0 91 44.4 122 49.8 94 42.6

Quit 75 33.9 82 36.4 78 36.6 81 39.5 105 42.9 84 38.0

Transfer to 

another 

government 

agency

10 4.5 11 4.9 3 1.4 10 4.9 17 6.9 10 4.6

Retirement 80 36.2 69 30.7 70 32.9 75 36.6 66 26.9 72 32.5

Disabled 6 2.7 9 4.0 4 1.9 12 5.9 7 2.9 8 3.4

Speciala 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Voluntary 74 33.5 60 26.7 66 31.0 63 30.7 59 24.1 64 29.0

Removal 41 18.6 52 23.1 48 22.5 33 16.1 43 17.6 43 19.6

Termination 

during 

probation

27 12.2 24 10.7 26 12.2 15 7.3 27 11.0 24 10.7

Adverse 

actions

14 6.3 28 12.4 22 10.3 18 8.8 16 6.5 20 8.8

Other 15 6.8 11 4.9 14 6.6 6 2.9 14 5.7 12 5.4

Death 9 4.1 3 1.3 7 3.3 4 2.0 12 4.9 7 3.2

Separationb 0 0.0 0 0.0 0 0.0 0 0.0 1 0.4 0 0.1

Expiration of 

appointmentc

6 2.7 8 3.6 7 3.3 2 1.0 1 0.4 5 2.2

Total 221 100.0 225 100.0 213 100.0 205 100.0 245 100.0 222 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Personnel Data. | GAO-16-666R

Notes: The sum of averages may not sum to total due to rounding.

a

Special retirements include non-regular retirements, such as voluntary early retirements. b

Separations occur when there is a reduction in force (layoffs) or when employees leave to enter uniformed service. c

Expiration of appointments occur when nonpermanent, time-limited appointments end due to the expiration of work 

or funds.
Page 28 GAO-16-666R VHA Clinical Employee Retention

Table 20: Number and Percent of Optometrists Who Left VHA, by Reason, Fiscal Year 2011 through 2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Resignation 14 29.8 17 30.4 19 28.4 28 32.6 25 28.7 21 30.0

Quit 14 29.8 16 28.6 19 28.4 28 32.6 23 26.4 20 29.2

Transfer to 

another 

government 

agency

0 0.0 1 1.8 0 0.0 0 0.0 2 2.3 1 0.9

Retirement 6 12.8 7 12.5 8 11.9 11 12.8 11 12.6 9 12.5

Disabled 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Speciala 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Voluntary 6 12.8 7 12.5 8 11.9 11 12.8 11 12.6 9 12.5

Removal 3 6.4 0 0.0 4 6.0 6 7.0 0 0.0 3 3.8

Termination 

during 

probation

0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Adverse 

actions

3 6.4 0 0.0 4 6.0 6 7.0 0 0.0 3 3.8

Other 24 51.1 32 57.1 36 53.7 41 47.7 51 58.6 37 53.6

Death 0 0.0 1 1.8 0 0.0 0 0.0 2 2.3 1 0.9

Separationb 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Expiration of 

appointmentc

24 51.1 31 55.4 36 53.7 41 47.7 49 56.3 36 52.8

Total 47 100.0 56 100.0 67 100.0 86 100.0 87 100.0 69 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Personnel Data. | GAO-16-666R

Notes: The sum of averages may not sum to total due to rounding.

a

Special retirements include non-regular retirements, such as voluntary early retirements. b

Separations occur when there is a reduction in force (layoffs) or when employees leave to enter uniformed service.

c

Expiration of appointments occur when nonpermanent, time-limited appointments end due to the expiration of work 

or funds.
Page 29 GAO-16-666R VHA Clinical Employee Retention

Table 21: Number and Percent of Nursing Assistants Who Left VHA, by Reason, Fiscal Year 2011 through 

2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Resignation 358 38.5 366 41.3 425 45.3 454 46.2 522 49.4 425 44.4

Quit 352 37.9 354 40.0 419 44.7 441 44.9 506 47.9 414 43.2

Transfer to 

another 

government 

agency

6 0.6 12 1.4 6 0.6 13 1.3 16 1.5 11 1.1

Retirement 292 31.4 279 31.5 269 28.7 263 26.8 283 26.8 277 28.9

Disabled 47 5.1 32 3.6 36 3.8 35 3.6 44 4.2 39 4.0

Speciala 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Voluntary 245 26.4 247 27.9 233 24.8 228 23.2 239 22.6 238 24.9

Removal 212 22.8 199 22.5 218 23.2 224 22.8 206 19.5 212 22.1

Termination 

during 

probation

100 10.8 92 10.4 113 12.0 126 12.8 104 9.8 107 11.2

Adverse 

actions

112 12.1 107 12.1 105 11.2 98 10.0 102 9.7 105 10.9

Other 67 7.2 42 4.7 26 2.8 41 4.2 45 4.3 44 4.6

Death 25 2.7 22 2.5 12 1.3 23 2.3 30 2.8 22 2.3

Separationb 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Expiration of 

appointmentc

42 4.5 20 2.3 14 1.5 18 1.8 15 1.4 22 2.3

Total 929 100.0 886 100.0 938 100.0 982 100.0 1,056 100.0 958 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Personnel Data. | GAO-16-666R

Notes: The sum of averages may not sum to total due to rounding.

a

Special retirements include non-regular retirements, such as voluntary early retirements. b

Separations occur when there is a reduction in force (layoffs) or when employees leave to enter uniformed service. c

Expiration of appointments occur when nonpermanent, time-limited appointments end due to the expiration of work 

or funds.
Page 30 GAO-16-666R VHA Clinical Employee Retention

Table 22: Number and Percent of Medical Records Technicians Who Left VHA, by Reason, Fiscal Year 2011 

through 2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Resignation 72 46.2 65 42.8 84 42.6 84 46.2 115 50.0 84 45.8

Quit 65 41.7 59 38.8 78 39.6 76 41.8 99 43.0 75 41.1

Transfer to 

another 

government 

agency

7 4.5 6 3.9 6 3.0 8 4.4 16 7.0 9 4.7

Retirement 68 43.6 77 50.7 88 44.7 77 42.3 98 42.6 82 44.5

Disabled 6 3.8 6 3.9 7 3.6 11 6.0 12 5.2 8 4.6

Speciala 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Voluntary 62 39.7 71 46.7 81 41.1 66 36.3 86 37.4 73 39.9

Removal 11 7.1 6 3.9 18 9.1 13 7.1 10 4.3 12 6.3

Termination 

during 

probation

6 3.8 3 2.0 11 5.6 7 3.8 8 3.5 7 3.8

Adverse 

actions

5 3.2 3 2.0 7 3.6 6 3.3 2 0.9 5 2.5

Other 5 3.2 4 2.6 7 3.6 8 4.4 7 3.0 6 3.4

Death 5 3.2 3 2.0 7 3.6 6 3.3 5 2.2 5 2.8

Separationb 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Expiration of 

appointmentc

0 0.0 1 0.7 0 0.0 2 1.1 2 0.9 1 0.5

Total 156 100.0 152 100.0 197 100.0 182 100.0 230 100.0 183 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Personnel Data. | GAO-16-666R

Notes: The sum of averages may not sum to total due to rounding.

a

Special retirements include non-regular retirements, such as voluntary early retirements. b

Separations occur when there is a reduction in force (layoffs) or when employees leave to enter uniformed service.

c

Expiration of appointments occur when nonpermanent, time-limited appointments end due to the expiration of work 

or funds.
Page 31 GAO-16-666R VHA Clinical Employee Retention

Table 23: Number and Percent of Health Technicians (Optometry) Who Left VHA, by Reason, Fiscal Year 2011 

through 2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Resignation 7 58.3 5 55.6 5 31.3 10 58.8 12 60.0 8 52.7

Quit 6 50.0 4 44.4 5 31.3 8 47.1 8 40.0 6 41.9

Transfer to 

another 

government 

agency

1 8.3 1 11.1 0 0.0 2 11.8 4 20.0 2 10.8

Retirement 4 33.3 3 33.3 9 56.3 5 29.4 5 25.0 5 35.1

Disabled 0 0.0 0 0.0 0 0.0 1 5.9 1 5.0 0 2.7

Speciala 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Voluntary 4 33.3 3 33.3 9 56.3 4 23.5 4 20.0 5 32.4

Removal 1 8.3 1 11.1 2 12.5 2 11.8 2 10.0 2 10.8

Termination 

during 

probation

1 8.3 1 11.1 2 12.5 2 11.8 1 5.0 1 9.5

Adverse 

actions

0 0.0 0 0.0 0 0.0 0 0.0 1 5.0 0 1.4

Other 0 0.0 0 0.0 0 0.0 0 0.0 1 5.0 0 1.4

Death 0 0.0 0 0.0 0 0.0 0 0.0 1 5.0 0 1.4

Separationb 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Expiration of 

appointmentc

0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Total 12 100.0 9 100.0 16 100.0 17 100.0 20 100.0 15 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Personnel Data. | GAO-16-666R

Notes: The sum of averages may not sum to total due to rounding.

a

Special retirements include non-regular retirements, such as voluntary early retirements. b

Separations occur when there is a reduction in force (layoffs) or when employees leave to enter uniformed service. c

Expiration of appointments occur when nonpermanent, time-limited appointments end due to the expiration of work 

or funds.
Page 32 GAO-16-666R VHA Clinical Employee Retention

Table 24: Number and Percent of Physicians Who Left VHA, by Reason, Fiscal Year 2011 through 2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Resignation 1,122 67.1 1,172 66.3 1,097 63.2 1,256 63.5 1,273 61.5 1,184 64.2

Quit 1,098 65.7 1,150 65.0 1,076 62.0 1,239 62.6 1,244 60.1 1,161 63.0

Transfer to 

another 

government 

agency

24 1.4 22 1.2 21 1.2 17 0.9 29 1.4 23 1.2

Retirement 397 23.8 411 23.2 481 27.7 564 28.5 633 30.6 497 27.0

Disabled 13 0.8 14 0.8 12 0.7 17 0.9 12 0.6 14 0.7

Speciala 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Voluntary 384 23.0 397 22.5 469 27.0 547 27.6 621 30.0 484 26.2

Removal 65 3.9 80 4.5 68 3.9 63 3.2 72 3.5 70 3.8

Termination 

during 

probation

22 1.3 16 0.9 22 1.3 21 1.1 25 1.2 21 1.1

Adverse 

actions

43 2.6 64 3.6 46 2.7 42 2.1 47 2.3 48 2.6

Other 87 5.2 105 5.9 89 5.1 96 4.9 93 4.5 94 5.1

Death 27 1.6 33 1.9 29 1.7 19 1.0 22 1.1 26 1.4

Separationb 0 0.0 0 0.0 0 0.0 0 0.0 1 0.0 0 0.0

Expiration of 

appointmentc

60 3.6 72 4.1 60 3.5 77 3.9 70 3.4 68 3.7

Total 1,671 100.0 1,768 100.0 1,735 100.0 1,979 100.0 2,071 100.0 1,845 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Personnel Data. | GAO-16-666R

Notes: The sum of averages may not sum to total due to rounding.

a

Special retirements include non-regular retirements, such as voluntary early retirements. b

Separations occur when there is a reduction in force (layoffs) or when employees leave to enter uniformed service.

c

Expiration of appointments occur when nonpermanent, time-limited appointments end due to the expiration of work 

or funds.
Page 33 GAO-16-666R VHA Clinical Employee Retention

Table 25: Number and Percent of Practical Nurses Who Left VHA, by Reason, Fiscal Year 2011 through 2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Resignation 564 54.6 585 52.7 649 55.9 590 53.0 729 58.0 623 54.9

Quit 553 53.5 549 49.5 622 53.5 567 50.9 697 55.5 598 52.7

Transfer to 

another 

government 

agency

11 1.1 36 3.2 27 2.3 23 2.1 32 2.5 26 2.3

Retirement 326 31.6 384 34.6 364 31.3 376 33.8 407 32.4 371 32.7

Disabled 46 4.5 54 4.9 35 3.0 34 3.1 48 3.8 43 3.8

Speciala 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Voluntary 280 27.1 330 29.7 329 28.3 342 30.7 359 28.6 328 28.9

Removal 123 11.9 116 10.5 128 11.0 126 11.3 98 7.8 118 10.4

Termination 

during 

probation

45 4.4 53 4.8 62 5.3 62 5.6 43 3.4 53 4.7

Adverse 

actions

78 7.6 63 5.7 66 5.7 64 5.7 55 4.4 65 5.7

Other 20 1.9 25 2.3 21 1.8 22 2.0 22 1.8 22 1.9

Death 14 1.4 20 1.8 17 1.5 17 1.5 17 1.4 17 1.5

Separationb 0 0.0 0 0.0 0 0.0 1 0.1 0 0.0 0 0.0

Expiration of 

appointmentc

6 0.6 5 0.5 4 0.3 4 0.4 5 0.4 5 0.4

Total 1,033 100.0 1,110 100.0 1,162 100.0 1,114 100.0 1,256 100.0 1,135 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Personnel Data. | GAO-16-666R

Notes: The sum of averages may not sum to total due to rounding.

a

Special retirements include non-regular retirements, such as voluntary early retirements. b

Separations occur when there is a reduction in force (layoffs) or when employees leave to enter uniformed service.

c

Expiration of appointments occur when a nonpermanent, time-limited appointments end due to the expiration of work 

or funds.
Page 34 GAO-16-666R VHA Clinical Employee Retention

Table 26: Number and Percent of Medical Records Administrators Who Left VHA, by Reason, Fiscal Year 

2011 through 2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Resignation 9 31.0 10 34.5 16 55.2 17 43.6 17 44.7 14 42.1

Quit 5 17.2 10 34.5 14 48.3 17 43.6 16 42.1 12 37.8

Transfer to 

another 

government 

agency

4 13.8 0 0.0 2 6.9 0 0.0 1 2.6 1 4.3

Retirement 17 58.6 17 58.6 13 44.8 20 51.3 21 55.3 18 53.7

Disabled 1 3.4 1 3.4 1 3.4 1 2.6 1 2.6 1 3.0

Speciala 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Voluntary 16 55.2 16 55.2 12 41.4 19 48.7 20 52.6 17 50.6

Removal 1 3.4 0 0.0 0 0.0 2 5.1 0 0.0 1 1.8

Termination 

during 

probation

1 3.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.6

Adverse 

actions

0 0.0 0 0.0 0 0.0 2 5.1 0 0.0 0 1.2

Other 2 6.9 2 6.9 0 0.0 0 0.0 0 0.0 1 2.4

Death 0 0.0 1 3.4 0 0.0 0 0.0 0 0.0 0 0.6

Separationb 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Expiration of 

appointmentc

2 6.9 1 3.4 0 0.0 0 0.0 0 0.0 1 1.8

Total 29 100.0 29 100.0 29 100.0 39 100.0 38 100.0 33 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Personnel Data. | GAO-16-666R

Notes: The sum of averages may not sum to total due to rounding.

a

Special retirements include non-regular retirements, such as voluntary early retirements. b

Separations occur when there is a reduction in force (layoffs) or when employees leave to enter uniformed service.

c

Expiration of appointments occur when a nonpermanent, time-limited appointments end due to the expiration of work 

or funds.
Page 35 GAO-16-666R VHA Clinical Employee Retention

Enclosure VI: Exit Survey Data from Departing Clinical Employees from the Five 

Shortage Occupations Who Completed VHA’s Exit Survey

The following tables describe the responses to various questions—including questions about 

their primary reason for leaving, job satisfaction, and treatment from their managers—provided 

by employees from the five shortage occupations who left VHA and completed the exit survey.

Table 27: Self-Reported Reasons Employees Left the Five Shortage Occupations, Fiscal Year 2011 through 

2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Advancement 427 26.9 507 30.0 509 26.6 553 28.3 690 27.9 2,686 27.9

Desire for parttime schedule 47 3.0 35 2.1 59 3.1 49 2.5 67 2.7 257 2.7

Family matters 314 19.8 298 17.6 341 17.8 341 17.4 451 18.2 1,745 18.1

Insufficient 

compensation 

or benefits

44 2.8 29 1.7 73 3.8 63 3.2 91 3.7 300 3.1

Retirement 388 24.5 425 25.2 460 24.0 442 22.6 563 22.7 2,278 23.7

Work 

dissatisfaction 312 19.7 348 20.6 406 21.2 427 21.8 536 21.6 2,029 21.1

No response 53 3.3 47 2.8 69 3.6 80 4.1 79 3.2 328 3.4

Total 

respondents 1,585 100.0 1,689 100.0 1,917 100.0 1,955 100.0 2,477 100.0 9,623 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Exit Survey Data. | GAO-16-666R

Notes: Respondents were instructed to select a single reason, but some did not respond. The overall response rate 

for the five shortage occupations ranged from about 30 to 35 percent, per year. 

The sum of averages may not sum to total due to rounding.

Table 28: Self-Reported Responses to Whether a Single Event Caused Employees from the Five Shortage 

Occupations to Consider Leaving VHA, Fiscal Year 2011 through 2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Yes 443 27.9 468 27.7 549 28.6 575 29.4 684 27.6 544 28.3

No 1,138 71.8 1,216 72.0 1,354 70.6 1,366 69.9 1,785 72.1 1,372 71.3

No response 4 0.3 5 0.3 14 0.7 14 0.7 8 0.3 9 0.5

Total 

respondents 1,585 100.0 1,689 100.0 1,917 100.0 1,955 100.0 2,477 100.0 1,925 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Exit Survey Data. | GAO-16-666R

Notes: Respondents were instructed to select a single response, but some did not respond. The overall response rate 

for the five shortage occupations ranged from about 30 to 35 percent, per year. 

The sum of averages may not sum to total due to rounding.
Page 36 GAO-16-666R VHA Clinical Employee Retention

Table 29: Self-Reported Responses to Whether Employees from the Five Shortage Occupations Were 

Satisfied with Their Jobs over the Past Year, Fiscal Year 2011 through 2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Generally 

satisfied 1,041 65.7 1,089 64.5 1,242 64.8 1,256 64.2 1,583 63.9 1,233 64.7

Not generally 

satisfied 392 24.7 406 24.0 472 24.6 487 24.9 619 25.0 472 24.8

Neither 

satisfied nor 

not satisfied

136 8.6 171 10.1 187 9.8 193 9.9 256 10.3 182 9.5

No response 16 1.0 23 1.4 16 0.8 19 1.0 19 0.8 17 0.9

Total 

respondents 1,585 100.0 1,689 100.0 1,917 100.0 1,955 100.0 2,477 100.0 1,904 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Exit Survey Data. | GAO-16-666R

Notes: Respondents were instructed to select a single response, but some did not respond. We grouped the 

responses “very satisfied” and “somewhat satisfied” into the category “generally satisfied” and responses ”not very 

satisfied and “not satisfied at all” into the category “generally not satisfied.” The overall response rate for the five 

shortage occupations ranged from about 30 to 35 percent, per year.

The sum of averages may not sum to total due to rounding.

Table 30: Self-Reported Responses to Whether Employees from the Five Shortage Occupations Were 

Satisfied with Their Senior Managers, Fiscal Year 2011 through 2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Generally 

satisfied 814 51.4 847 50.1 961 50.1 943 48.2 1,216 49.1 956 49.7

Not generally 

satisfied 458 28.9 527 31.2 589 30.7 618 31.6 780 31.5 594 30.9

Neither 

satisfied nor 

not satisfied

296 18.7 302 17.9 353 18.4 374 19.1 456 18.4 356 18.5

No response 17 1.1 13 0.8 14 0.7 20 1.0 25 1.0 18 0.9

Total 

respondents 1,585 100.0 1,689 100.0 1,917 100.0 1,955 100.0 2,477 100.0 1,925 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Exit Survey Data. | GAO-16-666R

Notes: Respondents were instructed to select a single response, but some did not respond. We grouped the 

responses “very satisfied” and “somewhat satisfied” into the category “generally satisfied” and responses ”not very 

satisfied and “not satisfied at all” into the category “generally not satisfied.” The overall response rate for the five 

shortage occupations ranged from about 30 to 35 percent, per year.

The sum of averages may not sum to total due to rounding.
Page 37 GAO-16-666R VHA Clinical Employee Retention

Table 31: Self-Reported Responses to Whether Supervisors Tried to Change Employees’ from the Five 

Shortage Occupations Minds About Leaving, Fiscal Year 2011 through 2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Yes 509 32.1 466 27.6 606 31.6 550 28.1 783 31.6 583 30.3

No 1,052 66.4 1,203 71.2 1,287 67.1 1,377 70.4 1,671 67.5 1,318 68.5

No response 24 1.5 20 1.2 24 1.3 28 1.4 23 0.9 24 1.2

Total 

respondents 1,585 100.0 1,689 100.0 1,917 100.0 1,955 100.0 2,477 100.0 1,925 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Exit Survey Data. | GAO-16-666R

Notes: Respondents were instructed to select a single response, but some did not respond. The overall response rate 

for the five shortage occupations ranged from about 30 to 35 percent, per year. 

The sum of averages may not sum to total due to rounding.

Table 32: Self-Reported Responses to Whether Employees from the Five Shortage Occupations Felt Their 

Supervisor Treated Them Fairly, Fiscal Year 2011 through 2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Agree 1,164 73.4 1,203 71.2 1,413 73.7 1,390 71.1 1,828 73.8 1,400 72.7

Disagree 234 14.8 269 15.9 274 14.3 310 15.9 361 14.6 290 15.0

Neither agree 

nor disagree 176 11.1 201 11.9 213 11.1 236 12.1 273 11.0 220 11.4

No response 11 0.7 16 0.9 17 0.9 19 1.0 15 0.6 16 0.8

Total 

Respondents 1,585 100.0 1,689 100.0 1,917 100.0 1,955 100.0 2,477 100.0 1,925 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Exit Survey Data. | GAO-16-666R

Notes: Respondents were instructed to select a single response, but some did not respond. We grouped the 

responses “strongly agree” and “agree” into the category “agree” and responses “disagree” and “strongly disagree”

into the category “disagree.” The overall response rate for the five shortage occupations ranged from about 30 to 35 

percent per year.

The sum of averages may not sum to total due to rounding.
Page 38 GAO-16-666R VHA Clinical Employee Retention

Table 33: Self-Reported Responses to Whether Employees from the Five Shortage Occupations Felt 

Respected, Fiscal Year 2011 through 2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Agree 1,077 67.9 1,135 67.2 1,292 67.4 1,303 66.6 1,657 66.9 1,293 67.2

Disagree 294 18.5 315 18.7 351 18.3 377 19.3 454 18.3 358 18.6

Neither agree 

nor disagree 205 12.9 223 13.2 263 13.7 256 13.1 348 14.0 259 13.5

No response 9 0.6 16 0.9 11 0.6 19 1.0 18 0.7 15 0.8

Total 

respondents 1,585 100.0 1,689 100.0 1,917 100.0 1,955 100.0 2,477 100.0 1,925 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Exit Survey Data. | GAO-16-666R

Notes: Respondents were instructed to select a single response, but some did not respond. We grouped the 

responses “strongly agree” and “agree” into the category “agree” and responses “disagree” and “strongly disagree” 

into the category “disagree.” The overall response rate for the five shortage occupations ranged from about 30 to 35 

percent per year.

The sum of averages may not sum to total due to rounding.
Page 39 GAO-16-666R VHA Clinical Employee Retention

Table 34: Self-Reported Responses to Whether Employees from the Five Shortage Occupations Would Have 

Been Enticed to Stay by Certain Benefits, Fiscal Year 2011 through 2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Alternative or 

part-time work 

schedule

461 29.1 513 30.4 623 32.5 577 29.5 760 30.7 587 25.4

Telework 71 4.5 98 5.8 133 6.9 129 6.6 203 8.2 127 5.5

Child or 

dependent 

care, including 

a child care 

center or 

subsidy

63 4.0 80 4.7 82 4.3 103 5.3 166 6.7 99 4.3

Student loan 

repayment or 

tuition 

assistance

191 12.1 213 12.6 279 14.6 268 13.7 384 15.5 267 11.5

Transit fare 

subsidy 10 0.6 13 0.8 21 1.1 19 1.0 18 0.7 16 0.7

VA-Paid work 

and family 

management 

benefit

40 2.5 48 2.8 51 2.7 40 2.0 85 3.4 53 2.3

No benefits 

would have 

helped

997 62.9 1,062 62.9 1,144 59.7 1,195 61.1 1,432 57.8 1,166 50.4

Total 

respondents 1,585 115.6 1,689 120.0 1,917 121.7 1,955 119.2 2,477 123.1 2,314 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Exit Survey Data. | GAO-16-666R

Notes: Respondents were instructed to select all applicable benefits or that none of these benefits would have 

enticed them to stay at VHA. As such, totals exceed 100 percent. The overall response rate for the five shortage 

occupations ranged from about 30 to 35 percent, per year.

The sum of averages may not sum to total due to rounding.
Page 40 GAO-16-666R VHA Clinical Employee Retention

Enclosure VII: Exit Survey Data from Departing Clinical Employees from the 10 

Occupations with the Highest Loss Rates Who Completed VHA’s Exit Survey

The following tables describe the responses to various questions—including questions about 

primary reason for leaving, job satisfaction, and treatment from their managers—provided by 

employees from the 10 occupations with the highest loss rates who left VHA and completed the 

exit survey.

Table 35: Self-Reported Reasons Employees Left the 10 Occupations with the Highest Loss Rates, Fiscal 

Year 2011 through 2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Advancement 274 31.6 358 36.8 355 32.8 342 32.5 478 34.8 1,807 33.8

Desire for parttime schedule 20 2.3 24 2.5 29 2.7 24 2.3 30 2.2 127 2.4

Family matters 156 18.0 167 17.2 173 16.0 203 19.3 260 18.9 959 17.9

Compensation 

or benefits 29 3.3 28 2.9 32 3.0 38 3.6 40 2.9 167 3.1

Retirement 169 19.5 191 19.7 221 20.4 193 18.3 270 19.7 1,044 19.5

Work 

dissatisfaction 180 20.8 169 17.4 228 21.1 211 20.1 256 18.6 1,044 19.5

No response 39 4.5 35 3.6 43 4.0 41 3.9 40 2.9 198 3.7

Total 

respondents 867 100.0 972 100.0 1,081 100.0 1,052 100.0 1,374 100.0 5,346 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Exit Survey Data. | GAO-16-666R

Notes: Respondents were instructed to select a single reason, but some did not respond. The overall response rate 

for the 10 occupations with the highest loss rates ranged from about 18 to 21 percent, per year.

The sum of averages may not sum to total due to rounding.

Table 36: Self-Reported Responses to Whether a Single Event Caused Employees from the 10 Occupations 

with the Highest Loss Rates to Consider Leaving VHA, Fiscal Year 2011 through 2015 

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Yes 251 29.0 271 27.9 308 28.5 312 29.7 401 29.2 309 28.9

No 614 70.8 698 71.8 758 70.1 735 69.9 968 70.5 755 70.6

No response 2 0.2 3 0.3 15 1.4 5 0.5 5 0.4 6 0.6

Total 

respondents 867 100.0 972 100.0 1,081 100.0 1,052 100.0 1,374 100.0 1,069 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Exit Survey Data. | GAO-16-666R

Notes: Respondents were instructed to select a single response, but some did not respond. The overall response rate 

for the 10 occupations with the highest loss rates ranged from about 18 to 21 percent, per year. 

The sum of averages may not sum to total due to rounding.
Page 41 GAO-16-666R VHA Clinical Employee Retention

Table 37: Self-Reported Responses to Whether Employees from the 10 Occupations with the Highest Loss 

Rates Were Satisfied with Their Job over the Past Year, Fiscal Year 2011 through 2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Generally 

satisfied 554 63.9 648 66.7 674 62.3 675 64.2 893 65.0 670 63.9

Not generally 

satisfied 215 24.8 213 21.9 269 24.9 248 23.6 309 22.5 251 24.0

Neither 

satisfied nor 

not satisfied

90 10.4 107 11.0 115 10.6 122 11.6 160 11.6 115 11.0

No response 8 0.9 4 0.4 23 2.1 7 0.7 12 0.9 12 1.1

Total 

respondents 867 100.0 972 100.0 1,081 100.0 1,052 100.0 1,374 100.0 1,048 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Exit Survey Data. | GAO-16-666R

Notes: Respondents were instructed to select a single response, but some did not respond. We grouped the 

responses “very satisfied” and “somewhat satisfied” into the category “generally satisfied” and responses “‘not very 

satisfied” and “not satisfied at all” into the category “generally not satisfied.” The overall response rate for the 10 

occupations with the highest loss rates ranged from about 18 to 21 percent per year. 

The sum of averages may not sum to total due to rounding.

Table 38: Self-Reported Responses to Whether Employees from the 10 Occupations with the Highest Loss 

Rates Were Satisfied with Their Senior Managers, Fiscal Year 2011 through 2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Generally 

satisfied 466 53.7 521 53.6 561 51.9 528 50.2 724 52.7 560 52.4

Not generally 

satisfied 233 26.9 245 25.2 294 27.2 304 28.9 373 27.1 290 27.1

Neither 

satisfied nor 

not satisfied

160 18.5 195 20.1 216 20.0 215 20.4 265 19.3 210 19.7

No response 8 0.9 11 1.1 10 0.9 5 0.5 12 0.9 9 0.9

Total 

respondents 867 100.0 972 100.0 1,081 100.0 1,052 100.0 1,374 100.0 1,069 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Exit Survey Data. | GAO-16-666R

Notes: Respondents were instructed to select a single response, but some did not respond. We grouped the 

responses “very satisfied” and “somewhat satisfied” into the category “generally satisfied” and responses “‘not very 

satisfied” and “not satisfied at all” into the category “generally not satisfied.” The overall response rate for the 10 

occupations with the highest loss rates ranged from about 18 to 21 percent per year. 

The sum of averages may not sum to total due to rounding.
Page 42 GAO-16-666R VHA Clinical Employee Retention

Table 39: Self-Reported Responses to Whether Supervisors Tried to Change Employees’ Minds about 

Leaving VHA from the 10 Occupations with the Highest Loss Rates, Fiscal Year 2011 through 2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Yes 286 33.0 299 30.8 335 31.0 322 30.6 432 31.4 335 31.3

No 571 65.9 661 68.0 725 67.1 723 68.7 929 67.6 722 67.5

No response 10 1.2 12 1.2 21 1.9 7 0.7 13 0.9 13 1.2

Total 

respondents 867 100.0 972 100.0 1,081 100.0 1,052 100.0 1,374 100.0 1,069 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Exit Survey Data. | GAO-16-666R

Notes: Respondents were instructed to select a single response, but some did not respond. The overall response rate 

for the 10 occupations with the highest loss rates ranged from about 18 to 21 percent, per year.

The sum of averages may not sum to total due to rounding.

Table 40: Self-Reported Responses to Whether Employees from the 10 Occupations with the Highest Loss 

Rates Felt That Their Supervisors Treated Them Fairly, Fiscal Year 2011 through 2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Agree 631 72.8 700 72.0 769 71.1 769 73.1 1,002 72.9 774 72.4

Disagree 134 15.5 143 14.7 187 17.3 144 13.7 178 13.0 157 14.7

Neither agree 

nor disagree 96 11.1 122 12.6 113 10.5 136 12.9 184 13.4 130 12.2

No response 6 0.7 7 0.7 12 1.1 3 0.3 10 0.7 8 0.7

Total 

respondents 867 100.0 972 100.0 1,081 100.0 1,052 100.0 1,374 100.0 1,069 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Exit Survey Data. | GAO-16-666R

Notes: Respondents were instructed to select a single response, but some did not respond. We grouped the 

responses ‘strongly agree’ and ‘agree’ into the category “agree” and responses “disagree” and 

“strongly disagree” into the category “disagree,” The overall response rate for the 10 occupations with the highest 

loss rates ranged from about 18 to 21 percent per year. 

The sum of averages may not sum to total due to rounding.
Page 43 GAO-16-666R VHA Clinical Employee Retention

Table 41: Self-Reported Responses to Whether Employees from the 10 Occupations with the Highest Loss 

Rates Felt Respected, Fiscal Year 2011 through 2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Agree 568 65.5 641 65.9 701 64.8 705 67.0 926 67.4 708 66.2

Disagree 181 20.9 183 18.8 218 20.2 196 18.6 239 17.4 203 19.0

Neither agree 

nor disagree 111 12.8 138 14.2 150 13.9 146 13.9 199 14.5 149 13.9

No response 7 0.8 10 1.0 12 1.1 5 0.5 10 0.7 9 0.8

Total 

respondents 867 100.0 972 100.0 1,081 100.0 1,052 100.0 1,374 100.0 1,069 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Exit Survey Data. | GAO-16-666R

Notes: Respondents were instructed to select a single response, but some did not respond. We grouped the 

responses ‘strongly agree’ and ‘agree’ into the category “agree” and responses “disagree” and 

“strongly disagree” into the category “disagree,” The overall response rate for the 10 occupations with the highest 

loss rates ranged from about 18 to 21 percent per year. 

The sum of averages may not sum to total due to rounding.
Page 44 GAO-16-666R VHA Clinical Employee Retention

Table 42: Self-Reported Responses to Whether Employees from the 10 Occupations with the Highest Loss 

Rates Would Have Been Enticed to Stay by Certain Benefits, Fiscal Year 2011 through 2015

2011 2012 2013 2014 2015 5-year average

Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Alternative or 

part-time work 

Schedule

223 25.7 272 28.0 295 27.3 261 24.8 315 22.9 273 21.5

Telework 47 5.4 56 5.8 71 6.6 71 6.7 107 7.8 70 5.5

Child or 

dependent 

care, including 

a child care 

center or 

subsidy

28 3.2 48 4.9 47 4.3 52 4.9 88 6.4 53 4.1

Student loan 

repayment or 

tuition 

assistance

127 14.6 135 13.9 129 11.9 149 14.2 217 15.8 151 11.9

Transit fare 

subsidy

3 0.3 13 1.3 9 0.8 11 1.0 11 0.8 9 0.7

VA-Paid work 

and family 

management 

benefit

27 3.1 40 4.1 30 2.8 34 3.2 39 2.8 34 2.7

No benefits 

would have 

helped

544 62.7 610 62.8 687 63.6 675 64.2 882 64.2 680 53.5

Total 

respondents

867 115.2 972 120.8 1,081 117.3 1,052 119.1 1,374 120.7 1,271 100.0

Source: GAO analysis of Veterans Health Administration (VHA) Exit Survey Data. | GAO-16-666R

Notes: Respondents were instructed to select all applicable benefits or that none of these benefits would have 

enticed them to stay at VHA. As such, totals exceed 100 percent. The overall response rate for the 10 occupations 

with the highest loss rates ranged from about 18 to 21 percent per year. 

The sum of averages may not sum to total due to rounding.
Page 45 GAO-16-666R VHA Clinical Employee Retention

Enclosure VIII: Comments from the Department of Veterans Affairs
Page 46 GAO-16-666R VHA Clinical Employee Retention
Page 47 GAO-16-666R VHA Clinical Employee Retention

(100598)
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