VETERANS HEALTH 

ADMINISTRATION

Steps Taken to Improve 

Physician Staffing, 

Recruitment, and 

Retention, but Challenges 

Remain

Statement of Debra A. Draper, Director, Health Care

Testimony 

Before the Subcommittee on Health, 

Committee on Veterans’ Affairs, House 

of Representatives

For Release on Delivery 

Expected at 10:00 a.m. ET

Thursday, June 21, 2018

GAO-18-623T

United States Government Accountability Office
United States Government Accountability Office

Highlights of GAO-18-623T, a testimony 

before the Subcommittee on Health, 

Committee on Veterans' Affairs, House of 

Representatives

June 21, 2018

VETERANS HEALTH ADMINISTRATION

Steps Taken to Improve Physician Staffing, 

Recruitment, and Retention, but Challenges Remain

What GAO Found

The Department of Veterans Affairs (VA) Veterans Health Administration (VHA) 

continues to face challenges related to physician staffing, recruitment, and 

retention, though it has begun work to implement recommendations made in 

GAO’s October 2017 report. Specifically, GAO’s report found the following:

• VHA’s data on the number of physicians that provided care at VA 

medical centers (VAMC) were incomplete. GAO found that data were

incomplete because they did not include data on the number of contract 

physicians and contained only limited data on the number of physician 

trainees—two types of physicians that augment the care provided by 

physicians employed by VHA. Thus, VHA data underestimated the total 

number of physicians providing care in its medical centers leaving it unable 

to ensure that its workforce planning processes sufficiently addressed gaps 

in staffing. GAO recommended that VHA implement a process to accurately 

count all its physicians. VHA did not concur with this recommendation, 

stating that it used other tools for workforce planning. VHA has since 

implemented a new human resources (HR) database—HR Smart—that has 

the capability to track each position at its VAMCs. However, VHA officials 

told us they do not plan to include information on physician contractors in this 

database.

• VHA provided VAMCs with guidance on how to determine the number 

of physicians and support staff needed for some physician 

occupations, although it lacked sufficient guidance for its medical and 

surgical specialties. GAO recommended that VHA issue guidance to 

VAMCs on determining appropriate staffing levels for all physicians. VHA 

concurred and reported it would develop staffing guidance for its medical and 

surgical specialties. VHA officials told GAO VHA signed a specialty care 

workgroup charter November 27, 2017; the primary goal of the workgroup 

was to develop a specialty care staffing model that would include staffing 

information for all specialty care. VHA anticipates completing its work and 

issuing staffing guidance by December 2018.

• VHA used various strategies to recruit and retain its physician 

workforce, but had not comprehensively evaluated them to assess 

effectiveness. Without such an evaluation, VHA did not have complete 

information on the underlying causes of the difficulties VAMCs face, or 

whether its recruitment and retention strategies were meeting physician 

workforce needs. GAO recommended VHA (1) establish a system-wide 

method to share information about physician trainees to help fill vacancies 

across VAMCs and (2) conduct a comprehensive, system-wide evaluation of 

VAMCs’ physician recruitment and retention efforts and establish an ongoing 

monitoring program. VHA concurred and reported it has since taken steps to 

address the recommendations. For example, VHA’s Office of Workforce 

Management and Consulting has partnered with its Partnered Evidencebased Policy Resource Center to evaluate and recommend a systematic 

approach for allocating workforce management resources. In addition, VHA 

has added the capability to track physician trainees to its HR Smart 

database. VHA expects to complete its efforts by September 2018 and 

September 2019, respectively.

View GAO-18-623T. For more information, 

contact Debra A. Draper, 202-512-7114 or 

draperd@gao.gov

Why GAO Did This Study

As the demand for VHA’s services 

grows—due, in part, to increasing 

demand from servicemembers 

returning from the United States’ 

military operations in Afghanistan and 

Iraq and the growing needs of an aging 

veteran population—attracting, hiring, 

and retaining top talent is critical to 

VHA’s mission to provide high quality 

and timely care for the nation’s 

veterans.

Physicians—who provide and 

supervise a broad range of care

including primary and specialty care—

serve an integral role in VHA’s mission. 

Certain physician types are 

consistently among the most difficult to 

recruit and retain, and are thus 

considered mission-critical by VHA. 

Over the past two decades, GAO and 

others have expressed concern about 

VHA’s ability to ensure that it has the 

appropriate clinical workforce, 

including physicians, to meet the 

current and future needs of veterans.

This statement is based on GAO’s 

October 2017 report and examines (1) 

VHA information on how many mission 

critical physicians provided care at 

VAMCs, (2) VHA guidance for 

determining its physician staffing 

needs, and (3) the strategies VHA 

used to support the recruitment and 

retention of physicians at VAMCs, and 

the extent to which it has evaluated 

these strategies to determine their 

effectiveness.

For this statement, GAO updated the

information from its October 2017 

report and obtained information from 

VHA officials in June 2018 about steps 

they have taken to implement the 2017 

recommendations. 
Letter

Page 1 GAO-18-623T Veterans Health Administration

Chairman Dunn, Ranking Member Brownley, and Members of the 

Subcommittee:

Thank you for the opportunity to participate in today’s hearing on the 

ability of the Department of Veterans Affairs (VA) Veterans Health 

Administration (VHA) to recruit and retain high-quality physicians. A 

strong clinical workforce capable of providing quality and timely care to 

our nation’s veterans is critical to the success of VHA, which operates 

one of the largest health care systems in the United States, providing 

care at 1,252 facilities, including 170 VA medical centers (VAMC).

1 As the 

demand for VHA’s services grows—due in part to increasing demand 

from servicemembers returning from the United States’ military operations 

in Afghanistan and Iraq, and the growing needs of an aging veteran 

population—attracting, hiring, and retaining top talent is critical to VHA’s 

mission to provide high-quality and timely health care for our nation’s 

veterans.

Physicians—who provide and supervise a broad range of care, including 

primary and specialty care—serve an integral role in VHA’s mission. VHA 

indicated that physicians occupy a top spot on its annual list of missioncritical occupations, as a result of factors including the time frames 

needed for VHA’s hiring process, a limited supply of candidates, and 

competition for candidates.

2 Within the physician category, VHA has also 

identified the top five physician occupations that are the hardest to recruit 

and retain. We use the term “mission-critical physician occupations” to 

refer to the top five physician occupations VHA identified in fiscal year 

2016 as most in need of staffing: primary care, mental health, 

gastroenterology, orthopedic surgery, and emergency medicine. VHA 

hires more than 2,800 mission-critical physicians annually. Yet, 

physicians have consistently been identified by VHA as a critical staffing 

priority due to recruitment and retention concerns.

Over the past two decades, we and others have expressed concerns 

about VHA’s ability to ensure that it has the appropriate clinical workforce 

 1

In addition to the 170 VAMCs, VHA also operates 1,082 outpatient sites of care, such as 

health care centers and community-based outpatient clinics.

2

VHA obtains data from its Veterans Integrated Service Networks and VAMCs on which 

occupations are the highest priority for recruitment and retention based on known 

recruitment and retention concerns, among other factors. See U.S. Department of 

Veterans Affairs, Veterans Health Administration, Mission-Critical Occupation Report 

(2016).

Letter
Page 2 GAO-18-623T Veterans Health Administration

to meet the current and future needs of veterans.

3 A 2015 independent 

assessment found that if VHA does not increase its total number of 

clinical employees, including physicians, it will be difficult for it to meet the 

projected demand for services.

4 Further, in July 2016, we found that the 

number of physicians who leave VHA had steadily increased from fiscal 

years 2011 through 2015. During this time, physicians were among the 10 

occupations with the highest rates of attrition each year.

5 The attrition was 

primarily due to voluntary resignations and retirements.

My statement today is based on our October 2017 report examining VHA 

physician staffing, recruitment, and retention strategies.

6 In particular, my 

statement focuses on (1) VHA information on how many mission-critical 

physicians provided care at VAMCs; (2) VHA guidance for determining its 

physician staffing needs; and (3) the strategies VHA used to support the 

recruitment and retention of physicians at VAMCs, and the extent to 

which it has evaluated these strategies to determine their effectiveness.

As part of that work, we made several recommendations for VHA to 

improve staffing, recruitment, and retention strategies for physicians.

To do the work for our October 2017 report, we reviewed key documents 

and interviewed knowledgeable officials from VHA in headquarters 

offices, as well as in six VAMCs across the country. More detailed 

information on the objectives, scope, and methodology for our 2017 

report can be found in that report. For this statement, we obtained 

information from VHA officials in June 2018 about any steps they have 

taken to implement our 2017 recommendations.

 3

We and the VA Office of the Inspector General have issued at least 16 reports between 

1981 and 2017 that raised a variety of concerns about VHA’s workforce. Recent GAO 

reports include, GAO, Veterans Health Administration: Better Data and Evaluation Could 

Help Improve Physician Staffing, Recruitment and Retention Strategies, GAO-18-124 

(Washington, D.C.: Oct. 19, 2017); Veterans Health Administration: Management 

Attention Is Needed to Address Systemic, Long-standing Human Capital Challenges, 

GAO-17-30 (Washington, D.C.: Dec. 23, 2016); and Veterans Health Administration: 

Personnel Data Show Losses Increased for Clinical Occupations from Fiscal Year 2011 

through 2015, Driven by Voluntary Resignations and Retirements, GAO-16-666R 

(Washington, D.C.: July 29, 2016).

4

See RAND Corporation, Assessment B (Health Care Capabilities), (Santa Monica, Calif: 

Sept. 1, 2015).

5

See GAO-16-666R.

6

See GAO-18-124.
Page 3 GAO-18-623T Veterans Health Administration

This statement is based on work conducted 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.

The attrition among VHA physicians has been of particular concern given 

that the Health Resources and Services Administration (HRSA) 

anticipates that by 2025 the national demand for physician services will 

exceed supply. HRSA’s Office of Rural Health Policy reported, in 2017, 

that physician shortages were exacerbated in rural areas, where 

communities struggle to attract and keep well-trained providers.

7 This 

difficulty has posed a particular challenge for VHA, as approximately one 

in four VAMCs is located in a rural area.

Most physicians providing care at VAMCs are employed by VHA. VHA 

also supplements the capacity of its employed physician staff by acquiring 

additional physician services through fee-basis arrangements or 

contracts. Under fee-basis arrangements, providers are paid a preagreed-upon amount for each service provided. Under contracts, 

physician services may be obtained on a short-term basis; for example, 

through sole-source contracts with academic affiliates.

8 VAMCs may also 

use physicians who volunteer their time, who are referred to as workwithout-compensation providers.

 7

Department of Health and Human Services, Health Resources and Services 

Administration, Designated Health Professional Shortage Areas Statistic, HRSA Data 

Warehouse, accessed May 31, 2017.

8

The term academic affiliate describes any of the following three entities in a partnership 

with a VAMC: (1) a university medical school, (2) a university hospital, or (3) a university 

affiliated physician practice group. If VA requires heath care resources—such as physician 

services, medical equipment usage, or clinical space—and intends to acquire these 

resources from its affiliate due to its connection with a residency program, VA can enter 

into a non-competitive contract with that affiliate. See 38 U.S.C. § 8153(a)(3)(A).These 

sole source contracts are available only to VAMCs and their affiliates, and allow a VAMC 

to obtain physician services directly from the affiliate without competition if those services 

are necessary to support learning opportunities for physicians during their residency 

training in VAMCs. See Department of Veterans Affairs, Health Care Resources 

Contracting—Buying, Title 38 U.S.C. 8153, VA Directive 1663 (Aug. 10, 2006). 

Background
Page 4 GAO-18-623T Veterans Health Administration

In addition to VHA-employed, contract, and fee-basis physicians, VAMCs 

often supplement their capacity by using physician trainees, who include 

medical residents and advanced fellows.

9 In 2016, 135 of the 170 VAMCs 

had active physician training programs. According to VHA officials, there 

were 43,768 medical residents who trained at a VAMC in 2016. VHA has 

been expanding its physician training program, as directed by the 

Veterans Access, Choice, and Accountability Act of 2014, as amended.

10

In 2017, VHA added 175 physician trainee positions across VAMCs 

nationwide, including 3 VAMCs that did not have physician trainees prior 

to this expansion. VHA’s objective is to add 953 additional physician 

trainee positions to its VAMCs by 2025 in order to improve access and 

hire additional physicians. Further, VHA officials told us they want to 

continue to add new positions that would eventually allow all VAMCs 

access to physician trainees.

 9

A medical resident or fellow is a physician who practices medicine under the direct or 

indirect supervision of an attending physician. Successful completion of a residency 

program is a requirement to obtaining an unrestricted license to practice medicine. 

Advanced fellows are individuals who have completed all desired residency training 

(including fellowships) and have stayed in VHA for additional training.

10Pub. L. No, 113-146, § 301(b)(2), 128 Stat. 1754, 1785 (2014), as amended by Pub. L. 

No. 114-315, § 617(a), 113 Stat. 1536, 1577 (2016) (codified at 38 U.S.C. § 7302 note).
Page 5 GAO-18-623T Veterans Health Administration

In our October 2017 report, we found that VHA’s data on physicians who 

provided care at VAMCs were incomplete. Specifically, we found that 

VHA had data on the number of mission-critical physicians it employed 

(more than 11,000) and who provided services on a fee-basis (about 

2,800), but lacked data on the number of contract physicians and 

physician trainees. As a result, VHA did not have data on the extent to 

which VAMCs used these arrangements and thus, underestimated its 

physician use overall. Therefore, VHA was unable to ensure that its 

workforce planning processes sufficiently addressed any gaps in staffing.

All six VAMCs included in our review used at least one type of 

arrangement other than employment for physicians, and five of the six 

used contract physicians or physician trainees. (See fig. 1.) On average, 

contract and fee-basis physicians made up 5 to 40 percent of the 

physicians in a given mission-critical physician occupation at each VAMC 

in our review.

11 For example, officials from a large, highly complex VAMC 

told us that, in March 2017, they augmented the 86 employed primary 

care physicians with eight contract and three fee-basis physicians, which 

represented about 16 percent of their primary care physician workforce.

12

Further, this VAMC also had about 64 primary care physician trainees 

providing certain medical services under the supervision of a senior 

physician.

 11Officials from one of the six VAMCs we reviewed told us that they used both contract 

and fee-basis physicians, but they were not able to determine if these physicians worked 

in mission-critical physician occupations. Also, because physicians who are compensated 

on a fee-basis do not have an assigned full-time equivalent (FTE), we were unable to 

calculate the percentage of FTEs that contract and fee-basis physicians contribute to a 

VAMC. VAMC officials told us that, in order to ensure a physician is on-call 24 hours a 

day, 7 days a week, they may have a number of physicians on contract that only provide a 

limited amount of care.

12The contract and fee-basis physicians constituted approximately 6 percent of the 

VAMC’s primary care FTE positions, which is lower because contract primary care 

physicians were often used on a part-time basis. Officials from this VAMC told us that 

employed primary care physicians filled 85 FTE positions, while contract physicians filled 

3, and fee-basis physicians filled about 1 FTE.

VHA Lacked 

Information on the 

Total Number of 

Mission-Critical 

Physicians Who 

Provided Care at 

VAMCs and Does Not 

Plan to Collect this 

Information
Page 6 GAO-18-623T Veterans Health Administration

Figure 1: VAMCs’ Use of Contract Physicians, Fee-Basis Physicians, and Physician 

Trainees for Mission-Critical Physician Occupations at the Six VAMCs Reviewed for 

Our October 2017 Report

During the course of our work for the October 2017 report, VHA officials 

told us that its personnel databases were designed to manage VHA’s 

payroll systems, but that these databases did not contain information on 

contract physicians or physician trainees. VHA officials told us they were 

working to include information on physician trainees in a new human 

resources (HR) database—HR Smart—which at the time of our review, 

was scheduled to be implemented in 2017. However, these officials were 

not aware of plans to add information to the database on contract 

physicians. Instead, VAMC leaders used locally devised methods to 

identify and track contract physicians, fee-basis physicians, and physician 

trainees. For example, one VAMC in our October 2017 review used a 

locally maintained spreadsheet to track its physicians under 

arrangements other than employment, while another VAMC asked 

department leaders to identify how many of these provided care within 

their respective departments. At each of the six VAMCs in our review, we 

found that department leaders were generally knowledgeable about the 

total number of physicians that provided care within the departments they 

managed. However, this locally maintained information was not readily 

accessible by VHA officials.
Page 7 GAO-18-623T Veterans Health Administration

To address the limitations in VHA’s data, we recommended in our 

October 2017 report that VHA develop and implement a process to 

accurately count all physicians providing care at each of its VAMCs, 

including physicians not employed by VHA. VHA did not concur with this 

recommendation, stating that it uses other tools for workforce planning. 

However, a VHA official acknowledged that data sources used for 

workforce planning may not include all types of contract physicians or 

work-without-compensation physicians.

As we discussed in our prior report, implementing such a systematic 

process would eliminate the need for individual VAMCs to use their own 

mechanisms, such as a locally developed and maintained spreadsheet to 

track its physician workforce, as was done by one VAMC in our prior 

review. Further, local mechanisms may not be readily accessible to VHA 

officials engaged in workforce planning, resulting in incomplete 

information for decision-making purposes. 

Since our report, VHA officials told us that they have completed 

implementation of HR Smart, which provides the capability to track every 

position with a unique position number, and each employee’s full 

employment history. However, VHA officials told us they do not plan to 

enhance the capability of HR Smart to track contractors.

We continue to believe that having a systematic and consistent process

to account for all physicians who provide care across VAMCs, including 

physicians not employed by VHA, would help address concerns that VHA 

is unable to identify all physicians providing care at its VAMCs.

In our October 2017 report, we found that VHA gave responsibility for 

determining staffing needs to its VAMCs and provided its facilities with 

guidance, through policies and directives, on how to determine the 

number of physicians and support staff needed for some physician 

occupations. Specifically, VHA provided this guidance for primary care, 

mental health, and emergency medicine, but lacked sufficient guidance 

for its medical and surgical specialties, including occupations such as 

gastroenterology and orthopedic surgery. For these occupations, VHA 

provided guidance on the minimum number of physicians, but did not 

provide information on how to determine appropriate staffing levels for 

physicians or support staff based on the need for care.

Specifically, the VHA guidance available at the time set a minimum 

requirement that VAMCs of a certain complexity level have at least one 

VHA Has Begun to 

Develop Guidance for 

Determining Its 

Staffing Needs for All 

Physicians
Page 8 GAO-18-623T Veterans Health Administration

gastroenterologist and one orthopedic surgeon that is available within 15 

minutes by phone or 60 minutes in person 24 hours a day, 7 days a 

week.

13 VHA guidance did not include information on how to use data, 

such as workload data, to manage the demand for care or help inform 

staffing levels for these physician occupations beyond this minimum 

requirement. Officials from four of the six VAMCs we reviewed for our 

October 2017 report told us that because they lacked (1) guidance on 

how to determine the number of physicians and support staff needed, and 

(2) data on how their staffing levels compared with those of similar 

VAMCs, they were sometimes unsure whether their staffing levels were 

adequate.

In our October 2017 report, we discussed that VHA had previously 

established, in 2016, a specialty physician staffing workgroup that 

examined the relationships between staffing levels, provider workload and 

productivity, veterans’ access, and cost across VAMCs for its medical and 

surgical specialties, including gastroenterology and orthopedic surgery. 

This group’s work culminated in a January 2017 report that found VHA 

was unable to assess and report on the staffing at each VAMC, as 

required by the Veterans Access, Choice, and Accountability Act of 2014, 

because a staffing model for specialty care had not been established and 

applied across VAMCs. This report made a number of recommendations, 

including that VHA provide guidance to its VAMCs on what level of 

staffing is appropriate for its mission-critical physician occupations. 

However, as we noted in our October 2017 report, VHA leadership had 

not yet taken steps to develop such staffing guidance. We reported that, 

according to a VHA official, other priorities were taking precedence and 

continued work in this area had not yet been approved by VHA 

leadership. Although VHA officials agreed that further steps should be 

taken, they did not indicate when these would occur. In our report, we 

concluded that until VHA issues guidance on staffing levels for certain 

physician occupations that provide specialty care to veterans, there would 

continue to be ambiguity for VAMCs on how to determine appropriate 

staffing levels.

 13VHA categorizes VAMCs according to complexity level, which is determined on the 

basis of the characteristics of the patient population, clinical services offered, educational 

and research missions, and administrative complexity. There are three complexity levels 

with level 1 representing the most complex facilities and level 3 the least complex. Level 1 

is further subdivided into categories 1a, 1b, and 1c. Therefore, VAMCs that are 

categorized as level 1a would offer the most advanced and complex medical treatment 

within VHA’s medical care system.
Page 9 GAO-18-623T Veterans Health Administration

To address this, we recommended that VHA develop and issue guidance 

to VAMCs on determining appropriate staffing levels for all mission-critical 

physician occupations. VHA concurred with our recommendation and 

reported it would evaluate and develop staffing guidance for its medical 

and surgical specialties.

Since our report, VHA officials told us that on November 27, 2017, the 

Executive-in-Charge for VHA signed the specialty care workgroup 

charter. The primary goal of the workgroup is to develop a specialty care 

staffing model that will include staffing information for all specialty care. 

VHA anticipates completing its work and issuing staffing guidance by 

December 2018.

In our October 2017 report, we found that VHA used various strategies to 

recruit and retain its physician workforce, including providing assistance 

recruiting for mission-critical physician occupations through the National 

Recruitment Program; policies and guidance; financial incentives to 

enhance hiring and retention offers; and a national physician training 

program. (See table 1.)

VHA Used Multiple 

Strategies for 

Physician 

Recruitment and 

Retention, but Has 

Not Comprehensively 

Evaluated Them to 

Assess Effectiveness
Page 10 GAO-18-623T Veterans Health Administration

Table 1: VHA Physician Recruitment and Retention Strategies

Providing assistance recruiting for 

mission-critical physician 

occupations

VHA operates the National Recruitment Program that provides direct physician recruitment 

services to Veterans Affairs medical centers (VAMC) for hard-to-recruit positions, including 

physicians. This program, which had 19 physician recruiters as of May 2017, according to 

officials, represents VHA at medical conferences, screens résumés, and develops 

marketing materials, among other things, to identify and refer physician candidates to 

VAMCs.

Policies and guidance VHA administers the policies and guidance developed by VA that provide the basic 

framework for hiring, paying, promoting, and retaining physicians. Using in-person and 

webcast sessions, VHA also provides basic and advanced training to VHA staff on 

personnel policies.

Financial incentives VHA provides financial incentives to strengthen efforts to recruit and retain physicians and 

help to narrow the differences between VHA salary offers and those of private sector 

employers. VAMCs adjust market pay, one component of physician compensation, to reflect 

a physician’s training, experience, and prevailing pay levels in the local medical community. 

Additionally, VHA may offer other types of financial incentives such as the Education Debt 

Reduction Program, which reimburses qualifying education loan debt for employees, 

including physicians, in hard-to-recruit positions.

Physician training program VHA’s physician training program provides VAMC officials with the ability to regularly 

interact with trainees and identify top-performing physicians who would be a “good fit” for 

permanent employment. According to officials, access to this pool of potential hires serves 

as an important recruitment resource. 

Source: Veterans Health Administration (VHA) | GAO-18-623T

In our October 2017 report, we found that VHA faced challenges using its 

strategies for recruiting and retaining physicians. For example, according 

to VHA officials, budget shortfalls in the Education Debt Reduction 

Program—which reimburses qualifying education loan debt for 

employees, including physicians, in hard-to-recruit positions—reduced 

VAMCs’ ability to offer this recruitment incentive to physician candidates. 

In addition, the relatively small number of physician recruiters in VHA’s 

National Recruitment Program—19 recruiters for the 170 VAMCs at the 

time of our report—limited their ability to understand the particular 

nuances of some markets, particularly in rural areas.

Further, despite VHA’s large and expanding graduate medical training 

program, VAMCs experienced difficulties hiring physicians who received

training through its residency and fellowship programs. VHA did not track 

the number of physician trainees who were hired following graduation, but 

officials told us that the number was small in comparison to the almost 

44,000 physician trainees educated at VAMCs each year.

We found that VAMCs faced challenges hiring physician trainees, in part, 

because VHA did not share information on graduating physician trainees 

for recruitment purposes with VAMCs across the system. VHA officials 
Page 11 GAO-18-623T Veterans Health Administration

told us that recruitment efforts could be improved by developing and 

maintaining a database of physician trainees, but said that VHA had no 

such database. According to VHA officials, information sharing could help 

both VAMCs in geographically remote locations that do not have a 

residency program and help identify trainees who want to work at VHA 

after graduating, but who received no offers from the VAMC they trained 

at due to the lack of vacancies in their specialty.

We also reported in October 2017 that VHA did not have complete 

information on whether its recruitment and retention strategies were

meeting its needs. VHA had gathered feedback on barriers VAMCs face 

when offering financial incentives to physician candidates through its 

Education Debt Reduction Program and created a workgroup to look at its 

overall use of physician retention strategies, although it had not 

completed a comprehensive review of its recruitment and retention 

strategies to identify any areas for improvement. As a result, VHA did not 

have complete information on the underlying causes of the difficulties 

VAMCs faced or whether its recruitment and retention strategies met its 

objective of having a robust physician workforce to meet the health care 

needs of veterans.

To address these issues, we recommended that VHA (1) establish a 

system-wide method to share information about physician trainees to help 

fill vacancies across VAMCs, and (2) conduct a comprehensive, systemwide evaluation of its physician recruitment and retention efforts, and 

establish an ongoing monitoring program. VHA concurred with our 

recommendations, and reported it planned to enhance its personnel 

database, HR Smart, to include physician trainees. Additionally, VHA said 

it planned to complete a comprehensive, system-wide evaluation of the 

physician recruitment and retention strategies.

Since our report, VHA reported taking some steps to address these 

recommendations. Specifically, officials told us they are working to 

include information in the newly implemented HR Smart database on 

work-without-compensation employees, such as physician trainees, and 

anticipate conducting pilot projects at various sites before fully 

implementing this capability by September 30, 2019. Additionally, officials 

said that they are in the process of completing a review of physician 

recruitment and retention incentives. Furthermore, according to VHA 

officials, beginning in October 2017, VHA’s Office of Workforce 

Management and Consulting partnered with the Partnered Evidencebased Policy Resource Center—an internal VHA resource center—to 

evaluate and recommend a systematic approach for allocating workforce 
Page 12 GAO-18-623T Veterans Health Administration

management resources, such as the Education Debt Reduction Program. 

VHA expects to complete its efforts by September 2018.

Chairman Dunn, Ranking Member Brownley, and Members of the 

Subcommittee, this concludes my statement. I would be pleased to 

respond to any questions you may have.

For further information about this statement, please contact Debra A. 

Draper 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 testimony. Key contributors to this statement were 

Janina Austin (Assistant Director), Sarah Harvey (Analyst-in-Charge), 

Jennie Apter, Frederick Caison, Alexander Cattran, and Krister Friday.

GAO Contact and 

Staff 

Acknowledgments

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