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25–123 2017

LEGISLATIVE HEARING ON DRAFT LEGISLATION 

TO IMPROVE THE AUTHORITY OF THE SECRETARY OF VETERANS AFFAIRS TO HIRE AND 

RETAIN PHYSICIANS AND OTHER EMPLOYEES 

OF THE DEPARTMENT OF VETERANS AFFAIRS 

JOINT HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH 

JOINT WITH

SUBCOMMITTEE ON ECONOMIC OPPORTUNITY 

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED FOURTEENTH CONGRESS 

SECOND SESSION 

WEDNESDAY, MARCH 16, 2016 

Serial No. 114–60 

Printed for the use of the Committee on Veterans’ Affairs 

( 

Available via the World Wide Web: http://www.fdsys.gov 

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(II) 

COMMITTEE ON VETERANS’ AFFAIRS 

JEFF MILLER, Florida, Chairman 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida, Vice-Chairman 

DAVID P. ROE, Tennessee 

DAN BENISHEK, Michigan 

TIM HUELSKAMP, Kansas 

MIKE COFFMAN, Colorado 

BRAD R. WENSTRUP, Ohio 

JACKIE WALORSKI, Indiana 

RALPH ABRAHAM, Louisiana 

LEE ZELDIN, New York 

RYAN COSTELLO, Pennsylvania 

AMATA COLEMAN RADEWAGEN, American 

Samoa 

MIKE BOST, Illinois 

CORRINE BROWN, Florida, Ranking 

Minority Member 

MARK TAKANO, California 

JULIA BROWNLEY, California 

DINA TITUS, Nevada 

RAUL RUIZ, California 

ANN M. KUSTER, New Hampshire 

BETO O’ROURKE, Texas 

KATHLEEN RICE, New York 

TIMOTHY J. WALZ, Minnesota 

JERRY MCNERNEY, California 

JON TOWERS, Staff Director 

DON PHILLIPS, Democratic Staff Director 

SUBCOMMITTEE ON HEALTH 

DAN BENISHEK, Michigan, Chairman 

GUS M. BILIRAKIS, Florida 

DAVID P. ROE, Tennessee 

TIM HUELSKAMP, Kansas 

MIKE COFFMAN, Colorado 

BRAD R. WENSTRUP, Ohio 

RALPH ABRAHAM, Louisiana 

JULIA BROWNLEY, California, Ranking 

Member 

MARK TAKANO, California 

RAUL RUIZ, California 

ANN M. KUSTER, New Hampshire 

BETO O’ROURKE, Texas 

SUBCOMMITTEE ON ECONOMIC OPPORTUNITY 

BRAD WENSTRUP, Ohio, Chairman 

LEE ZELDIN, New York 

AMATA RADEWAGEN, American Samoa 

RYAN COSTELLO, Pennsylvania 

MIKE BOST, Illinois 

MARK TAKANO, California, Ranking 

Member 

DINA TITUS, Nevada 

KATHLEEN RICE, New York 

JERRY MCNERNEY, California 

Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records 

of the Committee on Veterans’ Affairs are also published in electronic form. The printed 

hearing record remains the official version. Because electronic submissions are used to 

prepare both printed and electronic versions of the hearing record, the process of converting 

between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process 

is further refined. 

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(III) 

C O N T E N T S 

Wednesday, March 16, 2016 

Page 

Legislative Hearing On Draft Legislation To Improve The Authority Of The 

Secretary Of Veterans Affairs To Hire And Retain Physicians And Other 

Employees Of The Department Of Veterans Affairs ......................................... 1 

OPENING STATEMENTS 

Honorable Dan Benishek, Chairman, Subcommittee on Health ......................... 1 

Honorable Brad R. Wenstrup, Chairman, Subcommittee on Economic Opportunity ..................................................................................................................... 2 

Honorable Julia Brownley, Ranking Member, Subcommittee on Health ........... 3 

Honorable Mark Takano, Ranking Member, Subcommittee on Economic Opportunity ............................................................................................................... 3 

WITNESSES 

Max Stier, President and Chief Executive Officer, Partnership for Public 

Service ................................................................................................................... 4 

Prepared Statement ......................................................................................... 28 

Roscoe G. Butler, Deputy Director of Health Care, National Veterans Affairs 

and Rehabilitation Division, The American Legion .......................................... 6 

Prepared Statement ......................................................................................... 36 

Carlos Fuentes, Senior Legislative Associate, Veterans of Foreign Wars of 

the United States ................................................................................................. 8 

Prepared Statement ......................................................................................... 42 

Carolyn Clancy, M.D., Deputy Under Secretary for Health for Organizational 

Excellence, Veterans Health Administration, U.S. Department of Veterans 

Affairs .................................................................................................................... 9 

Prepared Statement ......................................................................................... 44 

Accompanied by: 

Elias Hernandez, Chief Office, Workforce Management and Consulting, 

Veterans Health Administration, U.S. Department of Veterans Affairs 

STATEMENTS FOR THE RECORD 

American Federation of Government Employees .................................................. 47 

National Association of VA Physicians and Dentists ........................................... 49 

Veterans Affairs Physician Assistant Association ................................................ 52 

Nurses Organization of Veterans Affairs ............................................................... 57 

Merritt Hawkins ...................................................................................................... 58 

Paralyzed Veterans of America .............................................................................. 63 

Disabled American Veterans .................................................................................. 65 

Iraq and Afghanistan Veterans of America ........................................................... 68 

Reserve Officers Association ................................................................................... 69 

American Podiatric Medical Association ................................................................ 74 

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Leonard.horne on VACREP0180 with DISTILLER

(1) 

LEGISLATIVE HEARING ON DRAFT LEGISLATION TO IMPROVE THE AUTHORITY OF THE 

SECRETARY OF VETERANS AFFAIRS TO 

HIRE AND RETAIN PHYSICIANS AND OTHER 

EMPLOYEES OF THE DEPARTMENT OF VETERANS AFFAIRS 

Wednesday, March 16, 2016 

U.S. HOUSE OF REPRESENTATIVES, COMMITTEE ON VETERANS’ AFFAIRS, SUBCOMMITTEE ON HEALTH, Washington, D.C. 

The Subcommittees met, pursuant to notice, at 2:04 p.m., in 

Room 334, Cannon House Office Building, Hon. Dan Benishek 

[Chairman of the Committee] presiding. 

Present: Representatives Benishek, Wenstrup, Bilirakis, Zeldin, 

Roe, Costello, Huelskamp, Coffman, Bost, Abraham, Brownley, 

Takano, Ruiz, Titus, Kuster, O’Rourke, McNerney. 

OPENING STATEMENT CHAIRMAN DAN BENISHEK 

Mr. BENISHEK. Good afternoon. The Subcommittee will come to 

order. Welcome to today’s joint Subcommittee on Health and Subcommittee on Economic Opportunity legislative hearing on draft 

legislation to improve the authority of the secretary of veterans affairs to hire and retaken physicians and other employees of the Department of Veterans Affairs. 

Thank you for all joining us here today. As I said before, providing a top-notch health care and benefits that our Nation’s veterans deserve is impossible without an equally top-notch workforce. 

VA’s future depends on VA’s ability to officially recruit and retain 

highly qualified and highly motivated professionals at all levels. 

Unfortunately, hiring remains a serious challenge across the department, a challenge that will only grow as VA’s current staff gets 

older and increasingly eligible for retirement and the private sector 

and health care and benefits landscape gets increasingly competitive. 

The draft bill that we will be discussing this afternoon would 

simplify and shorten the VA’s hiring process, strengthen VA’s ability to bring the very best employees onboard, most importantly, ensure a robust workforce is available to serve our veterans for years 

to come, contains a number of VA legislative proposals that would 

improve the department’s ability to recruit and fairly compensate 

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key leaders and grant schedule flexibility for critical medical personnel. 

It also contains other important provisions that would, among 

other things, increase training for VA human resources employees, 

create a centralized recruiting database to assist in identifying interested applicants for vacant positions, eliminate compensation 

panels that would lengthen the hiring process for incoming physicians, and unnecessarily take existing providers away from direct 

patient care, and allow certain aspiring VA leaders to participate 

in an executive management fellowship program to gain valuable 

private sector experience that could be used to improve the VA’s 

performance. 

I am grateful to be here today with Dr. Wenstrup, the Chairman 

of the Subcommittee on Economic Opportunity, to be working with 

him and other Members of our two Subcommittees on this very important issue. I thank you all for being here and now yield to Dr. 

Wenstrup for any opening statement he may have. 

OPENING STATEMENT OF BRAD R. WENSTRUP 

Mr. WENSTRUP. Well, thank you, Dr. Benishek and good afternoon. And thank you to everyone with us here today. 

I look forward to our discussion today, as we have spent several 

months working on this proposal and listening to key stakeholders 

and holding a joint roundtable last December to begin the discussion on the language and to ensure we are doing this right. 

I know this Committee has focused heavily on accountability and 

while I think it is of the utmost importance, I think it is important 

that we also focus on the hiring and retention of high-quality employees within the department so that our veterans receive the best 

services possible. 

Last year, I made a commitment to several of our colleagues to 

also focus on improving the hiring process at VA, and I am excited 

about the work that has been done to package some common sense 

provisions together. I would note that this is still a draft bill. Let 

me just say that again, this is still a draft bill, and I look forward 

to the feedback that we will receive today so that we can make necessary changes to make the bill as close to perfect as possible. 

I do want to keep my comments short so we can get to our witnesses and their testimonies and questions, but before I yield back 

to Dr. Benishek, I do want to make a couple of comments about the 

testimony and views VA provided to us today, which I have to say 

are somewhat minimal at best, at this time. 

I am disappointed the department was unable to provide views 

or comment on a majority of the provisions that are in this bill. We 

want your opinion. And I understand that we only gave VA a couple weeks’ notice about this hearing, and I know the OMB bureaucratic process is not known to be speedy, but this is not the first 

time the department has seen this bill or a version of this bill, as 

a draft was provided to the VA last November in preparation for 

our roundtable in December. So, I do hope to hear more from VA 

on these issues because we need your input. 

And with that, I yield back. 

Mr. BENISHEK. Thank you, Dr. Wenstrup. 

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I will now yield to Ms. Brownley, Ranking Member of the Subcommittee on Health, for any opening statement she may have. 

OPENING STATEMENT OF JULIA BROWNLEY, RANKING 

MEMBER 

Ms. BROWNLEY. Thank you, Mr. Chairman. 

And I want to thank you and Chairman Wenstrup for holding 

this hearing today. I would also like to thank the witnesses here 

today who have joined us to provide their expert views on the discussion draft we have before us. 

This draft legislation is another step forward in revising hiring 

practices at the Department of Veterans Affairs. As with any legislation, as Mr. Wenstrup said, we should make every attempt to 

scrutinize the provisions and understand the unintended consequences that may arise from good intentions contained in the 

bill. 

This draft includes my common sense provisions including setting competitive pay levels for medical center and network directors and ensuring that emergency room doctors and staff have the 

scheduling flexibility needed to provide quality services when they 

are needed. I support the effort to institute competitive pay for VA 

medical center directors. The West Los Angeles VA Medical Center, 

which serves my veterans in my county, in Ventura County, recently hired its first permanent director in more than two years. 

I believe that making medical center directors’ salaries more comparable with market rates would go a long way towards attracting 

and keeping the most-qualified candidates and filling the leadership vacuum that exists in many of the veteran-integrated service 

networks. 

I appreciate the concerns many of the witnesses have brought to 

your attention in their submitted testimony. I also have some concerns about the draft bill. In particular, I hope that we can work 

to come to an agreement, particularly, on Section 9 which modifies 

the existing veterans hiring preference. I would like to understand 

the pros and cons of this section better so as we move forward, we 

are not putting the VA at a disadvantage when competing for executive talent with other agencies in the private sector. 

I look forward to hearing from our guests today on their thoughts 

on improving the system, and, again, I thank both the Chairmans 

for calling this hearing. 

Mr. BENISHEK. Thank you very much. 

I will now yield to Mr. Takano, the Ranking Member of the Subcommittee on Economic Opportunity, for any opening statement 

that he may have. Mr. Takano? 

OPENING STATEMENT OF MARK TAKANO 

Mr. TAKANO. Thank you to both Chairmen for holding this hearing. Thank you, Chairman Benishek. 

Over the past three years, the Veterans’ Affairs Committee has 

worked hard to reform the VA, particularly, as it involves the discovery of health care by the Veterans Health Administration. During this time, we have focused much of our discussion and our disagreements on how easy we should make it for the VA to fire emLeonard.horne on VACREP0180 with DISTILLER

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ployees. We have also focused on the important role of VA whistleblowers and how we can best protect them from retaliation. 

Today, we have the opportunity to discuss another important element of employment at the VA, a draft bill that seeks to improve 

VA’s ability to attract, hire, and retain the best employees and providers. The draft legislation is a good starting point. I am encouraged by common sense solutions such as granting VA providers to 

work more or less 80 hours per bi-weekly work period. I want to 

thank my colleague Dr. Ruiz for introducing this idea. I just 

thanked you, Dr. Ruiz. 

I also support—you had a great idea with this 80 hours per biweekly work period—I also strongly support incentivizing more student veterans to pursue graduate medical education programs in 

mental health fields, and hope we can do more to encourage graduates to work at the VA. 

I want to ensure we do not dilute Veterans’ Preference or cut out 

valuable H.R. procedures for the sake of efficiency, but today I plan 

to listen to the hopefully robust discussion on these sensitive topics. 

So, again, I thank the Chairmen for bringing this bill to us to 

discuss and improve before it is introduced. 

Thank you also to the VSOs, the VA, and other representatives 

who have come to join in this discussion. I look forward to hearing 

how we can help VA improve its hiring policies. 

Thank you, and I yield back, Mr. Chairman. 

Mr. BENISHEK. Thank you, Mr. Takano. 

Joining us on our first and only panel is Max Stier, the President 

and Chief Executive Officer of the Partnership for Public Service; 

Mr. Roscoe Butler, the Deputy Director of Health Care for the National Veterans Affairs and Rehabilitation Division of The American Legion; Carlos Fuentes, the Senior Legislative Associate for 

the Veterans of Foreign Wars of the United States; and Dr. Carolyn Clancy, the Deputy Under Secretary for Health for Organizational Excellence for the Veterans Health Administration of the 

U.S. Department of Veterans Affairs; accompanied by Elias Hernandez, the Chief Officer for Workforce Management and Consulting. 

Thank you all for being here this afternoon. Mr. Stier, we will 

begin with you. Please proceed with your testimony. You have five 

minutes. 

STATEMENT OF MAX STIER 

Mr. STIER. Thank you very much for holding this hearing and for 

the work you have done here. 

The problems you are addressing are problems that face the entire government, but I would say that you are the best Committee 

on trying to address them, so kudos to you. Also, I wanted to thank 

you for the great work you have done with your own staff, because 

they have been exceptional to work with, and that is critical for 

you, for the legislation, and bluntly, for the country. 

This is an incredibly important issue. Three facts that stand out 

to—one of them is the limited demographic diversity that exists at 

the VA. In 2015, it was only two-thirds of 1 percent of VA’s workforce was under the age of 25. So, think about that, two-thirds of 

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1 percent, and only 5.35 percent were under the age of 30. So that 

is one devastating fact. Second, only around a half of 1 percent of 

new hires since 2012 have been under the Pathways Program, 

which is the primary way that agencies are supposed to be hiring 

either student interns or recent college graduates. The third devastating fact is a recent study that showed that ratings of government agencies on the statement, ‘‘My agency is unable to recruit 

the best employees,’’ should VA and its components were at or near 

the top. That is the backdrop that you are seeing here. It is so important. 

I have three areas, where I think you are really doing important 

work on this bill. One involves the talent itself. A couple of things 

that are powerful and you have heard in some of the opening statements that you made, supporting market pay for your medical directors, is very important. You are not going to get the talent that 

you need in that area unless you do that. 

We would argue at the Partnership that the pay system, more 

generally, in the Federal workforce is broken. It was built in 1949. 

It was about internal equity when you had a clerical workforce. 

The whole thing should be based on market compensation in a 

world in which that is the way we have to compete for talent. That 

may mean some folks are paid more, some folks less, but that is 

the right way to do it. But you are going in the right direction with 

that. 

Secondly, you improve the Pathways Program, which brings student interns and new college graduates in—in very important 

ways. That is going to be very important to do. One thing I would 

add is you have to encourage the VA to actually use the authority—and I will come back to this—the legislation is a starter pistol; 

it is not at the end of the day. You have given them tools, but I 

hope you will do oversight to make sure that they use that authority you are providing them. 

On data, you can’t manage what you don’t measure. I think in 

this bill you are requiring a number of data points to be collected 

around hiring effectiveness. It will give you real insight into whether VA is doing its job well, and that is critically important. 

And then on leadership accountability, the idea of holding the political appointees to the same standards as career leaders is absolutely essential. Across government, you have political appointees, 

4,000 of them. Few are in VA, but you still don’t have the normal 

line of sight for the career people that stacks up their performance 

plans against the objectives of the organization which starts with 

the leadership. You need clarity about what they are trying to 

achieve, how they are being held accountable, and then it cascades 

into the rest of the organization. That is really important. 

Three things that I think you could do better with this bill. One, 

for the passport idea, it seems to me that the re-employment of 

former employees is extremely important. Right now, the authority 

allows for only a one grade increase. I would suggest that that is 

an unnecessary restriction. If someone spends time in the VA or 

some other agency, which is the other piece of this, they ought to 

be able to come back if they have developed skills that they can 

then bring back to the organization more than just one grade up. 

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Secondly, I am troubled by the expansion of Veterans’ Preference 

to the SES. Veterans’ Preference is incredibly important. However, 

in the context of what the VA is dealing with right now with its 

SES, it is a troubled place. They can’t recruit people right now. 

This is not the time to make it more difficult. There are other 

things that could be done that I think would be more powerful and 

less concerning. 

And, third, on the executive management fellowship program, 

the cap needs to be raised from 30. Right now you have over 7,000, 

by our account, eligible participants; 30 just doesn’t make any real 

difference. The question has arisen, well, if you got a challenge for 

getting talent in, do you really want to send your people out? The 

answer is yes. You want to grow and develop your people. You will 

retain your talent better if you do it, and, bluntly, we think it 

should be a two-way program, so you can bring folks from the private sector in and that will also help you get great talent and refresh the workforce, which is so important. 

The so last issue is: this is not just about the legislation, as I 

mentioned; it is about the enablers—your oversight is going to be 

absolutely essential to ensure that the VA is doing the work that 

it needs to do and these provisions are funded. 

Happy to answers questions. That is as fast as I can talk. Thank 

you. 

Mr. BENISHEK. Good job, Mr. Stier, in talking fast. 

Mr. STIER. I should say I am Stier and it is pronounced— 

Mr. BENISHEK. Stier. 

Mr. STIER [continued]. —you know, if you look at it, it looks like 

Stier. Anyone who says Stier, ordinarily, you are like, you don’t 

know how to pronounce words, but parents decide pronunciation, so 

what can I do? So, it is Stier. 

Mr. BENISHEK. Yeah. No, no, no, that is fine. Great. Perfect. 

Thank you very much. 

Mr. STIER. Thank you. 

[THE PREPARED STATEMENT OF MAX STIER APPEARS IN THE APPENDIX]

Mr. BENISHEK. Mr. Butler, I will recognize you now for five minutes. 

STATEMENT OF ROSCOE G. BUTLER 

Mr. BUTLER. Thank you. For nearly two decades, The American 

Legion has been expressing concerns about staffing shortages for 

physicians and medical specialists in the VA. We’ve seen this because we have been there as part of our ongoing System Worth 

Saving task force visits that evaluate VA health care in every 

VISN, from rural to urban, and we have tried to make sure VA is 

fully staffed to provide high-quality, efficient care to meet the 

needs of local veterans. 

Chairman Benishek, Wenstrup, Ranking Member Brownley, 

Takano, and distinguished Members of the Subcommittee on 

Health and Economic Opportunity, on behalf of National Commander Dale Barnett and The American Legion, and the country’s 

largest patriotic wartime service organization for veterans, comprising over two million members and serving every man and 

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woman who have served, and worn the uniform for this country, 

we thank you for the opportunity to testify regarding the draft legislation regarding improving the authority for the Secretary of Veterans Affairs to hire and retain physicians and other employees of 

the department. 

As reflected in our written testimony and through the eyes of 

The American Legion’s System Worth Saving Program, which I frequently participate in, we have tracked and reported staffing shortages at every VA health care system across the country. We see the 

staffing shortages throughout the VA, and we feel it is getting 

worse, and not improving. The American Legion’s System Worth 

Saving 2014 executive summary found that several VA medical 

centers continue to struggle to fill critical leadership positions 

across multiple departments. 

These gaps have caused communication breakdowns between 

medical center leadership and staff that works within these departments; therefore, for the reason outlined in our written testimony, 

The American Legion fully supports Sections 2, 3, 4, 5, 8, 9, 11, 14, 

and 15 of the draft legislation to improve hiring practices at the 

Department of Veterans Affairs. 

However, Section 7 gives us great concerns. As it currently 

stands, VA has over half of their critical leadership positions either 

unfilled or filled by individuals on an interim basis. Sending a portion of the workforce out of VA every year would only exacerbate 

this situation. If VA can afford to lose those personnel for even a 

year, then we believe the VA may not need those positions to be 

filled. 

The American Legion would rather see the VA fill the positions 

and ensure there is a full workforce available to treat the needs of 

veterans, therefore, for this reason, The American Legion opposes 

Section 7, which would create within VA, an executive management fellowship program. 

There are plenty of other sections of this legislation that offers 

improvements to VA health care. Section 3 offers a fix to a problem 

The American Legion has long sought a solution to, adjusting Federal work guidelines to fix the unusual hours necessary to staff 

emergency rooms. 

Other sections address fixes to how VA determines market values to stay competitive for health care and hiring, how VA evaluates which portions are needed, and attempt to further refine the 

accountability process for VA employees. Any of these measures 

should contribute immeasurably toward improving VA and these 

are measures that should move forward with the passage of this 

legislation. 

Again, on behalf of our national commander, Dale Barnett, and 

the millions of dedicated veterans that comprise the Nation’s largest veterans’ service organization, we thank you for having the opportunity to speak today. I would be happy to answer any of the 

Committee’s questions, and, again, thank you. 

Mr. BENISHEK. Thank you very much, Mr. Butler. 

[THE PREPARED STATEMENT OF ROSCOE G. BUTLER APPEARS IN

THE APPENDIX]

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Mr. BENISHEK. Mr. Fuentes, you are now recognized for five minutes. 

STATEMENT OF CARLOS FUENTES 

Mr. FUENTES. On behalf of the men and women of the VFW and 

our auxiliaries, I would like to thank you for the opportunity to 

present our views on ways VA can improve retirement—I’m sorry— 

recruitment, retention of high-quality health care professionals and 

other employees. 

The VFW thanks you for recognizing that VA’s ability to hire and 

retain high-quality employees is equally as important as its ability 

to fire and demote employees who put veterans at risk. The VFW 

agrees with many of the ideas included in the draft legislation 

being discussed today, however, we would like to share an idea 

that we hope the Subcommittees will consider. 

During our site visits of VA medical facilities, the VFW has noticed one constant struggle: hiring and retaining entry-level clerks 

who help with answering phones, greeting patients, scheduling appointments, and other administrative tasks. During our visits, we 

often hear from providers and facility leadership say that the lack 

of administrative support limits their ability to deliver health care 

to veterans. This issue must be addressed, authorizing VA to quickly fill high-turnover positions at VA medical facilities. 

Similar to VA medical facilities, the VA Canteen Service relies on 

entry-level employees to operate and maintain its services; however, the Canteen Service is exempt from certain Title V competitive service requirements to ensure high turnover does not impact 

its ability to operate retail stores, cafes, and other quality-of-life 

programs in VA medical facilities around the country. The VFW 

urges Congress to consider extending these authorities to VHA to 

quickly fill high-turnover vacancies. 

The VFW supports most sections of the discussion draft being 

considered today, which takes a multifaceted approach towards expanding VA’s authorities to hire and retain high-quality employees. 

In the interest of time, I would like to comment on two sections 

we believe can be improved. The VFW opposes Section 4, which 

would expand VA’s Yellow Ribbon Program to require VA to help 

veterans cover the costs of advanced degrees in mental health. The 

VFW supports efforts to provide additional assistance for veterans 

who choose to advance their careers and assist their fellow veterans by obtaining advanced degrees in mental health; however, we 

do not believe that amending the Yellow Ribbon Program is the 

best option to do so. 

The Yellow Ribbon Program was established to supplement the 

Post-9/11 G.I. Bill by authorizing VA to enter into agreements with 

educational institutions to cover up to 50 percent of the gap between the costs of tuition and fees associated with degree programs 

and the statutory caps. 

The VFW is concerned that this legislation fails to ensure veterans have enough Post-9/11 G.I. Bill eligibility to complete their 

advanced degrees in mental health. For example, veterans who use 

their Post-9/11 G.I. Bill to obtain a bachelor’s degree and would 

like to participate in this program, are unlikely to have enough eligibility remaining to complete an advanced degree in mental 

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health. The VFW is a strong proponent of public-private partnerships, but believes that the program would be better suited under 

VA’s Health Professionals Education Assistance Program. 

Section 9 would require VA to comply with certain Title V competitive service requirements when hiring SES employees. While 

the VFW supports applying Veterans’ Preference when hiring VA 

SES employees, we feel that Congress must streamline, not impede, VA’s ability to hire qualified executives. That is why we recommend that the Subcommittees exempt VA SES employment 

process from Title V competitive service requirements. 

To ensure VA hires qualified veteran senior executives, Congress 

should require VA to properly consider veterans when considering 

SES employees, regardless of which authority or hiring authority 

they use. 

Mr. Chairman, this concludes my testimony. I would be happy to 

answer any questions you may have. 

Mr. BENISHEK. Thank you, Mr. Fuentes. 

[THE PREPARED STATEMENT OF CARLOS FUENTES APPEARS IN THE

APPENDIX]

Mr. BENISHEK. Dr. Clancy, you may proceed with your testimony. 

STATEMENT OF CAROLYN CLANCY, M.D. 

Dr. CLANCY. Good afternoon, Chairman Benishek, Chairman 

Wenstrup, Ranking Member Brownley, Ranking Member Takano, 

and Members of the Committee. Thank you for inviting us here 

today to present our views on the draft bill to improve the authority of the secretary of veterans affairs to hire and retain physicians 

and other employees. 

Joining me today is Elias Hernandez, the Chief Officer for Workforce Management and Consulting; Tia Butler, who is sitting behind me, the Executive Director of the Corporate Senior Executive 

Management Office; and Kimberly McLeod, Associate Chief Counsel. 

First, we want to thank the Subcommittees for including three 

of our legislative proposals in the draft legislation. These will give 

us the necessary resources to meet the department’s obligation to 

meet—to provide timely quality health care and benefits to our veterans. We are happy to support several sections of the proposed 

bill, including Section 2, which matches a proposal put forward last 

year in VA’s 2017 budget submission. 

VA believes that there are primary factors that warrant a separate compensation system for medical center directors and VISN or 

network directors, which are detailed in the written testimony. VA 

requests, however, that the section stating that medical center director and network directors be a qualified doctor of any kind, be 

removed from the bill. 

It is already difficult to recruit for these positions and this additional restriction would make it nearly impossible for recruit in 

some areas; moreover, running a hospital is an inherently complex 

skill set requiring a diverse background, including skills needed to 

manage from multimillion-dollar budget facility and staffing operations and so forth. Physicians may or may not have these skills 

and there are other graduate programs that do give people this 

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kind of training; in fact, we have a fellowship program for people 

who graduate from master’s of health administration programs. 

Section 3 of the proposed bill would allow VA to arrange flexible 

physician and physician assistant work schedules to allow for the 

hiring and full implementation of a hospitalist physician system 

and to accommodate the unusual work schedule requirements for 

emergency medicine physicians—thank you, Dr. Ruiz—VA supports 

this increased flexibility for critical medical personnel. 

Hospitalists and emergency medicine physicians specialize in the 

care of patients in the hospital, often working irregular work 

schedules to accommodate the need for efficient hospital care. And 

we believe that increased scheduling flexibility would align our 

practices with the private sectors, which would facilitate the recruitment and retention of emergency physicians as well as the operation of the hospitalist physician system at all VA medical centers. 

Section 4 of the bill would amend Title 38 to prohibit the use of 

transferred entitlement under the public-private contributions. VA 

supports legislation that would provide training and employment 

opportunities for veterans, however, the department has some concerns with this section of the bill. VA is not certain a change in 

the way VA and institutions of higher learning share contributions 

for specific degrees and programs would be beneficial. 

Under its current structure, the Yellow Ribbon Program is a remarkably successful program with nearly 2,000 participating institutions. For VA to support this bill, each of the professions listed 

that has educational and licensure requirements would need to 

have a corresponding provision that would state that the program 

meets the educational requirements defined by VA’s qualification 

standards. 

As for the report required in Section 5, we defer to the Office of 

Inspector General on how they would process this report. 

VA supports Section 6, which would eliminate the compensation 

panel recommendation process. This section is also similar to another proposal put forward in February 2016 in VA’s 2017 budget 

submission. The compensation panel process is time-consuming and 

adds little value as medical center directors and other approving officials already have the final authority to approve the rate of pay. 

This process also contributes to a delay in hiring, which is probably 

our greatest concern. It would be more cost-effective and efficient 

to allow a selecting official and to recommend the appropriate salary for prospective employees and eliminate this compensation 

panel process. 

We very much look forward to working with the Committees and 

our agency partners to finalize language on these provisions. The 

remaining sections will be discussed in a follow-up views letter that 

is currently being drafted and we will forward these remaining 

views and costs to you expeditiously. 

Thank you, Mr. Chairman for this opportunity to present our 

views on this draft bill, and my colleagues and I are happy to respond to any questions that you or other Members might have. 

Mr. BENISHEK. Thank you, Dr. Clancy. I really appreciate your 

answers there. 

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[THE PREPARED STATEMENT OF CAROLYN CLANCY, M.D. APPEARS

IN THE APPENDIX]

Mr. BENISHEK. I yield myself five minutes for questions. And, 

frankly, I was kind of excited to have this hearing because it is a 

lot of important issues. I think the roundtable really got us a lot 

of input and this is basically the next step. 

Dr. Clancy, I agree with you that this compensation panel 

doesn’t make a lot of sense to me because, a physician who is about 

to be hired is going to surely shop around to see what other people 

are offering and that doesn’t make sense—but what I would like 

to know is, what else can we do besides this, to speed up the process? I have heard that it takes up to a year to hire somebody, physicians in particular, at the VA, so besides a central database for 

finding people looking for work and this process here, what other 

processes could we do? And maybe Mr. Stier would like to comment 

on that, too. 

So, let’s start with Mr. Stier, and I will give you an opportunity, 

too, Dr. Clancy. Mr. Stier, what else should we be doing to make 

this process quicker? 

Mr. STIER. Well, part of it, which you already have in the bill, 

is that it is going to be really important to have good information. 

My bet is that there is a high degree of variability across the system as to who is hiring fast and who is not, and what the experience is like for the potential applicants to the positions. 

And so, collecting information about who is actually doing hiring 

well and making data available across the whole network of VA facilities, I think will help you identify the best practices that ought 

to be adopted more generally. 

What you are doing here, I think is very important, but I really 

do believe it is just the starter’s pistol and at the end of the day, 

ensuring that these authorities are used effectively, that the execution of the tasks that you are trying to facilitate happen effectively, 

is most important. 

Mr. BENISHEK. To be measured as they go. 

Mr. STIER. Correct. They need to be measured and they need to 

identify, again, where certain components are doing it well so that 

they become the model for best practices across the whole organization. 

I am confident that if you explored, you used a year figure, you 

would find organizations within the VA system that are actually 

doing it really, really well, best-in-class. The question is, what are 

they doing and why isn’t everyone else doing it, and how do you 

get them to do that? 

Mr. BENISHEK. Dr. Clancy, let me ask you in follow-up of what 

Mr. Stier was saying, do people who are interviewed for positions, 

are they given an opportunity to comment on the process? Do you 

collect that data at all? 

Dr. CLANCY. We collect exit-interview data when people leave. I 

am not sure about the front-end. 

Mr. BENISHEK. But when hiring, do you interview the people that 

you are hiring to comment on the process— 

Dr. CLANCY. Mr. Hernandez? 

Mr. BENISHEK [continued]. —perhaps in an anonymous way, so 

that they can give comments on the process? 

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Mr. HERNANDEZ. Yes, Mr. Chairman, we do collect information in 

terms of the interview process, however, that information is obviously not released to anyone, other than the hiring official. 

But what I would like to say is, I fully agree with everything 

that has been said here today, and I would like to share some information regarding, you know, some of the improvements we have 

made in the hiring process, in particular, for the positions of 

nurses. And this bill that is being introduced is also going to help 

us do even better in the hiring process. 

We do track the hiring process in terms of the speed of hire, and 

we have a measure in the organization where all the hiring actions 

must occur within 60 days. Eighty percent of those actions must 

occur within 60 days. 

The recent data that we collected, you know, in fiscal year 2015, 

and so far this year— 

Mr. BENISHEK. I guess I don’t understand though, it is 60 days? 

You are saying the hiring process is 60 days? That is contrary to 

most of the information that I have ever heard. Most of the time, 

people tell me it takes months. 

Mr. HERNANDEZ. Yes, Mr. Chairman, that is what I—you know, 

if I may, that is what I am trying to convey, that we still have 

issues, and I will tell you what those issues are shortly. 

So we collect the data and we measure the hiring process and the 

different stages of the process, and right now, we are about 78 percent of all the hires that have taken place in fiscal year 2015 have 

been met within 60 days; however, that measure only measures 

from the beginning of the process to a tentative job offer, okay. 

What happens after the tentative job offer is the information that 

we are really keying in, as an example, the physicians, we can give 

them a tentative job offer based on the data that we collected within 96 days; however, it takes an additional 32 days to bring them 

onboard. 

So there are a lot of factors associated with that in terms of, you 

know, the scope of practice, them being able to kind of close their 

scope of practice in the previous organization going into the new 

organization, and also the credentialing process, which, by the way, 

VHA has made major improvements to that area where we are 

right now averaging about 35 days for some of those credentialing 

processes, which is a whole lot better than what it is in the private 

sector of 45 days. 

The challenges that we have— 

Mr. BENISHEK. I guess that sounds like really great numbers, but 

that is just not the way it is from what I have been talking to people, okay. I talk to people and that is just not the numbers that 

you submit here; 60 days and 90 days is not it. 

But I am out of time and I am going to yield to Dr. Wenstrup. 

Mr. WENSTRUP. Thank you, Mr. Chairman. 

Mr. Butler, the American Legion’s written statement mentioned 

some of the challenges the VA faces attempting to recruit and retain medical staff in rural areas, and I know that is difficult in 

parts of my district as well. 

But do you believe that this bill that we are considering could 

improve the recruitment and retention in rural areas? And if it is 

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13 

not able to, what would you suggest maybe that we add to the bill 

to try and improve that? 

Mr. BUTLER. Well, I think there are good components, excellent 

components within the bill that will enhance VA’s existing hiring 

authority and give facility leadership the ability to hire employees 

more quickly. 

I was out on a recent visit in Reno, Nevada and, in response to 

the Chairman’s question, what I heard, there are certain hard-tofill positions, audiologists, and it is taking years to fill those positions, not necessarily because—well, because they don’t have the locations and the disciplines, the teaching facilities, they don’t have 

the source where people are interested in coming to like Nevada for 

those positions, and then they are competing with private industry. 

So I think that you have to build a program that is on the same 

level that the private industry program is, and it has the same or 

similar metrics, so that it is more attractive to outside providers 

when they are considering the VA. If they look at the outside community hospital versus the VA, it is much easier for them, higher 

pay and other things that drive them, that they will choose the 

community hospital over the VA. 

And I think from what we are seeing, that it takes a special 

breed of doctor to work for the VA. They really have to be committed, and have to care, have that mentality of caring for veterans 

and not all doctors, I would say, have that same mentality. Some 

people’s drivers is the money that they would make, but I think the 

doctors that really choose to work for the VA choose it for different 

reasons other than money. 

And so I think that you have to take all of those factors into consideration and then build a program that is much more competitive 

with the private community. 

Mr. WENSTRUP. Thank you. 

Dr. Clancy, on that same vein, are there barriers that Congress 

could break down to make it easier in the rural communities for 

recruitment and retention? 

Dr. CLANCY. So I appreciate my colleague’s comments very much 

from the American Legion. I will say, I think all of U.S. health care 

is struggling with how do you get people to come to rural areas. 

In fact, I saw something recently, I didn’t see the backup detail, 

you know, that claimed that physicians with higher educated specialties were harder to recruit to rural areas. 

If there is one area where our system would have a bit of a barrier and I am at a loss for how you all could help, although I would 

be happy to be surprised, a private sector hospital could actually 

be helping for the spouse to get a position, other opportunities and 

so forth, and that we are hiring for that one position, right? So that 

is about the only thing I can think that would be helpful. 

It is very clear to us that expanding our footprint in telehealth 

and other kinds of virtual care is going to be hugely important to 

our efforts in rural areas, but happy to work with you on other 

ideas. 

Mr. WENSTRUP. Well, one thought that I have in that vein is, you 

know, you are talking about small communities are having the 

same problem, same problem that VA is having. I mean, if both enLeonard.horne on VACREP0180 with DISTILLER

14 

tities are looking for one type of specialist, there should be ways 

to start thinking about collaborating— 

Dr. CLANCY. I think that is a great idea. 

Mr. WENSTRUP. —to bring a specialty to the area. 

With that, I yield back. 

Mr. BENISHEK. Ms. Brownley, you are recognized. 

Ms. BROWNLEY. Thank you, Mr. Chairman. 

I think just following up a little bit on this line of questioning, 

I just had a general question and would appreciate a short answer, 

if it is possible. But if we get to the consolidation of non-VA care 

and that program, how would that affect really the number of employees needed for veterans’ health care within the VA, if that 

makes sense? 

Dr. CLANCY. It makes perfect sense. I am very optimistic that we 

will indeed, with your help, get to consolidation of all paths to community care. And I think the answer to your question is going to 

depend on the part of the country that you are talking about, and 

the issue is going to be less about numbers of VA physicians, and 

more about the distribution by specialty. But I don’t believe that 

we have got a very clear-cut analysis, but we would be happy to 

get back to you with more information. 

Ms. BROWNLEY. Do you intend on doing some kind of analysis? 

Because I think it would be helpful in terms of what we are looking 

at here, I think it would also be helpful in terms of moving forward, in terms of good selling points, if you will, towards consolidation of these programs, which I think is important. 

Dr. CLANCY. I don’t know actually if it is on the list yet, but it 

is now. 

Ms. BROWNLEY. Okay. 

Dr. CLANCY. And obviously making that consolidation and integration happen is going to be key, but I am happy to take that 

back. 

Ms. BROWNLEY. Okay. You know, we have just kind of gone 

through really, as I mentioned in my opening remarks, a two-year 

space of time where we haven’t had a permanent director of the 

West L.A. Medical Center. We finally do now, we are very happy 

that we do— 

Dr. CLANCY. We are too. 

Ms. BROWNLEY [continued]. —but it is—has been a long road. 

And so I just wanted you to comment a little bit on succession 

plans and how they are being conducted at the VA, and are they 

being conducted, you know, across services and across the country? 

Dr. CLANCY. It is a standing practice that our facilities and our 

networks actually have a regular cycle of succession planning. As 

Mr. Stier alluded to earlier, I am quite confident that there is some 

variability. I haven’t taken a very close eye on all of those, but that 

has long been a standard practice for all of our facilities. 

Ms. BROWNLEY. You are sure that it is a standard practice across 

the country— 

Dr. CLANCY. Yes. 

Ms. BROWNLEY [continued]. —across centers? 

Dr. CLANCY. No, the extent to which the crisis and many of our 

vacancies have, you know, cut that off or interrupted it in the reLeonard.horne on VACREP0180 with DISTILLER

15 

cent past year or two, I don’t know, but I would be happy to have 

someone take a look at that and get back to you. 

But I will tell you, people take this very, very seriously. 

Ms. BROWNLEY. Thank you very much. 

And in terms of Mr. Stier’s opening comments too, with regards 

to demographics within the VA population, I mean, what are the 

challenges that you are facing in attracting particularly younger 

employees? 

Dr. CLANCY. Well, understand that except for truly exceptional 

people attracting doctors is going to be getting to the upper ends 

by the time you finish training of the category that Mr. Stier was 

referring to. 

My understanding is that over recent years there has been a little bit of a downturn in interest among younger people in working 

for Government writ large. Whether that affects VA more than 

other departments I don’t have good information about. 

I will say our Assistant Secretary for HR&A is constantly talking 

about the Pathways initiative and some parts of the department 

use that quite a bit. We can certainly take it back to see if the Veterans Health System might be using it more vigorously. 

Ms. BROWNLEY. I mean, are we tracking that information— 

Dr. CLANCY. Oh, yes. 

Ms. BROWNLEY [continued]. —so we understand where the problems and challenges are? 

Dr. CLANCY. Yes. 

Ms. BROWNLEY. In terms of this proposed legislation, do you have 

a timeframe when we might hear written views on the sections 

that aren’t included in the testimony today? 

Dr. CLANCY. I can assure you that literally people are working 

on this right now and we will get it to you as quickly as we can. 

Ms. BROWNLEY. Okay. And last and finally on the area on Section 9, that again I understand that you weren’t able to provide 

your views on Section 9 today, which would expand the eligibility 

for Veterans’ Preference in the Federal hiring process to both National Guards and Reservists who serve 180 cumulative days on active duty as opposed to 180 consecutive days, and I think as a Federal agency, VA would clearly benefit from hiring more Guards and 

Reservists. Is there a concern that expanding eligibility would dilute the Veterans’ Preference to the point of requiring veterans to 

compete against each other for Federal jobs? 

Dr. CLANCY. I am going to ask my colleague Mr. Butler if he has 

more information on that. 

Ms. BROWNLEY. No, it looks like I have run out of time, so— 

Dr. CLANCY. We will follow-up. 

Ms. BROWNLEY. Okay. 

Dr. CLANCY. Can we take that for the record? 

Ms. BROWNLEY. Thank you. 

I yield back. 

Mr. BENISHEK. Mr. Takano, you are recognized. 

Mr. TAKANO. Yeah, that is a question on which I am interested 

in hearing the VA’s answer. So I will take that question up, Ms. 

Brownley. 

Go ahead. 

Dr. CLANCY. All right. Elias, do you want to take that? 

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16 

Mr. HERNANDEZ. My humble opinion in that particular section is 

that, you know, our organization strive for hiring veterans. You 

know, we have hiring initiatives in our organization to hire more 

veterans. It is something that we probably have to kind of look at 

it a little bit more closely in terms of the impact. Like I say, my 

personal opinion is that, you know, the more veterans that are eligible for our jobs, the greater the opportunities for our organization 

to be able to hire them. 

Mr. TAKANO. Well, I will just give you this input. I represent an 

Air Reserve base where we have both Reservists and Guardsmen, 

and it is always difficult for them to find a flexible-enough employer who will enable them to do their reservist duties. 

And so I appreciate that you are going to review the impact it 

would have on the VA and whether or not it would be good or bad, 

but I understand the VFW has some concerns about this. And, Mr. 

Fuentes, would you care to comment on what your concerns are 

about this provision? 

Mr. FUENTES. And just to clarify our position, we support the 

change from cumulative—the change for Guard and Reserve—we 

support that section. 

Mr. TAKANO. Oh, good. 

Mr. FUENTES. What we have concerns with is the change that 

would require VA to comply with certain Title V competitive service legislation or law. 

Mr. TAKANO. Okay. 

Mr. FUENTES. And that was done because the intent of the legislation, my understanding is, so that Veterans’ Preference is opened 

up to retired veterans, retirees—most are retirees. So these are the 

folks, the officers who served 20 years, who would make great executives, who aren’t extended Veterans’ Preference at the moment. 

But it is not that we believe that they shouldn’t have Veterans’ 

Preference, it is that we feel that by trying to do something good, 

I think you are actually impeding VA’s ability to hire more expeditiously because you are now requiring them to comply with Title 

V restrictions. 

I don’t know if that makes sense. 

Mr. TAKANO. I do not quite understand. We will explore this a 

little further, but I am glad to hear that you have clarified the 180- 

day consecutive service. So you are not opposing that, you are saying that you don’t have an objection to that? 

Mr. FUENTES. Not at all. Our written testimony goes into how we 

believe that with our all-volunteer military and the way we have 

been fighting in the last two wars in Iraq and Afghanistan, it 

makes sense that we make this change, that we support this 

change. 

Mr. TAKANO. Our Reservists and members of the Guard I think 

would feel that this would treat them with respect that we also 

give them a hiring preference. 

Mr. FUENTES. Congressman, if I may, I am a Reservist, former 

Reservist and Afghanistan veteran, so I completely understand how 

this would impact my fellow veterans. 

Mr. TAKANO. It would have a great impact, I think, on our ability 

to help our Guardsmen find employment that works. 

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On the retiree issue, please help me understand this a little better. Because I thought that maybe your objection might be that we 

have people who haven’t reached the 20-year retiree level. I mean, 

I am thinking that military retirees may be in a better place than 

our veterans with shorter service, that being younger, it puts them 

at a disadvantage. 

Mr. FUENTES. We completely agree, I think that military retirees 

and officers who have served 20 years or more make excellent candidates for executives at VA. I think it is the vehicle that is utilized 

to make that happen that we have concerns about. 

Mr. TAKANO. All right. Let’s try to talk a little bit more about 

that offline to understand. It seems a little more subtle. So I didn’t 

hear the Title V complications. But I am glad to hear about your 

support of the 180-day non-consecutive. 

But just to be clear, the 180-days cumulative versus consecutive 

you are in favor of or you support? 

Mr. FUENTES. Yes, we support that aspect of the section. The section has a number of provisions and that one is one that we support. 

Mr. TAKANO. Okay. Well, great. Thank you for your testimony. 

Mr. BENISHEK. Dr. Roe, you are recognized. 

Mr. ROE. Thank you, Dr. Benishek. And thank you, all panelists, 

for being here today. It has been a good discussion, I think, and 

one that needs to be had. 

First of all, I want to just say for the record that, to me, a veteran is a veteran. If I didn’t know if you served in the Reserves, 

could care less, or the Guard. I was active duty; to me, it doesn’t 

matter, you served. But I tell everybody, the military ain’t Club 

Med. They send you where they send you and where they need you. 

So whether it is 180 consecutive days, 14 days in the summer and 

you never get deployed, you put yourself out there to be deployed 

if you need to be and, to me, that is service. 

So I wanted to get that on the record and want you to know that 

I am going to support that type of legislation or whatever going forward. I feel like you are a brother just like I am. 

Now, a couple things, I guess, Dr. Clancy, that we were looking 

at. I am concerned about the VA’s request to remove the VISN or 

Medical Center directors to be doctors or I would say other medical 

providers on the ground. It is already difficult to recruit for these 

positions and this additional restriction will make it nearly impossible in some areas. 

And then, what data do you have to back up the assertion that 

you think that medical expertise is unnecessary when recruiting a 

professional to lead a hospital or a group of hospitals? 

Let me give you an example. I don’t have an MBA from Harvard 

in business, but I have an MBA from paying bills for 30 years and 

running a practice, and managing people and helping manage a 

very large organization. So when you look at that, you are just like 

in the Reservists and Guard, they had that military experience, but 

they also have a civilian experience. It is very valuable when they 

go in the military. They may be accountants, they may be mechanics, they may be managers of a Walmart, whatever. They bring 

those skills with them and those are valuable leadership skills. 

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And it is just like I don’t have a Master’s in public health somewhere, but I have decades of real world experience that would be 

valuable in running a hospital, because I can promise you, I know 

exactly how an OR works, I know exactly how a medical floor 

works, I know exactly how the laundry works and especially when 

it doesn’t work, and especially when you don’t get your instruments 

sterilized and so on, that a person that has never walked in those 

shoes wouldn’t know. 

So how many of our directors at the VISN or otherwise are Medical Center directors are medically trained people? Nurse, nurse 

practitioner, doctor, pharmacist, whatever. 

Dr. CLANCY. I would have to take that for the record. And I take 

your comment very, very seriously. Some of our best Medical Center and network directors have been physicians, some of them are 

now. 

Mr. ROE. Yeah, and it doesn’t mean you wouldn’t be. 

Dr. CLANCY. My only point was, just as you have an MBA in paying bills, I am going to guess that you had colleagues who probably 

failed that course or who struggled much more to run the business 

that running a practice requires. 

My only point was that there is expertise in other areas that is 

quite important. 

Mr. ROE. No question. I totally agree with you there. It is not 

because you do practice doesn’t mean you ran one and I think that 

is exactly right. But I think you should look. 

I do think that those providers have a different set of lenses that 

they look through and the reason they do, I think, is they will always look through it, as you will, Dr. Clancy, through the eyes of 

how everything I do affects a patient and the care they get every 

day. Does it make it better and easier for the people that’s providing the care, if you have been down there actually doing it yourself and you do understand it. So I would leave it with that. 

I wonder if the staffing and the other question I have is, do you 

know what the demographics are of the 340-something-thousand 

slots that you have or the employees you have at the VA, what 

their ages are? Because if you are like a lot of them, I know Eastman Chemicals, a large company in my district, I think in the next 

five years 25 percent of their labor force can retire and they don’t 

know what they are going to do. I mean, they are trying to train— 

people are now working longer, thank goodness they are. And one 

of the reasons I think that there is not a very, as you pointed out 

just a minute ago, the very young, Mr. Stier, is that it does take 

us a while to get them trained up. You know, I tried as fast as I 

could to learn it, but it is just a lot to learn and it takes you a lot 

of years to do it, and I think that is one of the thing. 

And the other thing I think is, I wonder if this is generational. 

You see people, younger people tend to turn what they are doing 

over a lot more frequently than people in my generation who got 

a job at the plant, worked there for 40 years and retired. I wonder 

if it is that also. It is a challenge for everybody, not just the VA, 

is my point. 

Dr. CLANCY. I will simply say, we would be happy to give you 

specific numbers on what the age breakdown is. The issue of how 

many people are retirement-eligible is something that we watch a 

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19 

lot. As you say, many people for a variety of reasons have deferred 

that decision or in contrast to previous years, but it is something 

we keep a close eye on, and I am going to guess Mr. Stier and his 

colleagues do as well. 

Mr. ROE. Yeah, we know that 10,000 people turned 65 today. 

Dr. CLANCY. Yes. 

Mr. ROE. I mean, that is just a fact. 

Mr. STIER. I mean, there is no question that the retirement issue 

is a very prominent one, and I think it is really important to look 

at the mission-critical pieces at VA and not just the whole thing. 

But in general, VA struggles not just with the medical directors, 

but in bringing in young people. It is not the medical directors or 

the doctors themselves, VA is not hiring young people in any real 

number. 

Some of that has to do, again, just on the Pathways side, that 

VA is not doing what any other professional organization does, and 

this is true across government, of taking people in as student interns, seeing if they actually work out, and then converting them 

to full-time employees if they do well. That is not a model that is 

used in government more generally or at VA in particular, and it 

is a big mistake, because you can look at time to hire, which is the 

question we were discussing, but you really want to look at quality 

of hire, you want to look at the assessment, and there is no substitute for having an opportunity to work with somebody. 

So, again, government and VA in particular are not doing the 

most basic thing of seeing student interns as the primary hiring 

entry point, and that is something that could be done. You are 

going to improve the situation with a bill, but fundamentally that 

is going to be a management exercise on the part of the VA. 

Mr. ROE. I am sorry, I didn’t mean to go over. But I agree with 

you a hundred percent that four of the seven members of my staff 

here in Washington, D.C. came in basically as interns, entry-level 

jobs, and they are great. 

Mr. STIER. And you hired the ones that made sense. 

Mr. BENISHEK. Thanks, Dr. Roe. 

Mr. O’Rourke, you are recognized. 

Mr. O’ROURKE. Thank you, Mr. Chairman. I want to thank you 

and Chairman Wenstrup for your work and the work of other Committee Members on this draft legislation, and the work of your 

staffs and the minority staff as well. This is, I think, one of the 

most critical issues for us to be working on, and I appreciate the 

feedback from the VSOs and Mr. Stier and the VA on this. Whatever imperfections or improvements that can be made, let’s get to 

them as quickly as possible. And I hope that the VA, and it sounds 

like from some of your comments, Dr. Clancy, you are, I hope the 

VA will run with the spirit of this and whatever you can do administratively now, do it. You don’t need to wait for legislation from 

Congress to do so. 

Last summer we learned that there were 41,500 medical positions authorized, appropriated for, but unfilled at the VA. What is 

that number today? 

Mr. HERNANDEZ. Congressman O’Rourke, we do have a number 

of requirements, they have been initiated in WebHR. We don’t have 

a precise number of vacancies, due to the fact that we don’t have 

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20 

a position management system in the organization, but the number 

is currently 43,000 positions, and out of those, 37,176 are actually 

on the active recruitment phase. 

Mr. O’ROURKE. Okay. So I will just take from your answer, if we 

were at 41,500, we are now at 43. Okay. 

So we are having a really hard time not even treading water, but 

just not sinking all together. 

How many of those 43,000 are behavioral or mental health positions? 

Mr. HERNANDEZ. I have the numbers here, let me just find it real 

quickly. There are 3,497 physicians, close to 9,000 nurses. I have 

some specific numbers related to mental health, you know, there 

are psychiatric, there are about 3200 of those positions—well, let 

me rephrase that back. There are 3216 on board psychiatric, there 

are 275 actions in the WebHR system being recruited. 

Mr. O’ROURKE. How many psychiatrists are you short? 

Mr. HERNANDEZ. I don’t have that specific data in front of me, 

Congressman O’Rourke. 

Mr. O’ROURKE. So this is a request I have made of the Secretary 

already, and I will make it again through you, Dr. Clancy. I know 

the Secretary has a 12-point program to turn around the VA, I will 

again submit it should be a 13-point program and point number 

one should be reduce veteran suicide. If we do that, we are going 

to make decisions, including hiring decisions and decisions on 

where we prioritize accordingly. And we will know how many psychiatrists and psychologists and social workers short we are, and 

I think we will make some decisions about how we prioritize their 

hiring. 

I shared with you, Dr. Clancy, that we are at 89 FTEs, full-time 

equivalents, in El Paso for mental health today with 116 authorized and appropriated for, and we are at a two or three-year low 

for mental health providers. And we know that care delayed becomes care denied and results in some tragic outcomes, including 

veteran suicide. So I want to use this forum again to ask that we 

prioritize that. 

Within this bill, I am encouraged to see provisions for market 

pay. My only concern related to that is that perhaps in El Paso, 

which is not a rural area, but an under-served area, and then you 

have rural under-served areas, we may need to go far above market pay to get the number of psychiatrists, psychologists, behavioral health providers that we need. And so that would be a change 

that I would ask for. Pay whatever it costs to get the appropriate 

person. Understanding that American medicine generally is having 

a hard time producing psychiatrists and psychologists and mental 

health specialists, but, you know, there are people in Manhattan 

who are able to go see a psychiatrist about, you know, their dog 

urinating on the carpet, there should be veterans suffering from 

PTSD who are able to see somebody immediately without any question. We just need to do whatever it takes. 

And, Mr. Stier, I just have to tell you I really appreciate your 

comments about this being perhaps the starter pistol, and what is 

really needed ultimately is accountability and oversight. And for 

the record, I would love for you to tell us what you specifically recommend for that to ensure that we are following up on this. BeLeonard.horne on VACREP0180 with DISTILLER

21 

cause it can’t just be, look, this stuff is hard, we can’t hire these 

people, it is hard in American medicine, there have to be consequences if there are new authorities and resources given to get 

the job done and to prevent veteran suicide and provide greater access for mental health. 

So sorry to make a speech and not ask as many questions, but 

I would like the direct answers to those questions I asked of you, 

Mr. Hernandez and Dr. Clancy. 

Dr. CLANCY. We will get you that information expeditiously. 

I am going to presume, just to clarify, that getting the full spectrum of professionals who provide mental health care is what you 

would like, the social workers, psychologists, psychiatrists. 

Mr. O’ROURKE. Nurse practitioners. 

Dr. CLANCY. Yes. 

Mr. O’ROURKE. Everyone involved in the provision of that care, 

so that we can connect veterans who need it, who aren’t receiving 

it today, that is what I am looking for. 

Dr. CLANCY. We will get that to you expeditiously. 

I will also just insert for one moment that we are exercising all 

of the incentives that, thanks to the Congress, were provided in the 

Clay-Hunt bill as well, because we agree with you, whatever it 

takes; this is an imperative. 

And one other thing. One of the Secretary’s 12 breakthroughs actually does include a component on suicide. It is not explicit about 

the hiring piece, but to do it right, we have got to have the hiring 

piece as well. So that message has been heard. 

Mr. O’ROURKE. Thank you. 

Mr. BENISHEK. Dr. Abraham. 

Mr. ABRAHAM. Thank you, Mr. Chairman. And thank you for this 

hearing, it is a great hearing. 

I am going to pick up where Mr. O’Rourke left off, I thought his 

line of questioning was great. 

Mr. Hernandez, you said there was a 60-day period from when 

that applicant hits to when it is a job offer. What percentage of job 

offers that the VA extends are actually taken? What percentage of 

those physicians or nurses that come into the VA? Is it a 50 percent, is it a 25? So if you offer a hundred positions, how many are 

taken by the applicants? 

Mr. HERNANDEZ. If I understand the question correctly, out of 

the job offers that we made, you want to know what percentage of 

those— 

Mr. ABRAHAM. Accepted the offer, yes. 

Mr. HERNANDEZ [continued]. —accepted the job offer? 

Mr. ABRAHAM. Yes. 

Mr. HERNANDEZ. I don’t have that data with me. 

Mr. ABRAHAM. Okay. If you could, I would appreciate that. I 

think that is important. 

Do you know, in 2015, let’s go to DOs and MDs, just physicians 

themselves, how many hires were made by the VA, do you have 

that answer? 

Mr. HERNANDEZ. How many overall hires we did? 

Mr. ABRAHAM. Yes, sir. If you put MDs and DOs together, how 

many hires? Do you have that particular answer? 

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22 

And the reason I ask the question, I mean, you said with Mr. 

O’Rourke’s question that we had 43,000 open slots, I just wanted 

to see how many are being filled. And you can get back to me, that 

is fine. 

Mr. HERNANDEZ. Yes, I will get back with you. 

Mr. ABRAHAM. I didn’t mean to put you on the spot, that is not 

my intent here. My intent is just to get something I can wrap my 

head around and get an answer. 

Mr. HERNANDEZ. Yes, sir. 

Mr. ABRAHAM. Dr. Clancy, I know with the credentialing board 

that the VA has, is there any difference in standards between the 

MDs, the DOs, the DPMs, all the MPs and PAs, is it pretty much 

standard operating procedure across the board as to how they are 

graded before they are offered that job offer? 

Dr. CLANCY. Yes. What takes time here is, like many institutions, we do primary source verification. 

Mr. ABRAHAM. Right. 

Dr. CLANCY. So we are not sort of taking someone’s word for it, 

but yes. 

Mr. ABRAHAM. Okay. Mr. Stier, the figures that you have, do 

they agree with Dr. Hernandez as far as that 60-day? I am like Dr. 

Benishek, you know, I am out in the district and I am talking to 

my docs that are trying to get into the VA system and they say, 

you know, it has been over a year. So I just want to make sure we 

are all on the same page here. 

Do your figures go with what the VA is telling us here? 

Mr. STIER. So two things. The first is that I don’t have access to 

their direct hire information, so I have no independent sourcing. 

But I would say that what we have heard so far is a general number as opposed to the mission-critical positions that you are focused 

on, as I understand it, the doctors. 

So I think one of the interesting requests would be, can we get 

information about time to hire for, you know, MDs or DOs, so that 

you have the specific population you are interested in. 

And then I just would like to add again that time to hire is relevant, but at the end of the day, you can hire fast or slow, if you 

don’t hire well, you have not done the job. 

Mr. ABRAHAM. I totally agree with that. 

Mr. STIER. And I think one of the things that this bill is important about is that it is going to also require some critical information around applicant satisfaction, hiring manager satisfaction. So 

asking both the population that is applying for the job, what was 

the experience like, and then the people who actually need the 

hires, did you get the talent that you actually wanted and relative 

to, you know, what you have been doing in the past. So those 

things are very important. 

I think you heard one other thing that was really critical here 

is the technology. You don’t have an integrated HR system across 

the whole agency, so it is very hard to do the kind of work that 

you actually need to do in terms of comparing the information and 

holding folks accountable if you don’t have that. So that would be 

another place where I think further exploration would help, you 

know, understand how you can improve the situation. 

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23 

We don’t have, and again VA is not alone, we don’t have integrated HR platforms, it is a big mistake. Any other large organization that is well run in the private sector would have it. And it is 

a big problem in the government and it is not the agencies, there 

is lots of room for blame around. So to fix it, I think this is a place 

that Congress could help. 

Mr. ABRAHAM. Okay. 

Mr. FUENTES. Congressman, if I may— 

Mr. ABRAHAM. Yes, sir, Mr. Fuentes. 

Mr. FUENTES [continued]. —just one quick suggestion. 

Mr. ABRAHAM. Yes, sir. 

Mr. FUENTES. In order to identify the bottlenecks, I think one of 

the things that can be done is really take a look at the different 

segments and their hiring process. 

One of my biggest, I would say, complaints of how VA measures 

things is they select the start date or they select the time in which 

they start measuring. And I think what is needed is to really take 

a look at every single segment of the hiring process, from the time 

that someone has left, or that vacancy was created, until the time 

that we get someone to fill that vacancy. 

Mr. ABRAHAM. I understand, good point. 

I yield back, Mr. Chairman. Thank you so much. 

Mr. BENISHEK. Ms. Titus, you are recognized. 

Ms. TITUS. Thank you very much, Mr. Chairman. 

As we have had meetings over the last several years, you have 

heard me say many times that we need to not only focus on making 

it easier for the VA to discipline and dismiss employees, but also 

to recruit and retain the best employees. So I want to thank Dr. 

Benishek and also Dr. Wenstrup and your staff for bringing this 

legislation forward, and for including me and my staff in the process as you have drafted it, we very much appreciate that. 

I hope also as we continue working on the bill, that we will include in it legislation that Mr. Takano and I have worked on to 

kind of continue something we started when we were doing the 

Choice Act, which was to increase the number of GMEs. We had 

that for five years, I hope we can extend that to ten years, because 

we have often heard that where you go to school and do your residency is where you stay and practice. And so that might also be 

something that helps with this problem. 

Mr. Stier, your testimony presents some very compelling statistics that are pretty upsetting in terms of the retirement and the 

number of people who are going to be retiring, and the number of 

people who think it is not a great place to work and, you know, 

that seems to be a real challenge. But I think it also presents us 

an opportunity, because with this many vacancies, it kind of dovetails with the Secretary’s position of recreating the VA as my VA 

and making it more veteran-centric as opposed to agency-centric. 

And so I hope that we take advantage of the opportunity to 

broaden the kind of people we hire. You mentioned that we don’t 

have enough young people coming into the program and yet the 

number of young veterans is increasing in my district, it is almost 

as equal to Vietnam veterans at this point, and I think that number will overtake the previous war veterans. Also, more women are 

now coming into the VA, LGBT issues are coming in. 

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So I wonder if you are doing anything specifically to recruit these 

kinds of employees or if there is anything we can do to help you 

kind of broaden the base of people who are coming to work for the 

VA who can better serve the special needs of our new and younger 

veterans. 

I don’t know, we can start with anybody. 

Dr. CLANCY. So I will say we have a center for the department, 

and also an Office of Health Equity within VHA that reports directly to me that keeps a very close look on this, not just to count 

numbers, which is one step, but actually to identify outreach opportunities and opportunities where we can encourage a very broad 

applicant pool. So I did want you to be aware of that. 

Obviously, as our affiliates in medical schools and so forth themselves become more diverse, that becomes a terrific fertile recruiting ground and one that we take very seriously. The Secretary has 

been in more medical schools than I think he ever thought possible, 

but he never misses an opportunity to go out on recruiting opportunity for that. 

Ms. TITUS. Well, I am glad to hear that, because women veterans 

often tell me they would prefer to see a woman doctor, but that 

there aren’t many available. Some transgender veterans say there 

aren’t many who kind of understand their special issues or can talk 

to them or relate to them. So I think the more diversity you have 

in your recruiting, the better. 

I didn’t mean to cut you off, I’m sorry. 

Dr. CLANCY. No, I was going to say that we are making a change 

in the very near future. All of our facilities, and I bet Dr. Benishek 

would know this, have an our doctors Web site, but right now you 

click off by the alphabet. So if I knew that I was looking for 

Benishek, I would click on B, right? We are going to make it much 

easier for veterans to find information about physicians that they 

would be interested in. For example, if I want to see a woman physician, I can actually see a photo and things like that, and it will 

be a lot more contemporary than our current sites. 

Ms. TITUS. Mr. Stier, do you want to add to that? 

Mr. STIER. The one thing that I hope you will find germane is 

that there are a lot of good things that the VA is doing right now 

in terms of on the execution side, but we are coming up obviously 

to an election year, and one of the big challenges in government 

agencies is good work gets started and then it gets interrupted because of the change in the leadership. 

And so I think that is an area that this Committee could actually 

assist on in terms of trying to ensure at least two things, one of 

which is, you know, making sure that when there is an interruption of political leadership that the agency actually has plans to 

carry forward the good things that are going on, and that this Committee holds the next team accountable to carrying on the good 

work. So if there is some number of priorities that you want to see 

occurring, you get at them at the very front end. 

And, you know, we heard some discussion about the qualifications for Medical Centers and I would ask whether this Committee 

will push on qualifications for leading the VA as well, but obviously 

it is a huge job, it is a huge transformation effort, and the kinds 

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25 

of folks that you get into those positions and the speed in which 

you get them there will be very important. 

So I am kind of using your question for a little more and I hope 

that is okay. 

Ms. TITUS. That is fine, I appreciate that. 

Just real briefly. When we talk about recruiting in under-served 

areas, we tend to focus on the rural areas, but also some of our 

inner cities are also under-served. I know I represent the heart of 

Las Vegas. So let’s keep that in mind as we move forward, those 

areas can be under-served as well. 

Thank you, Mr. Chairman. 

Mr. BENISHEK. Dr. Ruiz, you are recognized. 

Mr. RUIZ. Thank you. I would also like to start by saying thanks 

to the leadership of both the Health and Economic Opportunity 

Subcommittees for holding this hearing, and for continuing to include my legislation, H.R. 4150, and Section 3 of the discussion 

draft. 

The inclusion of other medical professionals other than emergency physicians will only continue to ensure veterans receive the 

efficient, effective and continuous care that they deserve. By allowing schedulers and managers more flexibility, physicians and other 

care providers will be able to work schedules that are more beneficial to the patient and promote continuity of that care. 

However, I disagree with the VA’s suggestion that the language 

of this section be amended to say, quote, ‘‘is not less than,’’ unquote, as opposed to, quote, ‘‘does not exceed,’’ quote. I am concerned that requiring ‘‘is not less than’’ would likely lead to confusion and potential abuse within the department, and ultimately 

deter medical professionals from seeking employment within the 

VA. 

The point is to match scheduling and work practices with the private sector in the emergency department and other shift-like work 

like hospitalists who sometimes work a light-shift week for maybe 

one or two weeks and then resume with a very heavy-shift work 

week for one or two weeks that could be more or less than a specified number. So the idea is flexibility, not to create a rigid, concrete 

amount as the change in language would signify. 

So I urge my colleagues to keep this in mind as we continue to 

develop this discussion draft into legislation. And I look forward to 

continuing the discussion around Section 3 and the discussion draft 

as a whole. 

Let me ask you a question, Dr. Clancy. Does the VA have a physician shortage that mimics the general population physician shortage? 

Dr. CLANCY. Yes. 

Mr. RUIZ. Okay. 

Dr. CLANCY. Particularly primary care and mental health. I 

mean, those are tough for us. We got ahead of the curve briefly for 

mental health for the whole system, but because so few students 

are choosing those career paths, that becomes a rate limiter, and 

with mental health parity for the rest of the population. 

Mr. RUIZ. And how do you measure that? You know, in the 

United States we have the medically recommended number of one 

physician for 2,000, and to be medically under-served it is one to 

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26 

3,500. What is the recommendation for physicians within the VA 

and how do you measure it? Is it per population? Is it per attachment area population of veterans? How many physicians per veteran population is your goal? 

Dr. CLANCY. I don’t think that we have a physicians-per-veteranpopulation for the goal, which would be a bit tricky because— 

Mr. RUIZ. Do you think we should have one? 

Dr. CLANCY. We would be happy to explore that with you further. 

The issues are—that not all veterans in a particular area are enrolled in our system and some who are enrolled use our system for 

some services, but not all. 

Mr. RUIZ. So how do you determine need and how do you determine physician-shortage need within specific visits within specific 

VA health care systems? 

Dr. CLANCY. We determine that by how easy it is for veterans to 

get their needs met, that is literally veterans who report that they 

usually always can get the care that they need or want in a timely 

way, literally. And we actually look very closely, as Dr. Wenstrup 

knows, I am sorry he is not here because we have been over this 

with him a lot, in terms of physician productivity, and are we providing the right infrastructure support so that they can be as productive as possible. 

So it is a very dynamic— 

Mr. RUIZ. So where do you recruit these physicians where you 

have these unfilled vacancies and this physician-shortage needs, 

where is your best place to recruit them? And is the military a 

fruitful place for you to recruit not only physicians or residents or 

maybe perhaps even pre-meds from the medic community into the 

medical school, and then into your residency programs and ultimately into your VA? 

Dr. CLANCY. I don’t know if we have statistics on that, I will ask 

Mr. Hernandez in a second. I want to assure you that there is absolutely no source that we don’t turn to, whether that is the military. Our affiliates and the students who rotate through our facilities are a very good source. 

Mr. RUIZ. My specialty, as you know, is emergency medicine and 

I do have public health background and public policy background 

with my educational training, but my on-the-ground effort has been 

to address a physician shortage crisis and how to create pipeline 

programs from very difficult, under-served, hard-to-reach communities where you lack physicians, take students from those communities into medical schools, into residencies, back into those communities. 

So I want to be able to better define the problems that you are 

having using some real analytical tools rather than qualitative 

tools or maybe inaccurate tools of wait times, so that we can better 

match the need with the source, or maybe even create a pipeline 

program from pre-med medics into medical schools that feed the 

VA residency programs and into ultimately staying in the VA 

health care system. 

Dr. CLANCY. We would be delighted to work with you on that. 

Mr. RUIZ. Let’s work on that. 

Dr. CLANCY. Great. 

Mr. RUIZ. Thank you. 

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Mr. BENISHEK. Thank you, Dr. Ruiz. 

Well, that is pretty much it for the questions, but I just want to 

make one more comment that I have been thinking about through 

the whole hearing here. And it is something that since I worked 

within the VA, and I speak to a lot of VA physicians, and it is not 

something that we really addressed here in this legislation or the 

hearing, but my feeling is that with speaking to many physicians, 

that they do not have enough input in the way the processes that 

the VA does where they feel as if they are doing things as well as 

they could. 

And some of the comments Dr. Wenstrup touched on a little bit, 

but my experience is that physicians feel as if they are not being 

as efficient as possible because they don’t have enough input in the 

way things are done. The nursing department decides how the clinics are run and the physicians may not have enough input there. 

And in order to make it a competitive place to recruit physicians, 

they need to have the input to feel as if they are doing a good job, 

because I know things are changing in medicine where more and 

more physicians end up working for a big organization because you 

can’t do it. 

But you have to compete with the private sector and I think that 

you really need to work on that issue, because many of the physicians are very frustrated with it in the VA. And that the whole culture there needs to have physician leadership and communication 

with the medical director and the physicians on staff, and a visit 

to VA is an important part of that. So I want to encourage you to 

make that happen a little easier. 

So thank you all for being here again today. Does anyone have 

any other questions? 

The panel is now excused. 

I ask unanimous consent that all Members have five legislative 

days to revise and extend their remarks and include extraneous 

material. 

Without objection, so ordered. 

This hearing is now adjourned. 

[Whereupon, at 3:25 p.m., Subcommittees were adjourned.] 

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(28) 

1Statement of Max Stier, President and CEO of the Partnership for Public Service - Prepared 

for The House Committee on Veterans’ Affairs Subcommittee on Health Hearing Entitled, 

‘‘Overcoming Barriers to More Efficient and Effective VA Staffing’’, 114th Cong. (2015) (testimony of Max Stier). Print. 2 Hoyer, Megan. ‘‘Half of Critical Positions Open at Some VA Hospitals.’’ USA Today. 4 Sept. 

2015. Web. 1 Mar. 2016. 3 1AUnited States of America. Government Accountability Office. VA Health Care: Oversight 

Improvements Needed for Nurse Recruitment and Retention Initiatives. Washington, D.C., 2015. 

Page 9. Print. 4 1AIbid. 21. 

A P P E N D I X 

Prepared Statement of Max Stier 

Chairman Benishek, Chairman Wenstrup, Ranking Member Brownley, Ranking 

Member Takano, members of the Subcommittee on Health and Subcommittee on 

Economic Opportunity, thank you very much for the opportunity to share the Partnership’s views of the Subcommittees’ draft legislation to improve the authority of 

the Secretary of Veterans Affairs to hire and retain physicians and other employees. 

I am Max Stier, President and CEO of the Partnership for Public Service, a nonpartisan nonprofit organization that works to revitalize our federal government by 

inspiring a new generation to serve and transforming the way government works. 

Background 

On May 15, 2015, the Partnership submitted a statement to the Subcommittee 

on Health addressing how the Department could overcome barriers to efficient and 

effective staffing of medical and non-medical personnel 1. In our statement, we discussed how VA employees are deeply committed to the Department’s mission, but 

the agency as a whole struggles with declining morale and an inefficient hiring process. We recommended three ways VA could improve its talent acquisition processes: 

reforming the hiring process, standardizing onboarding across the organization, and 

placing renewed focus on employee engagement efforts. The Partnership reinforced 

those recommendations at the Subcommittees’ December 2, 2015 Roundtable on Veterans Affairs Hiring. I am pleased to note that the legislation being discussed today 

would address each of these recommendations in a substantive and meaningful way, 

and would, I believe, improve the Department’s ability to recruit, hire and retain 

the top-quality talent our Nation’s veterans deserve. 

VA Must Do More to Bring in Young Talent 

The ability of the Department of Veterans Affairs to care for and support America’s veterans depends on how well it can recruit, hire and retain highly qualified 

and engaged employees, particularly in the medical field. Unfortunately, the Department has struggled to bring in and hold on to top talent, with some reports showing 

nearly 41,000 vacancies at the Veterans Health Administration alone. 2 VA employees recognize these challenges as well. According to a Partnership for Public Service 

analysis of the Office of Personnel Management’s (OPM) 2015 Federal Employee 

Viewpoint Survey, fewer than half of VA’s employees responded positively to the 

statement, ‘‘My work unit is able to recruit people with the right skills’’ (43.2%), 

while a bare majority of VA employees (51%) believe ‘‘the skill level of my work unit 

has improved over the past year.’’ 

Recruitment and retention issues are exacerbated by an aging workforce which is 

becoming eligible for retirement in increasing numbers. For example, GAO found 

that by FY 2019 one in five VA nurses will be able to retire 1A3, while 42% of VHA’s 

overall senior leadership, including medical professionals, was retirement eligible in 

2015. 1A4 In order to create a balanced workforce and meet both short- and longterm talent needs, VA must do more to recruit and hire students and recent graduates, and millennials more generally. Focusing efforts to bring in young talent now 

has the additional benefit of allowing new employees to learn from thousands of talLeonard.horne on VACREP0180 with DISTILLER

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5 1AUnited States of America. Veterans Health Administration. Healthcare Talent Management, Workforce Management & Consulting Office. 2014 VHA Interim Workforce and Succession Strategic Plan. Page 13. Web. 6 1AIbid. 24. 

ented, dedicated and experienced medical professionals, benefits administrators, and 

mission-support staff before they leave the organization. 

The Department’s own 2014 Interim Workforce and Succession Strategic Plan 

noted that by the end of the decade the U.S. workforce will be approximately 50% 

millennials. 1A5 The Department of Veterans Affairs cannot be left behind. However, to date VA has struggled to build pipelines of young talent. In 2015, just 0.68% 

of VA’s workforce was under the age of 25 and 5.35% were under the age of 30. 

In terms of hiring, 15.7% of new VA hires were under the age of 30, while the comparable government-wide figure was 25.2%, according to OPM’s Fedscope database. 

In 2014 millennials made up 11.3% of the Veterans Health Administration workforce, where the bulk of the Department’s employees reside. 1A6 Exacerbating this 

problem is low satisfaction among younger employees. The latest Best Places to 

Work in the Federal Government Rankings, published by the Partnership for Public 

Service and Deloitte, found that VA ranked second-to-last among large agencies in 

satisfaction among employees under the age of 40. 

Partnership Views of the Draft Legislation to Improve VA’s Authority to Hire 

and Retain Physicians and Other Employees 

Because several sections of the proposed legislation are outside of the Partnership’s areas of expertise, I will focus my remarks on those provisions on which we 

are best equipped to comment. My remarks below address each relevant section individually. 

Section 2. Appointment and Pay for Directors of Medical Centers and Veterans Integrated Services Networks 

The Partnership supports greater use of market pay as a mechanism for attracting and rewarding top talent in government, though we do not have a specific view 

as to the qualifications standards for medical center and Veterans Integrated Service Network directors. The Partnership’s 2014 report with Booz Allen Hamilton, 

Building the Enterprise: A New Civil Service Framework, states that the current 

federal pay system undermines government’s ability to attract and retain high-quality professional and administrative personnel and proposes a market pay system 

that recognizes distinctions between job types, compensation, and performance common in the private sector. We are pleased to see the Subcommittees expanding this 

concept to these critical, high-visibility positions. 

Section 7. Executive Management Fellowship Program 

The Partnership has long supported efforts to expand the mobility of government 

employees and senior executives across agencies and between government and the 

private sector. For that reason, we strongly support the draft legislation’s Executive 

Management Fellowship Program, which would provide a one-year fellowship to eligible employees to work in private sector organizations engaged in the administration and delivery of health care or other benefits. In 2012 the Partnership and 

McKinsey and Company issued a report titled, Mission-Driven Mobility: Strengthening Our Government through a Mobile Leadership Corps, examining how the SES 

could meet its promise of serving as a mobile, enterprise-wide leadership team as 

originally envisioned by the Civil Service Reform Act of 1978. Our report describes 

the powerful positive impacts of mobility in building executive managerial skills, 

strategically filling vacancies, and infusing new thinking into an organization. Senior career employees at VA will benefit from access to diverse perspectives, a 

breadth of experience, and a deeper understanding of the private sector’s processes, 

technologies, and operational framework. The Executive Management Fellowship 

Program, aimed at SES and aspiring senior executives, if well-executed, offers to 

bring significant benefits to VA’s senior executive corps. 

We recommend the Subcommittees consider two changes to the Executive Management Fellowship Program as currently constructed. First, we suggest increasing 

the program’s cap of 30 participants, for example by initially implementing the Fellowship as a pilot program with a participant cap to determine its effectiveness, and 

then opening it up to a larger number of participants if warranted. To ensure that 

only the best employees are able to participate, the Subcommittees should also consider requiring eligible employees to have at least two consecutive outstanding ratings. The combined workforce of VHA and VBA is nearly 293,000, and there are 

more than 7,000 eligible participants. Cost concerns aside, the vast size of this 

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30 

7 1AUnited States of America. Government Accountability Office. VA Health Care: Oversight 

Improvements Needed for Nurse Recruitment and Retention Initiatives. Washington, D.C., 2015. 

Page 17. Print. 

workforce means that a cap of 30 participants will severely limit the program’s potential impact. The Partnership believes mobility is a worthwhile investment, and 

would demonstrate to senior VA employees that their agency values them and is 

willing to invest in their development. Our second recommendation is to look at 

ways in which the Fellowship program could be made into a two-way exchange, in 

which individuals from the private sector come to VA to share cutting-edge operational techniques and best practices. 

Section 8. Accountability of Leaders for Managing the Department of Veterans Affairs 

The Partnership strongly supports the draft legislation’s provision requiring political appointees at the Department to undergo a performance planning and appraisal 

process similar to that of the Department’s career senior executives. We additionally 

recommend that the Subcommittees look into how VA could create connectivity between the performance expectations for political appointees and career executives. 

Though political appointees and career executives face different demands and operate at different levels of the organization, aligning performance expectations in this 

way can help needed reforms and accountability cascade throughout the organization. 

As the highest level of leadership in the Department of Veterans Affairs, political 

appointees play a crucial role in providing leadership and setting priorities for the 

organization. Appointees should be held accountable for their performance and contributions like every other employee. Data from the Partnership’s analysis of the latest OPM Federal Employee Viewpoint Survey demonstrates why this provision is 

so important: in 2015, just 32.7% of VA employees responded positively to the statement, ‘‘In my organization, senior leaders generate high levels of motivation and 

commitment in the workforce’’, and only slightly more, 38.5%, positively responded 

to the statement ‘‘My organization’s senior leaders maintain high standards of honesty and integrity.’’ Appraising and holding accountable political leaders for setting 

priorities and expectations, and developing an empowering and engaged culture 

throughout the organization, will help to restore trust in senior leadership. 

We are particularly pleased that the performance plans will address the accountability of leaders for promoting good practices and supporting efforts to recruit, select and retain well-qualified individuals, engage and motivate employees, train and 

develop future leaders in the Department, and hold managers accountable for addressing performance issues. Each plays a critical role in building a high-performing 

workforce, and will further drive leadership attention to the pressing workforce 

issues within the Department. However, engaging and motivating employees may 

be one of the most immediate and impactful ways by which senior political appointees at VA can make an impact. As noted above, fewer than four in ten VA employees feel that their senior leaders are motivating them. The Partnership’s Best 

Places to Work in the Federal Government Rankings put VA employee satisfaction 

with senior leaders at 18 out of 19 large agencies. GAO has also found that employee dissatisfaction negatively impacts the ability of VHA to retain employees in 

mission-critical occupations. 1A7

Section 9. Modification of Veterans Preference 

While the Partnership supports the goal of a diverse federal workforce, including 

the continued recruitment and hiring of veterans, we have concerns over the proposed legislation’s expansion of veterans’ preference to the Senior Executive Service. 

The Senior Executive Service is, by law, excluded from the application of veterans’ 

preference, and applying such preference specifically to VA would put the Department at a disadvantage when competing for executive talent with other agencies 

and the private sector. Requiring, as the proposed legislation does, that VA should 

select candidates for senior executive positions ‘‘in the same manner and under the 

same conditions required for the competitive service’’ may further hinder the VA’s 

ability to recruit diverse talent with the skills the Department badly needs, such 

as in hospital administration and critical mission-support functions such as human 

resources, information technology, and financial management. 

We ask the Subcommittees to consider other ways to increase the number of veterans in senior executive positions that do not unnecessarily restrict the Department’s ability to bring in the executive talent needed to complete its transformation 

process. Concerns about a relative paucity of veterans in top leadership positions 

is a valid concern, and there are substantive ways in which the Subcommittees and 

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VA can work together to address it. For example, while VA does not have specific 

leadership development programs aimed at employees who are veterans, the Department can increase its efforts to encourage veteran employees to participate in its 

two primary leadership development programs, LeadershipVA and the Senior Executive Service Candidate Development Program, which prepare employees for senior 

leadership positions. VA could also enhance its outreach to the broader veterans’ 

community to recruit external veteran candidates for SES jobs at the Department. 

Such an approach would require VA to work with these candidates to help them 

navigate the SES application process, though we believe it is well worth the effort. 

Section 10. Reemployment of Former Employees 

The Partnership enthusiastically supports granting VA authority to noncompetitively appoint qualified former employees of VA to any competitive or excepted service position at the agency - an issue the Partnership discussed in our report, Building the Enterprise: a New Civil Service Framework. As the report notes, current law 

allows a former employee who has held a career or career-conditional position to be 

noncompetitively reinstated only at a grade level at or below that which they held 

before leaving government. This change, provided for in the draft legislation being 

discussed today, will give VA greater flexibility in bringing back employees who 

have gained valuable training and work experience in their time away from the Department, and would provide an additional incentive to employees who are considering a return to VA. 

We suggest, however, that the Subcommittees consider going further. Specifically, 

we would recommend removing the one grade level limit and opening the opportunity for noncompetitive reemployment to all federal employees, rather than just 

those previously employed at the Department. By removing this limitation, VA 

would offer further enticement to those former employees who are more advanced 

in their careers, providing the Department with an additional method by which it 

could recruit mid-career and senior-level talent. Opening the noncompetitive reemployment opportunity to all federal employees would give VA a leg up in recruiting 

talent from other agencies with similar workforces (e.g., HHS, NIH, DOD, etc.) and 

recognize the enterprise-wide nature of the challenges that agencies like VA face in 

hiring top talent. We understand and appreciate the concern over the potential of 

this flexibility to be used improperly, but believe this could be easily addressed by 

requiring the VA Inspector General or the Government Accountability Office to 

audit the use of this hiring authority within a specific timeframe to ensure that it 

is being used as intended. VA could also report on the use of this authority as part 

of the hiring effectiveness measures in Section 15. 

Section 11. Recruiting Database 

The Partnership supports the draft bill’s requirement for the Department of Veterans Affairs to create a Department-wide database for vacant mission-critical and 

hard-to-fill positions, particularly those that have been vacant for a prolonged period 

of time. VA’s decentralized hiring processes have led to many facilities competing 

for similar talent, and has prevented the Department from addressing critical shortages where they exist. The recruiting database will help VA move closer to an enterprise-wide hiring system that can effectively address recruitment, hiring and retention challenges where and when they occur, rather than simply hoping candidates 

for VA jobs find their way to the facilities where they are needed most. We recommend that VA consider how it can combine the recruiting database authorized 

by this legislation with the recently-enacted Competitive Service Act, which allows 

agencies to hire off each other’s certification list for a position. The Partnership believes the Act has the potential to greatly facilitate the filling of mission-critical positions both government-wide and within the VA, and we encourage VA to work 

with the Office of Personnel Management to make the best possible use of this new 

authority. 

Section 12. Human Resources Academy 

The Partnership supports all efforts to strengthen the federal human resources 

workforce. Our May 15, 2015 statement for the Subcommittee noted that VA HR 

staff tend to ‘‘post and pray’’ when hiring for key positions and receive limited training in workforce and succession planning. A September 2015 GAO report on the recruitment and retention of nurses also found that a lack of sufficient administrative 

support from HR departments at individual VHA facilities limited the extent to 

which those facilities could take advantage of recruitment and retention tools, 

though this report cited a lack of resources for HR teams as having just as big an 

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8 1AIbid. 17. 9 1A‘‘VA HR Academy.’’ Home. Department of Veterans Affairs, 17 Nov. 2014. Web. 09 Mar. 

2016. 10 1AStatement of John Palguta, Vice President of Policy, Partnership for Public Service - Prepared for The Senate Homeland Security and Governmental Affairs Subcommittee on Oversight 

of Government Management, the Federal Workforce, and the District of Columbia titled ‘‘Building and Maintaining and Effective Human Resource Workforce in the Federal Government’’, 

112th Cong. (2012) (testimony of John Palguta). Print. 

impact as training. 1A8 The decentralized nature of VA’s hiring system also tends 

to mean that recruiting and hiring is not done strategically and special hiring authorities and flexibilities are not used to the extent that they could be. 

The Department currently operates a ‘‘VA HR Academy’’, which provides access 

to training, career pathing tools like MyCareer@VA, and an HR competency model 

for VA HR employees to use as part of their professional development 1A9, but it 

has been underfunded in recent years. This legislation provides an opportunity to 

bring greater prominence and renewed focus to this underutilized resource. Specifically, the goals of the legislation to provide more training on best practices in recruiting and hiring mission-critical talent should be integrated into a strengthened 

HR Academy. The Subcommittees should request more information from VA on the 

current status of the HR Academy, and on ways the Academy’s offerings can best 

be tailored to meet the intent of this legislation and the Department’s most pressing 

current talent needs. Reviving the VA HR Academy has the potential to address the 

challenges this draft legislation seeks to take on, and could even help increase engagement among VA’s HR workforce. The Partnership’s 2015 Best Places to Work 

in the Federal Government Rankings showed the cohort of human resources employees at VA ranked 10 out of 18 large agencies in overall satisfaction. 

In 2012, the Partnership’s Vice President of Policy John Palguta testified before 

the Senate Homeland Security and Governmental Affairs Subcommittee on the 

Oversight of Government Management, the Federal Workforce and the District of 

Columbia on building and maintaining an effective federal human resource workforce 1A10. His testimony emphasized the important role HR plays in acting as a 

strategic advisor and business partner supporting the mission side of the organization and advocated for directing more resources to the federal HR workforce. Not 

only can better training for HR staff improve the quality of talent coming into VA, 

but has huge potential to improve morale and engagement, increase retention, and 

reduce turnover costs. 

Finally, we recommend both to the Subcommittees and to VA that the training 

provided by the VA HR Academy also include best practices for HR staff in effectively engaging with hiring managers to maximize the success of the hiring process 

and satisfaction with new hires, and to think more holistically about how other aspects of VA’s HR processes impact its ability to use the tools, flexibilities and authorities available. Another recommendation to the Subcommittees would be to expand the availability of training beyond just human resources staff to all VA employees who are engaged in recruitment activities. We hope the Subcommittees will 

consider other ways by which more attention and resources can be directed to VA’s 

human resources offices and staff, for example by specifically authorizing money for 

non-medical, mission-support training at the Department that will be protected from 

use for other administrative or personnel activities. HR plays a crucial role in ensuring that VA has the talent it needs to serve veterans, and we appreciate the Subcommittees substantive action in this area. 

Section 13. Promotional Opportunities for Technical Experts 

The Partnership is highly supportive of the draft legislation’s provision requiring 

the Secretary of Veterans Affairs to establish a promotional track system for employees of the Department who are technical experts. The rigid structure of the GS 

system requires employees to move into supervisory and management roles, even in 

cases where the employee may not be an effective manager but must take on such 

duties in order to advance in their career. This is especially true for employees who 

possess valuable technical expertise but are not suited for supervisory duties. Such 

employees may include medical professionals or experts in veterans’ benefits law 

who possess valuable expertise in complex subjects. 

However, we believe this provision can be further strengthened by making explicit 

that the Department should evaluate candidates for managerial or supervisory roles 

based on their executive and people skills as well as their technical expertise, and 

give candidates the opportunity to develop these skills. Like most other federal 

agencies, VA does not have a standard criteria for promoting managers. As noted 

above, managers are often promoted based on the technical expertise relevant to 

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11 1AStatement of the Honorable Robert A. McDonald, Secretary of Veterans Affairs, For 

Presentation Before the House Committee on Veterans’ Affairs, ‘‘Budget Request for Fiscal Year 

2017’’, 114th Cong. (February 10, 2016). Print. 12 1AUnited States of America. Veterans Health Administration. Healthcare Talent Management, Workforce Management & Consulting Office. 2014 VHA Interim Workforce and Succession Strategic Plan. Page 5. Web. 

their particular organization (e.g., VBA will look for managers with strong knowledge of claims administration). We recommend the Subcommittee consider language 

requiring aspiring supervisors and managers to demonstrate leadership skills either 

through their day-to-day work or through an educational requirement. This educational requirement could take the form of online or in-person classes developed 

and advertised through VA Learning University (VALU). Employees would not be 

able to advance into supervisory or managerial positions without being certified as 

having taken such a course. This would be a high-impact and light lift for the Department. Not only would it guarantee that every new manager understands the 

basic tenets of effective leadership, but would allow those individuals who are not 

fit for management to realize it before they take on a supervisory role. Only those 

employees who have the competencies necessary to be successful would become supervisors. 

Section 14. Comptroller General Report on Succession Planning 

The Partnership supports the requirement included in this draft legislation requiring the Comptroller General to report on succession planning efforts at the Department of Veterans’ Affairs. According to Secretary McDonald’s statement before 

the House Committee on Veterans’ Affairs on February 10, 2016 1A11 the Veterans 

Health Administration hired over 41,000 employees in 2015, though that hiring resulted in a net employment gain of about 14,000 staff. This, combined with the figures on retirements cited earlier, suggests a high level of turnover at the Department, and a need for a robust succession management process. The Partnership believes this report would be useful in helping the Department better understand the 

quality of succession planning going on throughout the organization and in developing a more consistent succession planning strategy. While VHA currently conducts strategic planning across its network of facilities 1A12, the GAO’s report would 

give Congress better visibility into the extent and usefulness of workforce and succession planning activities at these individual facilities, as well as at other facilities 

across the VA. As the Partnership’s 2011 report with Booz Allen Hamilton, Preparing the People Pipeline: A Federal Succession Planning Primer noted, succession 

planning is an effective tool for dealing not only with departures but also with retention by helping managers determine the critical skills that exist within their 

teams and how to develop and keep needed talent. The Partnership encourages VA 

to use this report to further refine and strengthen its internal succession planning 

processes, ensure that such processes are consistent across the organization, and tie 

them to the measures of hiring effectiveness required to be collected under Section 

15. 

Section 15. Information on Hiring Effectiveness 

The Partnership applauds the Subcommittee’s decision to include in its proposed 

legislation a mandate for VA to measure and report on the effectiveness of its hiring 

process, and we believe this requirement can be further strengthened. As I noted 

at the Roundtable on VA hiring hosted by the Subcommittees in December, you cannot manage what you cannot measure. VA must have actionable data in order to 

properly understand and address persistent hiring challenges. Yet the Department 

appears to lack a comprehensive understanding of the strengths and weaknesses of 

its hiring process. The language proposed here would require VA to collect and publically report on the effectiveness of its recruitment programs and hiring authorities, 

the quality of new hires, time-to-hire, applicant and employee satisfaction with the 

hiring process, and new hire satisfaction with onboarding, among other things. 

These data should allow VA to construct a fuller picture of its hiring process, including specific points where the process bogs down. Developing a fuller understanding 

of the use of special hiring tools, authorities and flexibilities is especially critical, 

as Congress has authorized a number of programs and tools at VA to promote hiring, particularly of medical professionals, such as the Education Debt Reduction 

Program, the Employee Incentive Scholarship Program, and various recruitment, retention and relocation incentives. 

To make this report even more valuable both to VA and to Congress, the Subcommittees should look at including a measure of ‘‘customer satisfaction’’ of hiring 

managers and new employees with VA’s human resources offices, for example by 

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13 1AUnited States of America. Office of Management and Budget. M 0914 0912: Memorandum for the Heads of Executive Departments and Agencies: Management Agenda Priorities 

for the FY 2016 Budget. By Brian C. Deese. July 18, 2014. Web. 14 1AUnited States of America. Veterans Health Administration. Health are Talent Management, Workforce Management & Consulting Office. 2014 VHA Interim Workforce and Succession Strategic Plan. Page 64. Web. 

asking their views of the information and support they received from their HR offices. It is worth noting that VA has collected this data in the past. Such a measure, 

if included, should also specify that data should be taken from HR offices across the 

VA enterprise, where the vast majority of hiring and other personnel actions take 

place. We encourage the Subcommittees to look into the administration’s and VA’s 

work to benchmark costs and best practices across agency mission-support functions 

and how these efforts can be further encouraged, a process that involves analyzing 

customer satisfaction in each function. VA is currently tasked with benchmarking 

administrative spending and identifying performance improvements opportunities in 

the areas of real property and financial management 1A13. An expansion of the 

benchmarking effort to VA’s HR by the administration would go a long way towards 

fixing the organization’s talent issues. We also recommend that, as part of the Department’s requirement to share this information to Congress, it be asked to report 

on the biggest pain points in or barriers to effective hiring. We believe this is an 

effective way for the Subcommittees to engage with VA on any additional reforms 

necessary to improve its hiring process. 

It is, however, important to understand that VA’s HR systems, as currently constructed, are not built to collect and centralize this information. In fact, this problem 

is not unique to VA - nearly every agency lacks such a system. While VA is currently developing an integrated human resources information system, it is still in 

its early stages and rudimentary. Personnel databases are scattered across the organization and within each of the Department’s individual subcomponents, and each 

subcomponent owns its own data. The bill as written requires VA to fully commit 

to constructing a centralized information system. This is a very worthy goal, and 

something we encourage the Department to pursue. It is important to understand, 

though, that it will take time. However, the Subcommittees’ draft legislation can 

serve as a useful focusing mechanism for the Department and prompt quicker development of this system. 

Section 16. Employment of Students and Recent Graduates 

The Partnership is highly supportive of the draft legislation’s provision codifying 

the Department’s authority to convert Pathways program participants to full-time 

entry-level positions. At the Subcommittees’ December roundtable on VA hiring, I 

emphasized how student interns and recent graduates provide the best way for the 

Department to assess and hire top young talent into the organization. Increasing 

the number of young people in an organization can provide fresh ideas, reinvigorate 

the workforce, and provide a pipeline of future leaders. This is true even at VHA, 

which could take advantage of students and recent graduates to fill nursing, physician assistant and mission-support roles. Increasing the number of students and recent graduates in VA’s workforce is critical given the overall dearth of young talent 

at VA which I noted earlier. The private sector makes significant use of student interns as a talent pipeline for entry level positions, but government squanders the 

opportunity to make use of this talent pool. Government as a whole, and the Department of Veterans Affairs in particular, needs to normalize the way interns are utilized. While the administration’s 2010 hiring reform, which included the Pathways 

internship programs, has made some progress, we do not believe it has been enough. 

The Partnership is very pleased that the Subcommittees have included this provision, which would codify VA’s existing authority under the Pathways programs to 

make excepted service appointments of student interns, volunteers with substantive 

duties, and interns contracted through third-party organizations. This change would 

demonstrate Congress’ support for Pathways and push VA to expand its use of the 

programs, which VA has already committed to implementing in its 2014 Interim 

Workforce and Succession Strategic Plan. 1A14 Ultimately, we believe this provision 

will increase the pool of proven, high quality entry-level talent available to VA. 

Section 17. Exit Surveys 

The Partnership supports mandating in statute an exit survey for employees who 

voluntarily separate from the agency, and we are particularly pleased that the Subcommittees have included a reporting requirement that will ensure that the Department is using the survey data to improve retention of VA employees, especially 

those in mission-critical occupations. VA Directive 5006 currently requires the DeLeonard.horne on VACREP0180 with DISTILLER

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15 1AIbid. 22 

partment to conduct a voluntary exit survey of employees separating from the organization, but we believe the survey is underutilized and that this provision will 

strengthen the survey and bring it renewed focus. Holding on to mission-critical talent requires understanding the reasons employees are leaving in the first place, and 

so VA’s ability to continue to strengthen its hiring process requires that the Department can measure its success and hold itself accountable for its improvement. We 

would encourage the Department of Veterans Affairs to use this mandate from Congress to make its current exit surveys more robust, participation more widespread 

and data more widely available to key stakeholders inside and outside of the organization. To this end, the Subcommittees should consider requiring the Department 

to publically report aggregate exit survey data. VA must make special efforts to ensure that these data, in combination with the other hiring and workforce planning 

information required to be collected by this legislation, is available to all human resources offices and hiring managers, and is actually being used to develop a comprehensive strategy for bringing in and holding on to the talent the Department 

needs. Data from the 2014 VHA Interim Workforce and Succession Strategic Plan 

proves the need for this effort - the report showed that only 25.8% of VA employees 

exiting the organization had their manager or supervisor talk to them about changing their mind 1A15. Keeping all of this in mind, we encourage the Subcommittees 

to continue to conduct meaningful oversight of VA’s hiring processes and workforce 

management. 

Enablers of Effective Implementation 

The Partnership believes this legislation has tremendous potential to improve the 

Department’s recruitment, hiring and retention of dedicated professionals to serve 

our Nation’s veterans. However, if the proposals offered here are to be meaningfully 

implemented, the Subcommittees must pay special attention to certain key enablers 

of that implementation. Legislation does not exist in a vacuum; it must be executed 

within an organization with unique strengths, weaknesses and challenges. If the 

Department’s leadership is not committed, or not supported in making these 

changes happen, the odds of success become much longer. Should this legislation 

pass, its execution will deserve, and require, the Subcommittees’ sustained attention. Below I identify several key enabling factors that will impact the potential of 

this legislation to bring about significant, positive change to how the Department 

manages its talent: 

• Support from Congress for VA employees - Congress has an important constitutional duty to ensure that VA serves veterans efficiently, effectively and with 

the respect they have earned. The Department’s employees are ultimately accountable to Congress, but Congress is also accountable to employees as the steward of 

the VA’s resources and priorities. We urge the Committee to work constructively 

with VA to address challenges facing its workforce, and to recognize the vast majority of VA’s employees who are hard-working, patriotic public servants who have 

dedicated their professional lives to serving America’s veterans. The public image 

of VA, which Congress has a hand in shaping, plays as important a role in supporting recruitment and retention as any single initiative of the Department. 

• Recognizing the impact of recent proposals on VA’s senior executive 

workforce - The Secretary’s recent proposal to place the Department’s senior executive corps under Title 38 grants greater flexibility to VA in hiring, paying and, if 

necessary, disciplining executives. However, the proposal will complicate the leadership and morale picture at VA. If that proposal moves forward, the Subcommittees 

should conduct rigorous oversight to ensure that it complements the intent of this 

legislation and furthers the goal of bringing top executive talent into the organization. 

• Clear accountability for implementation - As written, the bill does not provide for specific individuals to be responsible for implementing the various programs, flexibilities and reporting requirements this legislation creates. It is critically 

important to keep in mind that there is no one human resources office at VA. Dayto-day program and policy implementation is handled by the human resources offices of the Department’s subcomponents, and truly effective implementation will require the Subcommittees to, within the bill itself, delegate specific responsibilities 

or allow the Secretary to delegate specific responsibilities to those individuals best 

situated to make these improvements happen. 

• Development of a centralized, integrated VA human resources information system (HRIS) - VA, like nearly all federal agencies, lacks a single repository 

of personnel data. Instead, data critical to understanding the state of VA’s workforce 

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1 1AResolution 311: The American Legion Policy on VA Physicians and Medical Specialists 

Staffing Guidelines 

and hiring processes is scattered throughout the organization. While the Department is developing a HRIS, it should not be assumed that VA’s central HR office 

can pull this data together easily. The Subcommittees should sufficiently resource 

and conduct meaningful oversight of VA’s efforts to build an accurate, usable and 

fully integrated personnel information system. 

• Sufficient resources for training and development - Training is one of the 

most effective means by which VA can retain the best and brightest employees, improve morale, and reduce turnover costs. However, funding available for non-medical training at the Department has declined in recent years and has hurt its ability 

to provide quality developmental opportunities to employees, particularly those in 

mission-support functions such as human resources, who are at the front lines of 

the VA’s efforts to recruit top talent. Further complicating this picture is that such 

funds can be lumped in with other personnel costs and used for purposes other than 

staff development. The Subcommittees, as well as the Appropriations Subcommittee 

on Veterans Affairs, Military Construction, and Related Agencies, should ensure sufficient, dedicated funding for quality, recurring training for the mission-support 

services that enable the Department’s work. 

• Maintaining momentum through the transition - There are roughly ten 

months left in the current administration, and many of the Department’s key leaders will soon be gone. The commitment of current leadership to executing on this 

legislation will, potentially, be limited by an unwillingness to take on bold and timeand resource-intensive new initiatives. The Subcommittees provide important continuity across administrations, and so we urge you to sustain your commitment to 

building a strong, engaged and effective VA workforce. 

Conclusion 

Chairman Benishek, Chairman Wenstrup, Ranking Member Brownley, Ranking 

Member Takano and members of the Subcommittees on Health and Economic Opportunity, thank you for the opportunity to give the Partnership’s views of this legislation. The draft bill we are discussing today will make a meaningful and positive 

impact on the ability of the Department of Veterans Affairs to recruit, hire and retain the talent it needs to achieve its mission, and we are pleased to support it. I 

look forward to continuing to work with your Subcommittees to advance this legislation. Thank you, and I am happy to answer any questions you may have. 

f 

Prepared Statement of Roscoe G. Butler 

As far back as 1998, The American Legion expressed concerns regarding VA physicians and medical specialists staffing shortages within the Veterans Health Administration (VHA). This was accomplished by monitoring the progress in establishing patient centered primary care within each Veterans Integrated Service Network (VISN), including both rural and urban localities as well as ensuring that the 

model of care features both the quality and efficient combination of medical professionals that are tailored to the needs of the local veteran’s population. 1A1

Chairmen Benishek, Wenstrup, Ranking Members Brownley, Takano and distinguished members of the Subcommittees on Health and Economic Opportunity on behalf of National Commander Dale Barnett and The American Legion; the country’s 

largest patriotic wartime service organization for veterans, comprising over 2 million members and serving every man and woman who has worn the uniform for this 

country; we thank you for the opportunity to testify regarding the draft legislation 

regarding ‘‘Improving the authority for the Secretary of Veterans Affairs (VA) to 

hire and retain physicians and other employees of the Department of Veterans Affairs’’. 

From the inception of The American Legion’s System Worth Saving (SWS) Program in 2003, The American Legion has tracked and reported staffing shortages at 

every VA medical facility across the country and submitted those to Congress, VA 

Central Office (VACO), and to the President of the United States. Through numerous SWS hospital site visits, The American Legion has dedicated considerable resources to monitoring the Veterans Health Administration (VHA) healthcare system. 

Unfortunately, there are no easy solutions for VA when it comes to effectively and 

efficiently recruiting and retaining medical staff to treat the growing number of veterans that are entering the VA healthcare system. The American Legion believes 

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2 1AResolution No. 237: The American Legion Policy on VA Nurse Recruitment and Retention 3 1AThe American Legion: 2012 System Worth Saving Report on Rural Health Care 

that access to basic health care services offered by qualified primary care providers 

should be available locally as often as possible. VHA is still currently struggling to 

achieve the appropriate balance of primary care and medical specialists across the 

country. 

In 2004, The American Legion urged the VA to develop an aggressive strategy to 

recruit, train, and retain advanced practice nurses (APN’s), registered nurses (RN’s), 

licensed practical nurses (LPN’s), and nursing assistants (NA’s) to meet the inpatient and outpatient health care needs of veterans. The Legion fully supports VA’s 

education-assistance programs for APNs, RNs, LPNs, and NA’s. We also urged VA 

to provide equitable and competitive wages for Advanced Practice Nurses (APNs), 

Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and nursing assistants. 

1A2

Due to the fact that one out of every three veterans treated by the VA lives in 

a rural area, The American Legion remains concerned with the problems rural veterans face due to a lack of access to qualified health care. As the number of veterans 

residing in rural communities increases, veterans will continue to struggle to find 

timely and quality VA health care that meets their individual health care needs. 

VA medical centers in rural areas have often expressed concerns in recruiting and 

retaining qualified medical and clinical providers due to their inability to compete 

with medical centers in large metropolitan areas. In The American Legion’s 2012 

System Worth Savings (SWS) Report on Rural Healthcare, The American Legion 

found that: 

‘‘[Department of Veteran Affairs Medical Centers (VAMCs)] in rural America, recruitment and retention of primary and specialty care providers has been a constant 

challenge. Some clinicians prefer to practice in more urban settings with more research opportunities and quality of life that urban settings provide.’’ 1A3

In 2014, The American Legion published a SWS report titled ‘‘Past, Present, and 

Future of VA Healthcare’’, which noted several challenges VA still faced regarding 

recruiting and retention such as: 

• Several VAMCs continue to struggle to fill critical leadership positions across 

multiple departments. 

• These gaps have caused communication breakdowns between medical center 

leadership and staff that work within these departments. 

During our 2013 site visit to the Huntington VA Medical Center in Huntington, 

West Virginia, we recommended that, ‘‘VHA conduct a rural analysis for hard to recruit areas and look into different options to support VAMCs in getting talent they 

need to better serve veterans.’’ VHA needs to ensure that veteran health care is consistent across each Veterans Integrated Service Network (VISN). 

In 2015, during our SWS site visit to the VA Medical Center in St. Cloud, Minnesota, providers expressed concerns about the number of physician vacancies, and 

how the additional workload is impacting morale at the medical centers. During the 

same visit, one veteran expressed concern noting ‘‘every time [I] visit the medical 

center, [I am] assigned a new primary care provider because [my] last provider either quit or transfer to another VA.’’ 

There have been numerous reports citing VA’s staffing issues, for example in January 2015, the VA’s Office of Inspector General (VAOIG) released their determination of the ‘‘Veterans Health Administration’s Occupational Staffing Shortages,’’ as 

required by Section 301, of the ‘‘Veterans Access, Choice and Accountability Act 

(VACAA) of 2014’’. With this report, VAOIG determined that the five occupations 

with the largest staffing shortages were Medical Officers, Nurses, Physician Assistants, Physical Therapists, and Psychologists. The OIG recommended that the ‘‘Interim Under Secretary for Health continue to develop and implement staffing models for critical need occupations.’’ Ultimately, if the VA continues to struggle with 

retention and recruitment, the trend of closures (or continued closures) for multiple 

departments within VAMCs nationwide will continue. 

As The American Legion continues to conduct System Worth Saving Site visits 

across the VA health care system, we see VA staffing shortages getting worse rather 

than improving. 

Draft Legislation to Improve Hiring Practices at the Department of Veterans Affairs: 

This draft bill aims to improve the authority for the VA Secretary to hire and retain physicians and other employees of the VA. Below is a section by section analysis of the draft bill as presented: 

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4 1A38 U.S. Code § 7306 : Office of the Under Secretary for Health 5 1AAmerican Legion Resolution No. 101: Department of Veterans Affairs Recruitment & Retention-Sept. 2015 6 1A38 U.S. Code § 7423: Personnel Administration; Full-Time Employees-2011 7 1AResolution No. 251: Extended Hours and Weekends for Veterans’ Health Care-Aug 2014 

Section 2: Appointment and Pay for Directors of Medical Centers and Veterans 

Integrated 

Services Network (VISN) 

Currently, Paragraph (4) of section 7306(a) of Title 38, United States Code 

(U.S.C.) states that the Office of the Under Secretary for Health shall consist of 

such Medical Directors as may be appointed to suit the needs of the Department, 

who shall be either a qualified doctor of medicine or a qualified doctor of dental surgery or dental medicine 1A4. Subsection (a) of this bill would add ‘‘or other qualified 

medical professionals.’’ 

This subsection includes a new section in Title 38 U.S.C. Chapter 74, Subchapter 

IV ‘‘Pay for Nurses and Other Health-Care Personnel.’’ The new section, titled ‘‘Medical Directors and directors of Veterans Integrated Service Networks (VISN),’’ discusses elements of pay, base pay, market pay, requirements and limitations on total 

pay, treatment of pay, and ancillary effects of decreases in pay. 

The American Legion supports legislation addressing the recruitment and retention challenges that the VA has regarding pay disparities among those physicians 

and medical specialists who are providing direct health care to our Nation’s veterans 1A5. The American Legion supports this section. 

Section 3: Adjustment of Hours Authorized for Certain Full-Time Employees of 

Veterans Health Administration 

Currently, Section 7423(a) of Title 38, U.S.C., sets the hours of employment of 

Full Time Employees (FTEEs) to not less than 80 hours in a biweekly pay period 

1A6. This section is a legislative request by the VA which would allow the Secretary 

to modify the hours that employees work within the Veterans Health Administration by changing the regulation to ‘‘be more or less than 80 hours in a biweekly pay 

period if the total hours of employment for such an employee does not exceed 2,080 

hours per calendar year.’’ 

The American Legion encourages and supports VA in providing extended hours 

and weekend appointments for both primary and specialty care at all VA medical 

facilities in addition to their regular hours of operation 1A7. The American Legion supports this section. 

Section 4: Public-Private Contributions for Additional Educational Assistance for 

Graduate Degrees Relating to Mental Health 

This section allows the Secretary to pay 66 percent for the Yellow Ribbon Program 

under the Post-9/11 GI Bill for a graduate degree in the mental health field instead 

of ‘‘up to 50 percent’’ as is currently the case. The schools would then only be required to pay the remaining 34 percent as opposed to ‘‘an equal percentage.’’ 

This increase is not going to apply to all people using the GI. Bill, as there are 

several particular requirements to qualify. In order to qualify the veteran would be 

required to already have a bachelor’s degree; be eligible for the Post-9/11 GI Bill 

and eligible for the Yellow Ribbon Program; and pursuing the degree with the intention of being a mental health professional for VA. 

The Yellow Ribbon Program allows institutions of higher learning (i.e., colleges, 

universities, and other degree-granting schools) in the U.S. to voluntarily enter into 

an agreement with VA to fund tuition and fee expenses that exceed the tuition and 

fee amounts payable under the Post-9/11 GI Bill. It is well documented and understood that present and future labor shortages are in the healthcare field. It’s important to note - as the aging U.S. population causes the number of working-age adults 

to shrink - the demand for medical workers will certainly increase. Consequently, 

paired with the often high education and experience requirements needed to enter 

the job market - it has been a factor in the shortage in healthcare workers. 

Based upon VA’s report, they’ve determined that the five occupations with the 

largest staffing shortages’ were Medical Officer, Nurse, Physician Assistant, Physical Therapist, and Psychologist. Without question there is a tremendous need for 

healthcare professionals, and something has to be done to deal with this shortage. 

This increase in payment just might provide the right incentive for more schools 

to participate in the Yellow Ribbon Program and more student-veterans to potentially pursue employment within the healthcare field, which would lead to a greater 

percentage of potential employees in the healthcare industry. The healthcare industry is an attractive and high growth industry (includes good pay, benefits and mobility)—it’s a win-win for all of them and the VA. 

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8 1AResolution 312: Ensuring the Quality of Servicemember and Veteran Student’s Education 

at Institutions of Higher Learning- Aug. 2014 9 1A38 U.S. code § 7412: Annual determination of staffing shortages; recruitment and appointment for needed occupations-March 2016 10 1AResolution 114: Department of Veterans Affairs Veteran Integrated Service NetworksAug. 2014 

The American Legion seeks and supports any legislative or administrative proposal that improves, but not limited to the GI bill, Department of Defense Tuition 

Assistance (TA), Higher Education Title IV funding (i.e., Pell Grants, Student 

Loans, etc) and education benefits so servicemembers, veterans, and their families 

can maximize its usage. 1A8

The American Legion supports this section. 

Section 5: Modification to Annual Determination of Staffing Shortages in Veterans 

Health Administration 

Currently, subsection (a) of section 7412 of title 38 U.S.C. requires the Secretary 

to publish in the Federal Register, the five occupations of personnel of this title of 

the Department covered under section 7401 of this title for which there are the largest staffing shortages throughout the Department as calculated over the five-year 

period preceding the determination 1A9. This section would modify the Veterans Access, Choice and Accountability Act, (VACAA) which required the VA Office of Inspector General (VAOIG) on an annual basis to determine the five occupations that 

have the highest staffing shortages. The VAOIG would now be required to conduct 

a review to evaluate staffing shortages within five clinical and nonclinical fields 

within each Veterans Service Integrated Networks (VISNs). 

The American Legion encourages and supports the VHA leadership to conduct an 

internal review and develop an action plan to address VISN management, staffing 

and its current geographic boundaries/catchment areas for the purpose of providing 

veterans better and timely access to quality health care. 1A10

The American Legion supports this section. 

Section 6: Repeal of Compensation Panels to Determine Market Pay for Physicians 

and Dentists 

This section would replace subsection (c) paragraph (4) of Section 7431, Title 38 

U.S.C. Paragraph (4) which determines the amount of market pay for physicians or 

dentists, with a system that would require the Secretary consult two or more national surveys of pay for physicians or dentists, as applicable, whether prepared by 

private, public, or quasi-public entities in order to make a general assessment of the 

range of pays payable to physicians or dentists. It also requires the Secretary to consult with and consider the recommendations of an appropriate panel or board composed of physicians or dentists. 

The American Legion currently does not have a position on Section 6. 

Section 7: Executive Management Fellowship Program 

This would require the Secretary to select, each year, at least 18 but not more 

than 30 eligible Veterans Benefits Administration (VBA) and Veterans Health Administration (VHA) employees to participate in a one year fellowship with a private 

sector company or entity. 

As it currently stands, VA has over half of their critical leadership positions either 

unfilled or filled in an interim role. Sending a portion of the workforce out of VA 

every year would only exacerbate this situation. If VA can afford to lose these personnel for an entire year then they don’t need that position. The American Legion 

would rather see VA fill the positions they have and ensure there is a full workforce 

available to treat the needs of veterans. 

The American Legion opposes this section. 

Section 8: Accountability of Leaders for Managing the Department of Veterans Affairs 

The VA has come under scrutiny by Congress, Veterans Service Organizations 

(VSOs), media, veterans, and the American public for their failures in leadership 

performance and accountability which resulted in numerous quality and patient 

safety issues, as well as patient deaths. 

This section would add a new section following Chapter 7 of title 38, U.S.C.’s section 709 pertaining to Employment Restrictions. The new section, ‘‘Annual Performance Plan for Political Appointees,’’ requires the Secretary to conduct an annual performance plan for each political appointee of the Department that is similar to the 

annual performance plan conducted for an employee of the Department who is appointed as a career appointee within the Senior Executive Service at the Department. This assessment would ensure the employee is meeting their goals with reLeonard.horne on VACREP0180 with DISTILLER

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11 1AResolution No. 30: Department of Veterans Affairs Accountability- May 2015 12 1AResolution 301- Enforcing Veterans’ Preference Hiring Practices in Federal Civil Service: 

Aug 2014 

cruiting, engaging and motivating employees, training employees, and holding each 

employee accountable for performance issues. 

The American Legion urges Congress to enact legislation that provides the VA 

Secretary the authority to remove any individual from the Senior Executive Service 

(SES) due to performance and transfer those individuals to a General Schedule (GS) 

position without any increased monetary benefit. 1A11

The American Legion supports this section. 

Section 9: Modification to Veterans Preference 

Veterans’ preference is authorized by the Veterans’ Preference Act (VPA) of 1944; 

it only applies to federal government employment. It provides that most veterans 

are to receive an extra five points (ten points for disabled veterans) in receiving and 

keeping federal jobs. The Veterans’ Employment Opportunity Act (VEOA) of 1998 

extended certain rights and remedies to recently separated veterans. A grateful nation created veterans’ preference to ensure fair treatment for those citizens who 

served this country in the Armed Forces. The following recommendations are: 

➣ IChange the service requirements to receive veterans’ preference for Reservists 

and Guardsmen from 180 days of consecutive active-duty service to 180 days of cumulative active-duty service. 

Based upon the high percentage of Reservists and Guardsmen that have honorably served as well as been deployed multiple times in the war against terror - their 

days of service should merit inclusion within veterans’ preference criteria for 180 

days of cumulative service. 

➣ IExpand those to be considered ‘‘preference eligible’’ to include all retired service members, including those who retire above the rank of major or its equivalent. 

In addition, approximately 250,000 service members leave the Armed Forces every 

year, of which 6.4 percent are Officers O 094 and above (6.4 percent equates to 

roughly 16,000 Officers O 094 and above). America shouldn’t overlook the minority 

of high ranking officers who are ready to start a second career in public service. The 

lessons learned in the Armed Forces allow these individuals to provide a quality 

level of professionalism, expertise and patriotism within the structure of a federal 

agency who’s seeking that kind of talent. 

➣ IExpand veterans’ preference to also apply to hiring individuals for the Senior 

Executive Service at VA. 

The attributes that define a veteran employee, which include a strong work ethic, 

adaptability, organizational skills, team player, self-confidence, preparedness - are 

all things a leader needs to have in abundance. It only seems fitting that veterans 

applying for a Senior Executive Service position would receive veterans’ preference. 

Lastly, veterans’ preference should play a large role in employing veterans and 

their spouses. Federal agencies need to make sure that their Human Resource personnel are properly trained to effectively implement veterans’ preference. The federal government has scores of employment opportunities that educated, well-trained, 

and motivated veterans can fill given a fair and equitable chance to compete. Working together, all federal agencies should identify those vocational fields, especially 

those with high turnover rates, for transitioning veterans who are trying to continue 

their service within the federal government. 

The American Legion restates its commitment to ensure that veteran preference 

is consistently and accurately applied in federal civilian recruitment, application, 

and hiring 1A12. The American Legion supports this section. 

Section 10: Reemployment of Former Employees 

This section would allow the Secretary to noncompetitively reappoint a qualified 

former employee to any position within the VA as long as the position is not more 

than one grade higher than what they received in their former position and as long 

as if they employee left VA voluntarily within the prior two years and has kept all 

licensures and credentials up to date. 

The American Legion currently has no position on Section 10. 

Section 11: Recruiting Database 

This section would require the Secretary of VA to establish a single centralized 

database that lists all critical vacancies that are difficult to fill within VA. This 

database would contain information on qualified individuals who have applied previously for other positions within VA in which they have not been selected however, 

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13 1AResolution 101- Department of Veterans Affairs Recruitment and Retention: Sept. 2015 14 1AResolution 114: Department of Veterans Affairs Veteran Integrated Service NetworksAug. 2014 15 1AResolution 101:Department of Veterans Affairs Recruitment and Retention- Sept. 2015 

would be qualified for another position within VA. The Secretary would be required 

to use this database to consider qualified applicants who have already applied for 

other positions within VA to fill prolonged vacancies. 

The American Legion urges the VHA to continue to develop and implement staffing models for critical need occupations. 1A13

The American Legion supports this section. 

Section 12: Human Resources Academy 

This section would require Human Resources (HR) professionals within VA be 

trained in hiring Title 38 employees within VHA. These professionals will be adequately trained on how to best recruit and retain employees in VHA. 

The American Legion currently has no position on Section 12. 

Section 13: Promotional Opportunities for Technical Expert 

This section would require the Secretary to establish a promotional track system 

for employees of the VA for technical experts without requiring them to take managerial positions if they choose to stay employed at VA. 

The American Legion currently has no position on Section 13. 

Section 14: Comptroller General Study on Succession Planning 

This section would require the VA Comptroller General to conduct a succession 

planning study at each VA Medical Center (VAMC), Regional Office (RO), and National Cemetery (NCA). While The American Legion supports studies on VHA staffing, we currently do not have a position on staffing at the VARO’s or at NCA. 

The American Legion encourages and supports the VHA leadership to conduct an 

internal review and develop an action plan to address VISN management, staffing 

and its current geographic boundaries/catchment areas for the purpose of providing 

veterans better and timely access to quality health care. 1A14

The American Legion supports this section. 

Section 15: Information on Hiring Effectiveness 

This section requires VA to measure and collect certain information regarding hiring effectiveness. The American Legion continues to be concerned VA’s hiring process is cumbersome and negatively affects VHA’s ability to recruit and retain effective staffing levels in order to meet veteran’s overall health care needs. 

The American Legion urges the VHA continue to develop and implement staffing 

models for critical need occupations and that VA work more comprehensively with 

community partners when struggling to fill shortages within VA’s ranks. 1A15

The American Legion supports this section. 

Section 16: Employment of Students and Recent Graduates 

This section requires VA to promulgate regulations to allow for excepted service 

appointments of students and recent graduates leading to conversion to career or 

career conditional employment of a student or recent graduate. 

The American Legion has no position on Section 16. 

Section 17: Exit Surveys 

This section requires VA to request that employees voluntarily leaving VA service 

complete standardized exit surveys. 

The American Legion has no position on this section. 

Conclusion 

The American Legion understands that filling highly skilled vacancies at premiere 

VA hospitals around the country is challenging. We also expect VA to do whatever 

legally permissible to ensure that veterans have access to the quality healthcare 

they have come to expect from VA. VA leadership needs to do more to work with 

community members and stakeholders. 

Except as noted above, on balance there is a large amount of this proposed legislation which would have a positive effect on transforming VA to a more effective 

healthcare delivery system. 

As always, The American Legion thanks the Subcommittees on Health and Economic Opportunity for the opportunity to explain the position of the over 2 million 

veteran members of this organization. 

For additional information regarding this testimony, please contact Mr. Warren 

J. Goldstein at The American Legion’s Legislative Division at (202) 861 092700 or 

wgoldstein@legion.org 

f 

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Prepared Statement of Carlos Fuentes 

Chairmen Benishek and Wenstrup, Ranking Members Brownley and Takano and 

members of the Subcommittees, on behalf of the men and women of the Veterans 

of Foreign Wars of the United States (VFW) and our Auxiliaries, I want to thank 

you for the opportunity to present the VFW’s views on ways the Department of Veterans Affairs (VA) can improve recruitment and retention of high quality health 

care professionals and other employees. 

The VFW thanks you for recognizing that VA’s ability to hire and retain high 

quality employees is equality as important as its ability to fire or demote employees 

who put veterans’ lives at risk. The VFW agrees with many of the ideas included 

in the draft legislation being discussed today. However, we would like to share an 

idea that we hope the Subcommittees will consider. 

Expedited Authority to Hire Frontline Health Care Staff 

During our site visits of VA medical facilities, the VFW has noticed one constant 

struggle facilities face—hiring and retaining entry level clerks who help with answering phones, greeting patients, scheduling appointments, and other administrative tasks. During our visits, we often hear providers and facility leadership say that 

the lack of administrative support staff limits their ability to deliver health care to 

veterans, particularly when operating in a patient aligned care team (PACT) where 

team members are often left to backfill the duties of vacant positions. This contributes to attrition of existing employees who are overworked and underpaid because 

of vacancies that take too long to fill. Non-clinical VA employees, including frontline 

staff, are typically hired under title 5, United States Code (U.S.C.) authorities. Unfortunately, such authorities preclude VA from expeditiously hiring qualified candidates to fill vacancies. 

Under section 7802 of title 38, U.S.C., the VA Canteen Service is exempted from 

title 5, U.S.C., competitive service, general schedule pay rates and classification requirements to ensure it is able to provide veterans reasonably priced merchandise 

and services essential to their comfort and well-being. Similar to VA medical facilities, the Canteen Service relies on entry level employees to operate and maintain 

its services. However, without the exemptions from competitive service requirements, the VA Canteen Service would not be able to operate its retail stores, cafes, 

and quality of life programs in VA medical facilities around the country. 

The VA Canteen Service has the authority to bypass the USA Jobs process and 

hire employees through referral and traditional job search engines such as Monster, 

Indeed, and Career Builder. When it finds qualified candidates, the VA Canteen 

Service hires employees as contractors while they undergo the 30 0960 day process 

to become a federal employee. This process provides the VA Canteen Service the 

latitude it needs to ensure its retail stores remain fully staffed despite high turnover 

rates. The VFW urges Congress to provide the Veterans Health Administration 

(VHA) similar authorities to quickly hire into high turnover positions at VA medical 

facilities. 

Discussion Draft to improve the authority of the Secretary of Veterans Affairs to hire and retain physicians and other employees. 

The VFW strongly supports efforts to expand VA’s authorities to hire and retain 

high quality employees. This legislation takes a multifaceted approach towards 

achieving that goal. The VFW supports sections 2, 3, 5, 7, 8, 12, 14, 15, 16 and 17; 

does not oppose sections 6, 10, 11 and 13; has concerns with section 9; and opposes 

section 4. 

Section 2 would ensure VA has the authority to properly compensate medical center directors. The VFW generally supports this section and has two recommendations to improve it. Director positions are hard to fill positions because they are responsible for overseeing hundreds of employees delivering care and services to thousands of beneficiaries. Such a charge requires proper incentives, such as marketbased compensation, which this legislation would address. 

However, VA must also have the leeway to quickly hire a qualified candidate 

when one is identified. The best qualified person for a medical center position may 

not be searching for a job on USA Jobs, and if VA identifies a qualified candidate 

it should not be required to have that candidate apply for an opening through USA 

Jobs. This legislation would also preclude directors from appealing a decrease in pay 

resulting from an involuntary reassignment in connection with a disciplinary action. 

While the VFW fully supports the reduction in pay of VA employees who have committed malfeasants, we believe such individuals have the right to due process. For 

that reason, we suggest the Subcommittees clarify that the reduction in pay is final 

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after the employee has been offered the opportunity to appeal the disciplinary action. 

The VFW supports section 3, which would grant VA health care providers the 

ability to have flexible working hours that best suit the demand for health care by 

the veterans they serve. In response to the access crisis, VA has made a full-fledged 

effort to increase access for veterans who rely on VA for their health care needs. 

In the past year, VHA has increased clinic production by 10 percent, adopted best 

practices from the private sector, and increased the number of health care employees by more than 14,000. Yet, VA continues to face numerous challenges in meeting 

the growing demand on its health care system. One of those challenges is the statutory 40-hour work week limitation for title 38, U.S.C., employees. The VFW supports efforts to eliminate this access barrier and improve VA’s ability to recruit and 

retain high quality health care professionals. 

The VFW opposes section 4, which would amend the Yellow Ribbon Program to 

require VA to cover up to 66 percent of the full cost of an advanced degree in mental 

health care. The VFW is a strong advocate and proponent of the Yellow Ribbon Program and the Post-9/11 Educational Assistance Act, commonly referred to as the 

Post-9/11 G.I. Bill. The VFW also supports efforts to provide additional assistance 

for veterans who choose to advance their careers by obtaining a graduate or doctoral 

degree in mental health care. However, the VFW does not believe amending the Yellow Ribbon Program is the best option to do so. 

The Yellow Ribbon Program was established to address the gap between the cost 

of tuition and fees associated with approved degree programs and the amount VA 

is statutorily able to cover under the Post-9/11 G.I. Bill. To supplement the Post9/11 G.I. Bill, VA is authorized to enter into an agreement with educational institutions to cover up to fifty percent of such gaps, which may be up to tens of thousands 

of dollars. While the VFW agrees that increasing the percentage VA is statutorily 

authorized to cover under the Yellow Ribbon Program would incentivize educational 

institutions to establish Yellow Ribbon agreements with VA, it does not provide 

much incentive for veterans to obtain degrees in mental health care. 

Furthermore, the discussion draft fails to ensure veterans have enough Post-9/11 

G.I. Bill eligibility to complete their degree program. This is a particular concern 

for veterans who use their Post-9/11 G.I. Bill benefits to obtain a bachelor’s degree 

and would like to participate in this program. Given that the Post-9/11 G.I. Bill is 

limited to 36 months of eligibility, it is unlikely that these veterans would have 

enough eligibility remaining to complete an advanced degree in mental health. 

The VFW is a proponent of public-private partnerships, but believes this program 

would be better suited under VA’s Health Professionals Educational Assistance Program (HPEAP). VA operates six different educational assistance programs under its 

HPEAP authorities, including a debt reduction program and several employee scholarships. One of those programs is the Visual Impairment Education Assistance Program, which was created by Public Law 111 09163, the Caregivers and Veterans 

Omnibus Health Services Act of 2010, to increase the supply of qualified blind rehabilitation specialists for the department and the nation. 

This program authorizes VA to provide any person enrolled in a degree or certificate program in visual impairment or orientation and mobility up to $45,000 to complete their educational program if they agree to serve as a full time VA employee 

after completing such program. The VFW urges Congress to consider a similar program that would authorize VA to cover the cost of a veteran’s advanced mental 

health care degree, up to the post-9/11 G.I. Bill rate, for veterans who agree to serve 

as a VA mental health care professional. 

Section 9 would amend veterans preference to ensure veterans who served in the 

Guard and Reserves are afforded the same hiring preferences as their active duty 

counterparts. Currently, veterans who served after September 11, 2001, are required to have served at least 180 consecutive days on active duty. Due to our allvolunteer military and the nature of the wars in Iraq and Afghanistan, the Guard 

and Reserves have been utilized much more than they have during past conflicts. 

However, not all Guard and Reserves service members receive active duty orders 

for more than 180 days. Thus, many veterans that deployed into harm’s way in support of the wars in Iraq and Afghanistan are not eligible for veterans hiring preferences. The VFW supports correcting this inequity. 

Section 9 would require VA to comply with title 5 competitive service requirements when hiring Senior Executive Service (SES) employees. While the VFW supports applying veterans preference to the employment process for VA SES employees, we feel that Congress must streamline, not impede, VA’s ability to hire qualified executives. That is why we recommend that the Subcommittees amend this section to exempt VA’s SES employment process from title 5 competitive service requirement. To ensure VA hires qualified veterans as senior executives, Congress 

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should amend title 38 to ensure VA properly considers veterans when hiring SES 

employees. 

Mr. Chairman, this concludes my testimony and I will be happy to answer any 

questions you or the Subcommittee members may have. 

Information Required by Rule XI2(g)(4) of the House of Representatives 

Pursuant to Rule XI2(g)(4) of the House of Representatives, the VFW has not received any federal grants in Fiscal Year 2016, nor has it received any federal grants 

in the two previous Fiscal Years. 

The VFW has not received payments or contracts from any foreign governments 

in the current year or preceding two calendar years. 

f 

Prepared Statement of Carolyn Clancy, M.D. 

Good morning Chairman Benishek, Chairman Wenstrup, Ranking Member 

Brownley, Ranking Member Takano, and Members of the Committee. Thank you for 

inviting us here today to present our views on the draft bill to improve the authority 

of the Secretary of Veterans Affairs to hire and retain physicians and other employees of the Department of Veterans Affairs, and for other purposes. Joining me today 

is Elias Hernandez, Chief Officer, Workforce Management and Consulting; Tia N. 

Butler, Executive Director, Corporate Senior Executive Management Office; and 

Kimberly P. McLeod, Associate Chief Counsel. 

We are pleased to see the Committee include in the draft legislation, three of our 

legislative proposals which will give us the necessary resources to meet the Department of Veterans Affairs’ (VA) obligation to provide timely, quality health care and 

benefits to Veterans. Due to the timing of the hearing, the VA is unable to provide 

views for sections 7, 9, 10, 11, 12, 15, 16, 17 as well as costs for section 4. These 

are currently being drafted and we will forward the remaining views and costs to 

you as soon as they are available. 

Section 2, Appointment and pay for directors of medical centers and Veterans Integrated Services Networks 

VA supports section 2 as the provision matches a proposal put forward in February 2016 in VA’s Fiscal Year 2017 budget submission. VA believes that there are 

three primary factors that warrant a separate compensation system for Medical Directors and VISN Directors. First, existing pay compression within the current Senior Executive Service (SES) pay system and the closely proximate rates of pay for 

direct reports to Medical Center Directors and VISN Directors have resulted in declining Director applicant pools. Second, a high number of existing (an estimated 84 

percent by FY 2018) Directors are or will soon be eligible for retirement. Third, private sector pay for health care leadership positions is highly competitive. 

In addition, there are limited pay incentives for experienced Medical Center Directors and VISN Directors to voluntarily move to fill more demanding positions. Due 

to the SES pay compression between experienced Medical Center Directors and 

VISN Directors, the small pay raise, if any, that VHA is able to offer in a reassignment may cause the candidate to be disadvantaged financially. The most significant 

cost disparities occur due to housing costs and in some cases, higher tax rates (e.g., 

New York, California). With current executive pay authorities, a move for the good 

of the organization most of the time means a move to the financial detriment of Directors and their families. On average, it has taken over 6 months to fill Medical 

Center Director and VISN Director positions, with many being re-announced multiple times for positions in both rural and major metropolitan areas. The reluctance 

on the part of these senior leaders to relocate is understandable. It is imperative 

that VHA have the ability to implement pay to retain eligible leaders, reward mobility, and ensure knowledge transfer to the next generation of Medical Center Directors and VISN Directors. VA would request, however, that the section stating that 

the Medical Director and VISN Directors be a qualified doctor of any kind be removed from the bill. It is already difficult to recruit for these positions. This additional restriction would make it nearly impossible in some areas. VA estimates that 

enactment of section 2 would cost $8.8 million in FY 2017, $46 million over 5 years, 

and $93.2 million over 10 years. 

Section 3, Adjustment of hours authorized for certain full-time employees of Veterans 

Health Administration 

Section 3 would allow VA to arrange flexible physician and physician assistant 

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sician system and to accommodate the unusual work schedule requirements for 

Emergency Medicine (EM) Physicians. 

VA supports increased flexibility for critical medical personnel. Hospitalist physicians and EM physicians specialize in the care of patients in the hospital, often 

working irregular work schedules to accommodate the need for continuity of efficient 

hospital care. VA believes that increased scheduling flexibility would align VA practice with the private sector, facilitating the recruitment, retention of emergency physicians and the recruitment, retention and operation of a hospitalist physician system at VA medical centers (VAMC). We understand that the Office of Personnel 

Management has some concerns with respect to certain of the bill’s provisions. The 

Administration looks forward to working with the Congress and our agency partners 

to finalize language on these provisions. VA would request the language in section 

3 (2) include the language of, ‘‘is not less than’’ in place of ‘‘does not exceed’’. 

VA believes section 3 would be cost neutral in terms of impact on salaries as it 

merely authorizes flexibility in physician and physician assistant work schedules to 

allow for the hiring and full implementation of a hospitalist physician system and 

improvements in EM physician coverage and enhanced ability to recruit EM trained 

and experienced physicians. 

LRD 

Section 4, Public-private contributions for additional educational assistance for graduate degrees relating to mental health 

Section 4 of the bill would also amend current section 3319 of title 38 to prohibit 

the use of transferred entitlement under the new program. If enacted, the amendments made by section 4 would apply to a quarter, semester, or term that begins 

on or after July 1, 2017. 

VA supports legislation that would provide training and employment opportunities for Veterans; however, the Department has some concerns with this section of 

the bill. VA is not certain a change in the way VA and IHLs share contributions 

for specific degrees and programs would be beneficial. Under its current structure, 

the Yellow Ribbon Program is a remarkably successful program with nearly 2,000 

participating institutions. During FY 2015, 49,905 students were beneficiaries of the 

program. 

In order to implement section 4, VA would have to identify Post-9/11 GI Bill Veterans who are currently pursuing an advanced degree in mental health, determine 

their eligibility for the new program, and verify that each Veteran intends to seek 

employment with VA. This would create a significant administrative burden as the 

Long Term Solution (LTS), the system used to process Post-9/11 GI Bill payments, 

does not have the capability to issue varying Yellow Ribbon payments based on the 

type of program being pursued. Subject to the availability of funding, VA would 

need one year from the date of enactment to make programming changes to the LTS 

to support implementation of this section. In addition to LTS changes, the amendments made by section 4 would also require changes to the Comparison Tool, VA 

Online Certification of Enrollment (VA ONCE), and Web Enabled Approval Management (WEAMS) computer systems. Otherwise, manual processes would be required, 

which would result in a decrease in timeliness and accuracy for processing GI Bill 

claims. 

Further, the amendments made by section 4 would authorize VA to establish 

residencies and internships at VA medical facilities for Veterans participating in the 

program. VHA has already established training programs in mental health disciplines in many locations. These programs lead to a degree, licensure, certification, 

or registration. The process to develop training programs requires relationships with 

accredited educational sponsors and suitable infrastructure for the training program, including space, qualified faculty preceptors, information technology (IT) 

equipment, staff support, and a sufficient number of patients to satisfy the needs 

of the educational program. Therefore, establishing residencies and internships 

must occur in settings with appropriate infrastructure and collaborative educational 

partnerships. 

This bill also does not address the unique qualification standards of each of the 

professions that are listed in the bill. Each of the 14 professions/disciplines listed 

has unique qualification standards which must be met to be eligible for VA employment. For some of these professions (e.g. psychologist, social worker, mental health 

nurse, marriage and family therapist), the qualification standards include both educational accreditation as well as licensure requirements. Other professions listed 

(e.g. addiction therapist, vocational rehabilitation therapist) do not have educational 

or licensure requirements. 

The Yellow Ribbon Education program allows for Veterans to attend mental 

health programs that do not meet the accreditation standards required in the VA 

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qualification standards. Thus, if an individual obtained a degree in those programs, 

that individual would not be eligible for VA employment. 

For VA to support this bill, each of the professions listed that has educational/ 

licensure requirements would need to have a provision that would state that the 

program meets the educational requirements defined by the VA qualification standards. Additionally, for some of the professions listed, even with such a provision, it 

may not be possible to guarantee VA employment (even if the educational requirements of the profession are met). For example, the Psychology Qualification Standards require that an individual have graduated from a program accredited by the 

American Psychological Association (APA) as well as have completed an internship 

accredited by APA. While the bill suggests that the Secretary may establish 

residencies and internships at medical facilities of the Department, the Secretary 

is not able to accredit these internships. 

VA is still determining costs associated with this provision. 

Section 5, Modification to annual determination of staffing shortages in Veterans 

Health Administration 

Section 5, would amend 38 USC §7412 (a) to require the Inspector General of the 

Department of Veterans Affairs (VAOIG) to determine and the Secretary of Veterans Affair to publish in the Federal Register, the five clinical occupations and the 

five nonclinical occupations of personnel of the Department covered under section 

7401 for which there are the largest staffing shortages with respect to each Veterans Integrated Services Network (VISN) as calculated over the five-year period 

preceding the determination. 

The VA defers to VAOIG on how they would process this report. 

Section 6, Repeal of compensation panels to determine market pay for physicians and 

dentists 

Section 6 would modify 38 USC § 7431 to eliminate the compensation panel recommendation process required under 38 USC §7431(c)(4)(B). 

VA supports this section as it is similar to another proposal put forward in February 2016 in VA’s Fiscal Year 2017 budget submission. The ‘‘Department of Veterans Affairs Health Care Personnel Enhancement Act of 2004’’ (Public Law 108 

09445, dated December 3, 2004) established the current pay system for Veterans 

Health Administration (VHA) physicians and dentists. A requirement of the pay system that has proven to be of little or no value is the compensation panel process. 

The current statute requires that the recommendations of a panel composed of 

physicians or dentists be considered when determining the amount of market pay 

for a physician or dentist. To the extent practicable, the panel must consist of physicians or dentists (as applicable) who are practicing clinicians and who do not hold 

management positions at the medical facility at which the physician or dentist subject to the consultation is employed. In most circumstances, this requires physicians 

or dentists to take time away from providing direct patient care in order to perform 

the unnecessary administrative function of recommending the amount of pay for 

prospective employees. 

The compensation panel process is time consuming and adds no value as Medical 

Center Directors and/or other approving officials have the authority to approve (decide) the final rate of pay. Currently there are three separate reviews being conducted for VHA physicians and dentists prior to their appointment, to include: (1) 

a Professional Standards Board reviews the qualifications standards and makes a 

recommendation to appoint an individual tentatively selected for a position; (2) the 

compensation panel recommends market pay and annual salary for the provider; 

and (3) the Medical Staff credentialing and privileging committee reviews the provider’s credentials and recommends medical staff clinical privileges. 

As an example, a compensation panel may be required to convene to make a salary recommendation for two prospective physician candidates. At a minimum, three 

physicians would be required to meet to review a recommendation made by the selecting official or Chief of Staff, and complete the Compensation Panel review form. 

Using an average salary for a VA physician of $218,237 (or $104.92 per hour) in 

manpower hours it would cost $52.46 per 30 minutes x 3 physicians, or approximately $157 per compensation panel. 

This may seem like a trivial amount but if you consider the number of times each 

medical center convenes a compensation panel, multiplied by the number of VA facilities across the country, the manpower cost of this administrative function is 

much more significant. In VA facilities with numerous physician and dentist vacancies, compensation panel members may be required to spend many hours a week 

meeting to deliberate and recommend salary for prospective employees. Market pay 

criteria and documentation on the Compensation Panel Recommendation and ApLeonard.horne on VACREP0180 with DISTILLER

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proval form, VA Form 10 090432a, is time consuming and continues to be a challenge for clinicians. 

This arduous process also contributes to a delay in hiring. A VA facility is often 

unable to convene a Compensation Panel on a timely basis because its members are 

unable to quickly meet due to patient care responsibilities. Physicians and dentists 

typically will not accept employment or give notice without a firm salary offer, and 

in cases where Compensation Panels are delayed, it pushes back the starting dates 

of new providers which also negatively impacts patient care. 

It would be more cost effective and time efficient to allow a selecting official and/ 

or Chief of Staff to recommend to the facility director the appropriate salary for prospective employees and eliminate the compensation panel process. 

The VA believes this proposal to be cost neutral. Physicians and dentists will continue to be paid rates approved by the appointing official. This proposal will benefit 

VA by streamlining the appointment process. 

Section 8, Accountability of leaders for managing the Department of Veterans Affairs 

Section 8 would amend chapter 7 of Title 38 by adding in a new section 709A, 

which would require the Secretary to annually assess the performance of political 

appointees in a manner similar to the assessment of career Senior Executive Service 

employees. 

Section 13, Promotional opportunities for technical experts 

Section 13 would require VA to develop a promotional track, which does not involve a transition to a management position, for employees who are considered technical experts. VA is committed to ensuring that its employees are allowed to advance in their careers, regardless of whether the employee wants to be a manager. 

Consequently, VA supports this section. 

Section 14, Comptroller General study on succession planning 

Section 14 would require the Comptroller General to conduct a study on the succession planning at each medical facility of the Department of Veterans Affairs, the 

Veterans Benefits Administration and the National Cemetery Administration and 

submit it to the House and Senate Veterans’ Affairs Committees not later than one 

year after the date of enactment of this Act. 

The study would include: a determination of the mission-critical positions within 

the entity and the vacancy risk of such positions; an analysis of the future needs 

for mission-critical positions and gaps within the existing talent poll of the entity; 

a description of strategies to close skill gaps through the use of training for existing 

staff, targeted recruitment, and hiring; a plan to regularly evaluate progress of staff 

and update existing succession plans using clear and measureable metrics and 

benchmarks; a demonstration of the capacity of the entity to execute succession 

plans with successful succession management strategies; and any other matters 

Comptroller General determines appropriate. 

VA defers to GAO. 

Mr. Chairman, this concludes my statement. Thank you for the opportunity to appear before you today. We would be pleased to respond to questions you or other 

members may have. 

f 

Statements For The Record 

AMERICAN FEDERATION OF GOVERNMENT EMPLOYEES 

Overview: AFGE strongly objects to Section 6 of this draft bill. It would destroy 

the critical market pay process established through strong bipartisan support twelve 

years ago when Congress enacted P.L. 108 09445 to ensure that VA provider pay 

would be competitive with other health care systems. More specifically, this bill 

would devastate the Department’s ability to recruit and retain physicians and dentists through: 

fi IElimination of the requirement that the Secretary consult two pay surveys; 

fi IElimination of the requirement that the Secretary consider the recommendations of a panel of peers; and, 

fi IReturn of all market pay determinations to full Secretary discretion. 

The VA desperately needs stronger market pay requirements, not a market pay 

process completely subject to Secretary discretion. Currently, the VA is losing large 

numbers of physicians and dentists because of broken pay policies, including: manLeonard.horne on VACREP0180 with DISTILLER

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agers who pay new hires $20,000 or more than incumbents; managers who make 

pay promises to new hires that they break once the provider is on board; management’s refusal to convene market pay panels every two years; and improper pay 

panel composition. 

This provision would vastly increase the use of arbitrary pay policies against 

front-line providers in order to further management cronyism, discrimination 

against older physicians and other targeted groups and retaliation against vocal providers. The mean-spirited and arbitrary nature of this provision makes even less 

sense given that it appears to eliminate an important right for one group of providers while giving that identical right to VA directors! 

Analysis of other sections: 

Section 2(a): This subsection would expand eligibility for medical center director 

(MC) and Veterans Integrated Service Networks (VISN) director appointments to all 

qualified medical professionals. AFGE supports. 

Section 2(b): 

fi IThis subsection would extend part of the existing market pay process to MC 

and VISN directors. AFGE supports consideration of recruitment and retention 

needs for setting market pay for these positions and the requirement to adjust pay 

every two years. However, AFGE strongly recommends greater transparency in all 

market pay-setting processes (directors, and management and non-management 

physicians and dentists). More specifically, all employees and their representatives 

should have the same rights to request copies of survey data as was afforded to registered nurses by Section 601(j) of the Caregiver Act. 

fi ISimilarly, all employees whose market pay is set by pay panels (which does 

not apply to directors under this bill) should have the right to request information 

about the composition of their panels. 

fi IFrequency of market pay adjustments: Noncompliance with the current requirement to make market pay adjustments at least every two years is rampant. 

Directors are far more likely to get timely adjustments under this bill than frontline healthcare providers. Therefore, AFGE strongly urges the Committee to ensure 

that managers be held accountable for delays in convening market pay panels and 

implementing pay adjustments through performance measures and new requirements to report market pay adjustments to Congress. In addition, physicians and 

dentists deserve equal bargaining rights so they can challenge unfair and illegal pay 

practices. Therefore, AFGE urges the Committee to approve H.R. 2193, introduced 

by Representative Mark Takano (D 09CA). H.R. 2193 is a valuable recruitment and 

retention bill because it also equalizes rights to bargain over indirect patient care 

matters such as scheduling and assignments. 

fi IPay decreases: This provision would deny directors all rights to appeal pay 

decreases. AFGE strongly opposes this provision. Such broad Secretary discretion 

will encourage abuse of discretion by officials seeking to harass, discriminate and 

conduct de facto terminations. Under current law, management and non-management physicians and dentists are protected to some extent against arbitrary market 

pay decreases as long as they stay in the same position. However, as already noted, 

non-management physicians and dentists have very little actual ability to challenge 

unfair and illegal pay actions because of unequal bargaining rights. 

Section 3: This provision would provide flexible work schedules for most ‘‘pure 

Title 38’’ personnel. AFGE supports this provision. AFGE again urges passage of 

H.R. 2193 to ensure that every VA employee has an equal right to challenge unfair 

management practices related to schedules, assignment and other routine workplace 

matters. 

Section 4: No comment. 

Section 5: This provision would expand the annual staffing shortage determinations to include nonclinical occupations. AFGE supports. 

Section 7: This provision would place Veterans Health Administration (VHA) and 

Veterans Benefits Administration (VBA) employees in private-sector executive management fellow programs. AFGE strongly opposes this provision. This is likely to be 

a costly program of little value. The skills required to be effective in the VBA and 

VHA workplace must be learned in-house using strong in-house mentors with sufficient time and skills, not private sector managers who have no experience with the 

VA’s unique population, or its unique health care system and benefits programs. 

Section 8: This provision would establish an annual performance plan for political 

appointees. AFGE supports. 

Section 9: This provision makes it easier for reservists to earn veterans’ preference by counting cumulative service. AFGE supports. 

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Section 10: This provision allows for noncompetitive appointments with significant 

pay increases for returning employees, subject to full Secretary discretion. AFGE 

strongly opposes this provision. Upper management is very likely to abuse this hiring authority to hire their own friends and pass over other qualified applicants 

using the competitive process. In addition, it will be very easy for managers and employees they favor to game the system by leaving the VA in order to return at a 

higher grade. VA managers already engage in far too much cronyism in both the 

hiring and pay processes. 

Section 11: This provision would establish a single database of vacant positions. 

AFGE generally supports this concept but is concerned that veterans working in 

VHA will be harmed by any increase in Secretary hiring discretion. More specifically, Congress should more closely monitor the VA hiring process to ensure that 

all applicants have a fair chance to be considered under this single database. Congress should also enact legislation to close the harmful loophole in the Veterans Employment Opportunities Act that deprives Title 38 appointees of equal veterans’ 

preference rights, allowing managers to pass them over for non-veterans in the hiring process. (Language to close this loophole was included in H.R. 2275 in the 113th 

Congress). 

Section 12: This provision would establish a VHA training academy to improve 

human resources (HR) training. AFGE supports improved training for HR personnel 

who appear to lack critical skills in areas such as coding personnel actions, applying 

shift differential pay rules and determining the cope of Title 38 bargaining rights. 

However, as we have seen from the VBA academy training program, on-the-job 

training under strong mentors is also a critical component of any training process. 

Section 13: This provision establishes a technical expert promotional track. AFGE 

supports. 

Section 14: This provisions mandates a GAO study of succession planning. AFGE 

supports with the provision that researchers adequately consider the input of front 

line employees and their representatives who have unique insights into training, recruitment and hiring. 

Section 15: This provision requires the Secretary to collect information on hiring 

effectiveness. AFGE generally supports more data collection but urges the Secretary 

to adequately consider the input of front line employees and their representatives 

who have unique insights into hiring. AFGE strongly opposes any increase in the 

use of special hiring authorities that adversely impact veterans’ employment. 

Section 16: This provision would increase the use of excepted service appointments for students and recent graduates. AFGE strongly opposes this as it is likely 

to adversely impact veterans’ employment. 

Section 17: This provision would improve and expand the Department’s use of exit 

surveys. AFGE supports the use of exit surveys but will only support this provision 

if: (1) the Secretary adequately considers the input of front line employees and their 

representatives; and (2) the Secretary is required to share the survey results with 

employees and their representatives, veterans’ groups and other stakeholders. 

f 

NATIONAL ASSOCIATION OF VA PHYSICIANS AND DENTISTS 

Chairmen Benishek and Wenstrup, thank you for the opportunity to comment on 

your proposed legislation ‘‘To improve the authority of the Secretary of Veterans Affairs to hire and retain physicians and other employees of the Department of Veterans Affairs and for other purposes.’’ 

I am a practicing physician with more than 4 decades with the VA and the President of the National Association of Veteran Administration Physicians and Dentists 

usually referred to as NAVAPD. 

I might add that I too am a veteran, having served for two years on active duty 

in the US Public Health Service. 

The National Association of VA Physicians and Dentists (NAVAPD) is a 501(c)(6) 

nonprofit organization and is dedicated to improving the quality of patient care in 

the VA health care system and ensuring the doctor-patient relationship is maintained and strengthened. 

NAVAPD believes that a key means of enhancing the care of the Veterans is by 

employing the best physicians and dentists. NAVAPD believes it is essential for 

health care providers to be involved in decisions regarding delivery and quality of 

care. 

In the late 1960s and 1970s nearly all of the VA Medical Centers were led by Directors who were physicians and your draft legislation says Veterans Affairs Medical Center and Veterans Integrated Service Networks directors ‘‘may be appointed 

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to suit the needs of the department, who, to the extent practicable, shall be a qualified doctor of medicine or a qualified dental surgeon or other qualified medical professional’’. I strongly support this provision and suggest you consider eliminating 

‘‘who, to the extent practicable’’. 

Currently, in the VA, the single greatest impediment to recruiting and retaining 

physicians and dentists is the disenfranchisement and marginalization that many 

of the current physicians and dentists experience daily. Today, most VA physicians 

and dentists feel like their opinions are neither helpful nor requested. In many facilities, their suggestions are summarily rebuffed as inconsequential. At many centers, physicians and dentists are no longer even considered professionals but referred to as simply the ‘‘workers’’. These observations do not just come from 

NAVAPD leadership, but directly from our members, VA docs and dentists. Men 

and women who want to help improve ‘‘the system.’’ 

The proposed revisions to legislation regarding physician work hours would at 

least theoretically permit VA medical center leaders to unilaterally and dramatically 

alter a physician’s tour indefinitely, and without any stated reason. Specifically, the 

provision which states ‘‘The Secretary may modify the hours of employment for employees in a position specified in any of paragraphs (1) through (6) of section 7421(b) 

of this title to be more or less than 80 hours in a biweekly pay period if the total 

hours of employment for such an employee does not exceed 2,080 hours per calendar 

year.’’ appears to make it possible for physicians to be told they must work every 

weekend, or move to night or evening shifts, or have frequently changing tours. 

While all physicians recognize that in a medical emergency they must do whatever 

they can to protect patients and treat immediate medical problems, any involuntary 

change in their negotiated tour should be motivated by a bona fide emergency that 

demands the attention of a physician. It stands to reason that these circumstances 

should have defined endpoints in time and clearly articulated goals, and should include a general staffing shortfall (where the services needed could be provided by 

non-physicians). The authority proposed by this revision should be qualified by 

these stipulations. 

Recommend the legislation clarify the 24/7 rule’s original intent that it go into effect only if a national or state emergency is declared by either a Governor or the 

President. Currently the 24/7 rule is used as a threat by hospital directors and it 

should not be used to intimidate the physicians and dentists. It also appears to be 

used as a no-cost method of solving staffing shortages or operational problems. This 

is an inappropriate abuse of privilege to solve the consequences of poor management. 

The following are - apart from the important matter of momentary compensation 

- key factors that are widely reported as undercutting physicians’ performance and 

satisfaction. 

1. Denigration of CME. It is quite apparent that the VA has little regard for the 

continuing professional education of its physicians. Despite the fact that the Physician Pay Law of 2004 stipulates financial support of CME, it is regularly reported 

that the process for a physician to make use of the $1000 allocated for CME is so 

cumbersome, untimely and burdensome that many simply forego the education itself 

or in some cases pay out of pocket. Furthermore, the allocation is paltry in relation 

to actual, current CME costs. The Physician Pay Law uses the language ‘‘up to 

$1000’’ to indicate that the maximum funding is $1000 instead of the total cost of 

a much larger cost. Instead, hospital Directors have used this language to argue 

that they can provide any amount below $1000. This is the opposite intent of the 

law, and further frustrates physicians. 

One would think that the VA would see, as obvious, that the ultimate beneficiary 

of CME is the veteran-patient. Instead, the VA treats CME as an indulgence. The 

damage done is to the capability and morale of physicians as well as to patients. 

In, comparison with what the physician would have available in the private sector, 

it’s hardly a recruiting tool; it is a disincentive to join or remain in the VA. 

2. Ignoring the Federal Physician Pay Law/Ghost pay. The VA often acts as if 

there is no legal foundation of physician pay. There is. Physician Pay has three legally defined components: Base Pay, Market Pay, and Performance Pay. 

In the Pay Law, performance pay is authorized up to $15,000 per physician and 

appropriated for incentivizing physicians, but no one seems to know where it goes, 

and some do not even seem to know that it exists. Local Directors arbitrarily restrict performance pay to any level they wish. How? Funds are allotted to VISNs 

and then to facilities for performance pay, but only smaller amounts are dispersed. 

Where are the remaining funds? 

Stipulated bi-annual market surveys and adjustments are skipped or ignored, 

market adjustments seem to go to ‘‘favored’’ staff members. Pay panels are assembled with pre-conceived performance pay outcomes. VA leaders at all levels (local, 

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VISN, Central Office) need to be pressured to bring pay management into conformance with the Pay Law. The Pay Law is law, not a suggestion. 

Upper echelon VA management seems to think that continuing obscurity is the 

best way to handle this issue. In fact, however, what gets perpetuated is distrust 

and the sense that superiors are specially helping themselves and their friends with 

these funds. Transparency and behavior that is CONSISTENT with the Physician 

Pay Law are sorely needed. 

3. Disrespect Disparity. In a private sector organization, no one would expect a 

staff person to treat a physician as just another ‘‘worker’’ nor expect that a physician would be without remedy when support personnel regularly fail to perform at 

a satisfactory levels. At VA facilities, a supporting employee - tech, secretary, etc. 

- sees his or her supervisor as the individual to be pleased, not the physician involved in patient care. Reports of this phenomenon are legion. 

This will not be remedied unless personnel come to see that properly supporting 

the physician is of paramount importance - and this will not occur unless there is 

a system whereby the physicians can anonymously rate personnel, including their 

supervisors. A department head should be held to explain why any such ratings 

within the department are low. 

Relatedly, there are many reports by physicians complaining that their time is 

taken up by basic secretarial work - a problem that would be much alleviated by 

making support staff concretely responsible to physicians rather than living in a 

parallel merit system controlled by a reigning supervisor. The VA has systematically 

shifted physician-roles to non-physicians while simultaneously encumbering physicians with more non-physician duties, such as filing reports. This disrespect for physician skills and roles starts are the tops and filters down to all layers of the organization. 

4. The HR problem. HR has too wide a variety of responsibilities and some basic 

conflicts of interest - which cannot be remedied within HR. 

A key responsibility is to locate and intake needed personnel, particularly physicians. It is generally reported that the process is so slow and cumbersome that good 

recruits are routinely lost to other jobs. The draft bill proposes to offer education 

to HR personnel, but it does nothing to eliminate or streamline the requirements 

of the recruiting process that are the heart of the problem. The bill also needs to 

add accountability to the education. Lots of money is spent by the VA on educating 

HR personnel, but performance has not improved. This must change if VA is to turn 

its image around. 

Another key responsibility is to process and resolve employee (including physician) complaints about their working conditions or treatment by co-workers or superiors, but HR is hopelessly conflicted. HR works for management, not the employees. 

It naturally sees its function as one of employee pacification, not employee support 

and assistance. Given the numerous employee-biased programs within the government, HR fears retaliation for assertive corrective action and thus is reluctant to 

challenge problematic employees. 

Although the VA regularly issues declarations purporting to support employees’ 

rights to challenge possible wrongdoing and inefficiencies, such declarations are 

toothless and largely ignored. There is a need to create a separate system - an ombudsman system, similar to the IG system where the ultimate authority lies outside 

the department - to process such employee grievances. There really is no other solution. Furthermore, this would free up HR to concentrate on other important functions, including recruiting. 

5. Shedding Stupid Rules. There are numerous physician complaints about time 

being misused by VA requirements for TMS testing - essentially unrelated to their 

duties of patient care. There are also rules that obstructively interfere with the 

flexible management of physician time. For example, if a physicians needs to make 

arrangement to be away for several hours in an afternoon to take care of a nonVA problem he or she must take off the entire day as personal time - a rule that 

serves little purpose but to irritate. If the VA has a serious interest in retaining 

physicians by creating a benign working, atmosphere, someone should be put in 

charge of weeding out noxious over-regulation. 

NAVAPD supports: 

• modification to annual determination of staffing shortages; 

• reemployment of former employees; 

• recruiting database; 

• Comptroller General study on succession planning VA-wide (although don’t 

know why you don’t ask GAO to do it now rather than wait for enactment) 

• promotional opportunities for technical experts; 

• information on hiring effectiveness; and 

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1 1AWilliam Fenn, PhD, PA, Vice President, American Academy of Physician Assistants, Testimony before the United States Senate Committee on Veterans Affairs, Hearing on S. 1155, 

a bill to elevate the VA’s PA Advisor to a full-time director of PA services in VA central office, 

(October 21, 2009) 2 1APhysician Assistant Education Association, Letter to Senate Majority Leader Harry Reid 

and Speaker of the House Nancy Pelosi (January 15, 2010) http://www.paeaonline.org/ 

index.php?ht=a/GetDocumentAction/i/99520 3 1AAmerican Academy of Physician Assistants, Press Release (March 5, 2011) http:// 

www.aapa.org/news—and—publications/pa—pro—now/item.aspx?id=1917 

• exit surveys. 

While NAVAPD is largely focused on physician and dentist related issues, we cannot ignore issues that impact recruitment and retention of other critical professionals in the VA facilities. VA’s ability to fully serve Veterans is also predicated 

upon sufficient levels of these personnel. Nursing is represented by its own unions 

and organizations, but other key professionals are not, and they are also critical to 

effective patient care. Many do not receive appropriate consideration of attractive 

pay and benefits to assure their recruitment and retention. We believe that arbitrary segmentation is counter to the need to attract and keep skilled staff. We believe that the Hybrid designation for many professionals (such as Respiratory 

Therapists) should be eliminated and these professions should be made full Title 38 

employees with the obligations and benefits of that designation. 

We applaud the intent of the Human Resources Academy but would recommend 

a review of the responsibilities of HR professionals and what could be consolidated/ 

centralized so valuable time could be spent on recruitment/retention. The Department of Commerce is implementing a ‘‘shared service for HR processing departmentwide’’ and leaving policy, professional training, hiring decision-making at operational unit level. NASA has a similar operational model. 

Many of your provisions could be undertaken administratively by Veterans Affairs 

management if they had the political will. I am also including my recent statement 

before the Congressionally mandated Commission on Care in January. 

Thank you again for inviting NAVAPD to provide our comments regarding your 

important draft legislation. 

f 

VETERANS AFFAIRS PHYSICAN ASSISTANT ASSOCIATION’ 

Chairman Benishek, Chairman Wenstrup, Ranking members; Congresswoman 

Brownley, Congressman Takano and other members of the House Veterans Affairs 

Subcommittees on Health and Economic Opportunity, on behalf of the entire membership of the Veterans Affairs Physician Assistant Association (VAPAA) we appreciate the invitation to submit this testimony for the record. We thank bipartisan 

members of this committee for critical legislation for Physician Assistant (PA) Workforce issues before you today in the VA System with sponsoring ‘Grow Our Own Directive: Physician Assistant Employment and Education Act of 2015.’’ (S.2134) and 

(H.R. 3974) and we thank Congresswoman Ann Kuster for her leadership on this 

bill. 

The Physician Assistant (PA) profession has a special unique relationship with 

veterans. The very first classes of physician assistants to graduate from PA educational programs were all former Navy corpsmen and Army medics who served in 

the Vietnam War and wanted to apply their knowledge and experience in a civilian 

role in 1967. Today, there are 199 accredited PA educational university programs 

across the United States and approximately 2,020 PAs are employed by the Department of Veterans Affairs (VA), making the VA the largest single federal employer 

of PAs. These PAs provide high quality, cost effective quality health care working 

in hundreds of VA medical centers and outpatient clinics, providing medical care to 

thousands of veterans each year in their clinics. Physician Assistants work in both 

ambulatory care clinics, emergency medicine, CBOC’s in rural health, and in a wide 

variety of other medical and surgical subspecialties. 1A1 1A2 In the VA system 

about a quarter of all primary care patients treated are seen by a PA 1A3. Approximately 32% of PAs today employed by VHA are veterans, retired military, or currently serving in the National Guard and Reserves. 

The Veterans Affairs Physician Assistant Association (VAPAA) maintains that 

Physician Assistants are a critical component of improving VA health-care delivery, 

and have consistently recommended that VHA include them in all health-care national strategy staffing policy plans. Since our testimony last May, the VA has identified that both in VA OIG Reports, and VHA Succession Planning Committee that 

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2 1A[2] US News and World Report, Best Careers 2011: Physician Assistant (December 6, 

2010) http://money.usnews.com/money/careers/articles/2010/12/06/best-careers-2011-physician-assistant 4 1ASecretary VA Budget Testimony February 2016 before House VA Committee on VA Budget 5 1AVAOIG Report #15 0900430 09103, January 30, 2015 VA Health Care Critical Occupations Staffing 

the PA occupation is in top five critical healthcare occupations with high retention 

and vacancy problems. However, since January 1993 when VA added the Title 38 

GS 0913, Chief Grade more than 22 years ago, little else has been done for this critical workforce and hope that as these committees review changes to improve access 

to care for veterans and oversight on VHA strategy for its healthcare workforce that 

changes will be included to address these PA problems. 

Civilian Growth Physician Assistant Profession 

Forbes, US News & World Report, and New York Times articles all again named 

Physician Assistant occupation the single best master’s degree for the third year in 

a row, citing the profession’s favorable outlook for salary and long-term employment. 

The PA field was listed as one of the 50 best careers in 2014 due to increasing demand for health-care services, the impending retirement of baby boomers, and 

broader efforts to limit health-care costs. 1A2According to the US Bureau of Labor 

Statistics the PA profession is expected to grow by 30% from 2012 -2022 

In early February, VA Secretary Bob McDonald and USH Dr. Shulkin testified 

about the challenges facing VHA in hiring employees. Secretary McDonald told the 

House Veterans Affairs Committee that he has personally visited dozens of colleges 

to recruit medical students, but that the people he talked to had the perception that 

the agency was intent on firing its employees. The VA also struggles to recruit medical personnel away from the private sector to come to the agency where they are 

likely to have a lower salary and be posted to less desirable, rural locations. 

The VA hired 41,000 new employees last year, but that represented a net increase 

of only about 14,000 staff, or 4.7 percent of the Veterans Health Administration payroll, according to Secretary McDonald’s prepared statement for the House VA Committee. The department said in an emailed statement early February that the VA 

has about a 9 percent turnover rate - which it said is better than an 18 percent 

turnover rate in the private sector. 

VA officials said the current staffing shortage mirrors national trends in health 

care, where a study by the Association of American Medical Colleges predicted that 

the shortage of physicians could range from 46,000 to 90,000 in the next 10 years. 

1A4

VHA Recruitment and Retention of Physician Assistants; Problems Continue to 

rise 

Physician Assistants provide health care access for millions of veterans each year, 

VHA has not developed any strategic national plans to address the chronic 10% to 

14% total loss rate, which is one of the highest of any profession in VHA - top five 

hard to recruit occupations. With the existing reported disparity in pay between PAs 

employed by the VA and the private sector market this problem continues to grow. 

For several years, The Independent Budget veterans service organizations (IBVSOs) 

along with American Academy Physician Assistants (AAPA), and Veterans Affairs 

Physician Assistant Association (VAPAA), have all recommended that Congress ensure the retention and recruitment problems for PA’s be immediately rectified with 

new national targeted policy and programs for this critical occupation. 

The VA Office of Inspector General (OIG) Report #15 0900430 09103, January 30, 

2015; conducted a determination of Veterans Health Administration (VHA) occupations with the largest staffing shortages as required by Section 301 of the Veterans 

Access, Choice, and Accountability Act of 2014. VAOIG determined Physician Assistant, were 3rd compared to all other VHA occupations with the largest staffing shortages. 1A5 In addition to the VAOIG report the National Workforce Succession Planning 2015 - the data demonstrates the scope of the problems. 

Data VHA National Workforce Succession Planning 2015 

• In 2016 37% of VHA PA is eligible to retire. That is approximate loss of 600 

Physician Assistants. By 2021 48% of VHA PA’s are eligible to retire. 

• 2014 - PA’s had the highest Total Loss Rate of 10%; of the other top ten occupations. 

• 2014 - 14.28 % VHA PAs left the VA due to Compensation (salary and benefits). 

The PA workforce has grown far less than other physician extend positions within 

the VHA and little is being done about it; therefore, what should be a warning signal of serious retention and recruiting problems is being left to local VAMCs to 

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manage. Despite increasing discrepancy in salary levels, benefits, and education 

debt reduction programs between the civilian sector and the VAMCs often tells our 

members there is no problem. Currently Physician Assistants remain in an antiquated pay system with no competitive market survey resulting in a large pay disparity with the civilian sector. Last May I testified that the VA utilize the Nurse 

Locality Pay System surveys (LPS) allowing for annual market salary surveys aligning these professions within the VA with the private sector market. Inclusion of 

Physician Assistants into the Nurse LPS within Grow Our Own Directive H.R. 3974 

will allow for salary adjustments so that the VHA can be competitive. 

VAPAA is also concerned that the use of recruitment incentives within the VA 

is at the discretion of the hiring facility and is not standardized across the VA system. During 2012 092013 only 44 Physician Assistants have received $319,074 in 

funding to further their education in comparison to Seven hundred five registered 

nurses seeking to become Nurse Practitioners receiving scholarship awards totaling 

over $11,842,919 in support of NPs and NP programs. VA should implement recruitment and retention tools targeting Employee Incentive Scholarship Program by including PA as a hard to recruit occupation at the facility level to reflect WSP and 

OIG findings. Include Employee Debt Reduction Program funding to include PAs 

and make it available to all advertised PA vacancy announcements as EDRP cannot 

be issued unless it is advertised in the initial vacancy announcement. VISN and VA 

medical center directors must be held accountable for the failure to utilize these recruiting tools. Evidence of the problem from small sample of VAMC’s reflecting lack 

of VHA controls on providing scholarships to PAs. 

New Orleans Office the National Healthcare Recruiter, Workforce Management & 

Consulting VHA Healthcare Recruitment & Marketing said they have no Health 

Professional Scholarship Program (HPSP) funds of their own, so they are using 

funds provided by the VACO Office of Academic Affiliations to provide HPSP to 

nurses who want to be NPs. They have stated that these funds are not available 

to Intermediate Care Technician (ICTs) combat OIF OEF veterans, seeking to become PAs. The same office assured senior PA office representatives at the same time 

that they have EISP VANEEP/NEEI scholarship funds are available for VAMCs 

who request the funds. 

Cincinnati VAMC has told their ICTs who asked for VANEEP for PA education 

that they have been ‘‘out of’’ VANEEP funds for the last 4 years. What exactly does 

that mean since the funds come from New Orleans? No VAMC funds the VANEEP 

locally. 

San Diego VAMC told one of our ICT that they have ‘‘suspended’’ all scholarships 

and no support for PA students will occur. 

The VAMC in Spokane told an ICT that PAs were not a critical occupation in the 

VA and that therefore she was not eligible for VA scholarship funds. 

PAs then across the country find on USA JOBS web site and in VA news stories 

the following: Through its network of academic affiliations and sponsored programs, 

VA invests $900 million annually to provide clinical education and training programs to approximately 120,000 health care trainees. Sixty percent of VA’s psychiatrists, 70 percent of its psychologists and 35 percent of its social workers have previously participated in VA’s training programs. 

These committees must make certain that opportunities for required PA continuing medical education and training exist within the VA education programs. 

Physician Assistants provide high quality, cost effective medical care as they are 

held to the same standards of health care delivery as their MD/DO VA colleagues 

who are afforded a yearly stipend for continuing educations. PAs must maintain 

CME hours. Physician Assistants mush recertify by examination every 10 years. In 

order to be competitive with the civilian sector, the VA must make certain that employees gain opportunities for required PA professional development and continuing 

education and training in support in maintaining a high level of professional competence. 

Continued Delays in Hiring PA Employees 

VAPAA has found since last May’s hearing that whenever a PA employee leaves 

the VA system, VA acknowledges that it can take still six months to a year to fill 

one vacant position-assuming a viable pool of candidates is interested and available. 

When VA seeks to replace health care professionals, VA cannot compete with nimble 

private health care systems. The lengthy process VA requires for candidates to receive employment commitments and boarding continues to hinder the VA ability to 

recruit and officially appoint new employees. 

Private health care systems can easily fill PA vacancies in a matter of days or 

weeks. While PA applicants may have noble intentions of working for the VA and 

serving veterans, many will forgo what could be a 4 to 6 month long waiting period 

and pursue timely employment opportunities elsewhere. For these reasons, we ask 

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Congress to carefully review VA appointment authorities, internal credentialing 

processes, and common human-resources practices to identify ways to streamline 

the hiring process. If VA takes months to fill its health care vacancies, VA will continue to fail the delivery of timely, quality care to our nation’s veterans. 

Members of HVAC and SVAC both introduced bipartisan legislation last October, 

providing for specific plans for Grow Our Own, asking that VA utilizing VHA provisions (Titles III and VIII of the newly enacted Veterans Access, Choice, and Accountability Act of 2014) to include the national VHA plans for expanding recruiting 

for new FTEE PA positions and for retaining an optimal PA workforce utilizing our 

recommendations below. 

Department of Veterans Affairs ‘‘Independent Care Technician’’ (ICT) Program, 

One Solution to Support Transitioning Medics and Corpsmen OIF OEF OND into 

‘‘Grow Our Own’’ to Physician Assistant Occupation 

VAPAA points to another solution for meeting the healthcare workforce challenges 

in a recent pilot program. On October 26, 2011, the Administration announced its 

commitment to providing support to unemployed Post 9/11 combat veterans and it 

highlighted the PA profession as a prominent targeted career path for new returning veterans who had served as medics and corpsmen with combat medical skills 

similar to the history of returning Vietnam War veterans with these skills within 

the ICT pilot VA program at 19 VA sites. Under this initiative, the Administration 

promoted incentives to create training, education, and certifications of these veterans needing in transition to a civilian application of their military medical skills, 

being hired to work inside VA emergency departments, and has expanded into primary care, mental health, and surgery clinic positions. While these ICT veterans 

should be provided VANEEP, EDRP, EISP, and HPSP scholarships for entering accredited PA University programs they are being told by local facilities they have no 

funds for them, only for Nursing Educational programs. 

The VA has an excellent opportunity to facilitate and coordinate ‘‘Grow Our Own’’ 

combat medics, Corpsmen, or Air Force paramedics to transition to the physician 

assistant occupation. However the (ICT’s) currently in the Grow Our Own VA program are being frustrated by statements they should not expect scholarships from 

VA, and there is lack of VHA policy language directing VAMCs to ensure educational support of these combat veteran PA program candidates, assisting them in 

admission to accredited PA university Master’s programs with targeted scholarships 

for PA Education. Ten former OIF OEF combat veterans already enrolled in University PA program in Tennessee are told they will not be eligible for scholarships. 

The VAPAA is concerned over this ICT program started in 2012, reported to be 

expanding to more full time ICTs. The continued lack of use of recruitment educational incentives within VHA and having it left at the discretion of the local hiring 

facility is setting up further frustration across the VA system with the lack of VHA 

scholarships for the critical PA occupation. The Office of VA Healthcare Retention 

and Recruitment and the VAMC’s participating in the pilot ICT program have no 

dedicated VHAS support to transition them into PAs in the Employee Incentive 

Scholarship Program (EISP) or EDRP. The barriers to PA recruitment and retention 

will continue unless congressional members provide oversight, VHA must ensure 

that employee incentive programs, such as the EISP and the VA Employee Debt Reduction Program are made consistently available to all critical healthcare workforce 

PA vacancy announcements and utilized in ICT the program. VISN and VA medical 

center directors they must be held accountable for the failure to utilize these recruiting tools. 

The ICT Program establishment and expansion was authorized by the SEC VA 

in March 2015. The program expansion will increase ICTs in the VA from the original 45 by hiring 234 more ICTs. Hiring the additional 234 ICTs has been left to 

the discretion of the Facility Directors of individual VAMCs. 

Between March 2015 when the ICT expansion was approved and March 2016, less 

than 6 of the additional 234 ICTs have actually been hired by the VA. VHA was 

supposed to develop a national VA veteran employment program targeting OIF OEF 

combat medics and corpsmen that is being managed by local VAMCs with little 

oversight from VHA or VISN Directors. 

Critical Workforce Occupations: 

VA’s mission statement for human resources is to recruit, develop, and retain a 

competent, committed, and diverse workforce that provides high quality service to 

veterans and their families. VA identifies specific occupations as ‘‘critical occupations’’ based on the degree of need and the difficulty in recruitment and retention. 

There are 3 types of primary care clinical providers within the VA that provide direct patient care - Physicians, Physician Assistants and Nurse Practitioners. Physicians have mandated yearly market pay survey. Nurse Practitioners, by virtue of 

being a nurse, are under the mandated yearly RN LPS. 

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PAs in few facilities fall under Special Salary Rates; however, this is NOT mandated yearly. Some facilities have not performed a special salary survey for 11 

years, resulting in the reporting in the VISN 2014 0915 Workforce Succession Plan 

- 12 out of the 21 VISNs (88 VA main facilities) reported the reason that their VISN 

cannot hire PA’s is because they cannot compete with the private sector pay. Some 

VAMCs have refused to pursue steps to solve the current retention problems for 

PAs. 

Recommendations: We ask that both committees recognize the advantages to the 

Recruitment and Retention of Physician Assistant (PA) Workforce in the VA System 

by supporting enactment and supported by the veteran service organizations at the 

November 18, 2015 hearing on S. 2134 and call attention the VHA witness Dr. 

Carolyn McCarthy testified in favor of this legislation ‘Grow Our Own Directive: 

Physician Assistant Employment and Education Act of 2015.’’ (S.2134) and (H.R. 

3974) 

HR 3230 - Veterans Access, Choice, and Accountability Act of 2014 directs the 

Secretary, under the VA’s Health Professionals Education Assistance program, to 

give scholarship priority to applicants pursing education or training towards a career in a health care occupation that represents one of the five largest staffing 

shortages. 

The measure used under the Choice Act- OIG Top 5, prevents PA eligibility for 

EISP scholarship funds, as EISP - VANEEP, NEEI (VHA handbook 1020) conveniently only recognizes local facility workforce succession planning and ignores the 

OIG top five. 

To prevent local nursing bias, include PA at all facility level to reflect WSP and 

OIG findings as a hard to recruit occupation as this is the qualifying factor for EISP 

funding - VANEEP/NEEI 

In VHA Handbook 1020 - Employee Incentive Scholarship Program (EISP) Procedures: includes a priority protocol for nursing only scholarship funds, (1) applicants 

enrolled in academic programs which provide the minimum education for entry level 

in to the occupation RN to BSN, (2) RN to Master’s degree program (NP), (3) RN 

to doctorate (NP), and (4) RN to a degree related to their occupation. 

Include PAs in the hierarchy for funding allocations for EISP - VANEEP, NEEI 

scholarship funds. Include medicine - Designated Learning Officer (DLO) a part of 

the local facility selection committee for applicants. 

Include EDRP in all PA job postings. 

Include targeted scholarships for the ICT program OIF OEF Grow Our Own returning veterans, and mandate VHA shall appoint PA ICT program director to coordinate the educational assistance necessary and be liaison with PA university programs. 

H.R. 3974 would direct new Physician Assistant director position to work within 

the National Healthcare Recruiter, Workforce Management & Consulting VHA 

Healthcare Recruitment & Marketing Office. This position then can develop targeted recruiting plans with 187 PA programs, working in a way that the local 

Human Resource Officer (HRO) often will not due to lack of staffing. The VA employed PA national Healthcare Recruiter would develop improvements in finding 

qualified candidate in a matter of days not months. VHA must incorporate new PA 

consultant manager into this National Healthcare Workforce program office. 

Conclusion: 

Chairman Benishek and Chairman Wenstrup, and Ranking member Brownley 

and Takano, other members of HVAC committee as you strive to ensure that all veterans receive timely access to quality healthcare and as you build increased capacity 

for delivery of accessible high quality health care, and demand more accountability 

into the VA health care system, I strongly urge the full Committee to review the 

important critical role of the PA profession and ensure legislatively that VHA takes 

immediate steps to address these longstanding problems and continue to work with 

VAPAA in supporting our nation’s veterans. 

DISCLOSURE OF FEDERAL GRANTS OR CONTRACTS 

Veterans Affairs Physician Assistant Association 

The Veterans Affairs Physician Assistant Association (VAPAA) does not currently 

receive any money from a federal contract or grants. During the past six years, 

VAPAA has not entered into any federal contracts or grants for any federal services 

or governmental programs. 

VAPAA is a 501c (3) nonprofit membership organization. 

f 

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NURSES ORGANIZATION OF VETERANS AFFAIRS 

STATEMENT OF SHARON JOHNSON, MSN, RN 09BC, PRESIDENT 

Chairman Benishek, Chairman Wenstrup, and Members of the Subcommittees on 

Health and Economic Opportunity, on behalf of the nearly 3,000 members of the 

Nurses Organization of Veterans Affairs (NOVA), I would like to thank you for the 

opportunity to submit testimony on today’s draft legislation to Improve the Authority of the Secretary of VA to Hire and Retain Physicians and other Employees of 

the Department of Veterans Affairs. 

NOVA is a professional non-profit organization for registered nurses employed by 

the VA. 

NOVA appreciates the opportunity to provide our input and, as nurses who make 

up one third of the VA workforce, we will highlight areas of concern that are pertinent to our mission. 

While overall we appreciate the intent of the bill and support any activities that 

will improve how VHA hires, retains and recruits its workforce, the bill as written, 

does very little to affect nursing personnel and the staffing shortages being felt nationwide. 

For example, Section 2, paragraph 4 states that the Medical Director should be 

a doctor or other qualifying medical professional. NOVA believes that this minimizes the expertise of those professionals who are trained in healthcare and administration and limits flexibility in hiring within these leadership positions. 

Section 2 (7) (D) for clarification, mention is made of ‘‘Advanced Degree in Mental 

Health’’ and line 18 has Nursing Assistant. Nursing Assistants have no degrees and 

perhaps this was inserted in error. 

Section 3 - Adjustment of Hours Authorized for Certain Full-Time Employees of 

VHA implies that any hours can be worked to meet the biweekly pay period of 80 

hours with a cap at 2,080 in a calendar year. NOVA has concerns that payroll and 

human resources systems will not be able to manage this change unless IT software 

is rebooted and HR staff is trained to meet this change. 

NOVA applauds Section 5, which would clarify staffing shortages and include clinical as well as non-clinical personnel as needed. 

NOVA has no comments on Sections 6 through 9 of the Draft Bill. 

Section 10 - Reemployment of Former Employees. 

While NOVA appreciates the need to recapture former employees to help with 

staffing shortages within VA, for RN appointments, the grade is based on the Nurse 

Qualification Standards so the employed candidates would need to meet those 

standards. The scope is different for each grade. A reemployed candidate may not 

meet the qualifications for the next higher grade. And while it may be competitive, 

it could also be inequitable for those already employed using qualification standards 

under the accepted service position. 

Section 11- Recruiting Database. 

It is unclear to us how a national data base will work and what the expectation 

is. Problems often arise with national databases unless there is a short time period 

that applicants remain ‘‘active (i.e. 30 or 60 days) within the system and effective 

management of the database is provided. Good candidates would be scooped up 

quickly or will get other offers outside VA. For positions identified as mission critical, there should be greater pay flexibility built in to be competitive and attract 

candidates to those positions. For example, if an engineer or HR Specialist is a mission critical occupation and there are no hiring flexibilities, it will not help if they 

leave to go to other agencies or the private sector for more pay or higher grades. 

Section 12 - Hiring Academy. 

Retention of HR Specialists is of concern to NOVA. While an HR Academy is a 

noble idea, unless the workload and ineffective systems under HR are addressed, 

a high vacancy rate and ongoing retention issues will continue to be a concern. We 

also add that there should be something more specific that defines the appropriate 

training milieu based on the complexity of HR, such as face to face training when 

needed, and ensuring funds for travel are appropriated to continue providing effective training for all HR staff. 

Section 13 - Promotional Opportunities for Technical Experts. 

NOVA applauds this section and recognizes that technical experts need to be able 

to obtain promotions without having to leave their roles and pursue a managerial 

position. 

Section 14 - Comptroller General Study on Succession Planning. NOVA has no 

issues with this section. 

Section 15 - Information on Hiring Effectiveness. 

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We appreciate a system to track use and impact of hiring authorities and flexibilities. NOVA has already testified that there is a knowledge gap in hiring authorities 

and flexibilities within HR. We also applaud the inclusion of a process for tracking 

satisfaction and timeliness of the hiring process. 

Section 16 - Employment of Students and recent Graduates. 

NOVA supports the allowance of excepted service appointments and recent graduates. NOVA is an advocate of staff developmental opportunities such as internships 

and residency programs. 

Finally, Section 17 looks to standardize the process for exit interview surveys, 

which is critical in measuring and identifying any common themes so that action 

could be taken as well as assisting in identifying opportunities for improving the 

workforce environment within VA. 

In summary, NOVA supports all efforts directed towards the retention, as well as 

recruitment for the VHA’s largest workforce. Reviewing and enhancing nurse pay 

to be competitive with community and private sector standards; removing the cap 

from nurse pay scales to enable current employees to apply for critical leadership 

positions and increased support with monies for travel and education for nursing 

staff would go a long way in enhancing the VA as the employer of choice for 

healthcare professionals across the nation. 

Staffing methodology should be the accepted and supported mechanism for all facilities that VACO supports to determine nurse staffing, as well as having the Chief 

Nursing Officer at the table when patient care decisions and planning is made. 

Once again, NOVA thanks the Committees for the opportunity to submit testimony and we would be happy to assist with adding language in the bill to accommodate and revise any of the issues mentioned in our testimony. 

Statement on Receipt of Grants or Contract Funds: Neither Ms. Sharon Johnson, 

nor the organization she represents, the Nurses Organization of Veterans Affairs 

(NOVA), has received federal grant or contract funds relevant to the subject matter 

of this testimony during the current or past two fiscal years. 

f 

MERRITT HAWKINS 

TRAVIS SINGLETON, SENIOR VICE PRESIDENT 

Overview: 

We would first like to thank Dan Benishek, M.D., Chairman of the Committee of 

Veterans’ Affairs Subcommittee on Health, and Brad Wenstrup, Chairman, Subcommittee on Economic Opportunity, for the opportunity to submit this statement 

of record concerning draft legislation to improve the ability of VA healthcare facilities to effectively recruit and retain qualified physicians and other employees. 

Merritt Hawkins is the largest physician search and consulting firm in the United 

States, carrying out over 3,100 physician and advanced practitioner search assignments annually for healthcare facilities located in all 50 states. Established in 1987, 

Merritt Hawkins is a company of AMN Healthcare (NYSE: AHS), the largest 

healthcare staffing organization in the country and the innovator of healthcare 

workforce solutions. 

Over the course of 27 years of providing physician search services to the 

healthcare industry, Merritt Hawkins has worked with VA healthcare facilities in 

all regions of the country. Most recently, we have partnered with VA facilities on 

physician or advanced practitioner search assignments at VISN 20, VISN 4, VISN 

16, VISN 23, VISN 1, and VISN 20. We are currently the only permanent placement 

physician search firm that has a GSA number and is listed on 738X. 

In addition, we have worked with hundreds of other government sponsored or 

supported healthcare facilities where the physician recruiting dynamics are similar 

to those typically present at VA facilities. These include numerous Federally Qualified Health Centers (FQHCs), Indian Health Service (IHS) facilities, and Department of Defense facilities. 

In December, 2015, Merritt Hawkins submitted a Statement of Record for a 

roundtable discussion regarding how to improve the ability of the Department of 

Veteran’s Affairs to efficiently and effectively recruit and retain high quality physicians and other employees. Based on our knowledge of physician staffing and physician practice patterns, Merritt Hawkins’ president, Mark Smith, was invited in July, 

2012, to provide testimony before the House Committee on Small Business on the 

decline of solo and small physician practices. 

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In addition to our work with VA and other government sponsored facilities, Merritt Hawkins has worked with thousands of private sector healthcare systems, community hospitals, academic centers, medical groups, urgent care centers, retail clinics, and other facilities. We therefore have an extensive background from which to 

draw in comparing the best physician recruiting practices of government facilities, 

such as the VA, to those of a wide range of other facilities in the private sector. 

We will make such comparisons further in this statement but will first briefly address prevailing conditions in today’s physician recruiting market. 

Medical Professional Recruitment: Market Context 

In the previous Statement of Record Merritt Hawkins submitted to the Subcommittees in December, 2015 we outlined prevailing physician recruiting market 

conditions in today’s rapidly evolving healthcare system. We will not repeat this entire discussion here, but will state that both the government and the private 

healthcare sectors are challenged by prevailing physician shortages which are projected to worsen. 

The Association of American Medical Colleges (AAMC) projects a shortage of up 

to 91,000 physicians by 2025 (see The Complexities of Physician Supply and Demand, Association of American Medical Colleges, March 2015). The shortage is 

being driven by a growing and aging population, advances in medical technology, 

and the increased availability of health insurance through the Affordable Care Act. 

Fueling the shortage is the fact that residency training positions for medical graduates have grown only incrementally over the last 18 years, as federal funding for 

physician training was capped by Congress in 1997. 

The effect of these shortages is apparent in Merritt Hawkins’ 2014 Survey of Physician Appointment Wait Times and Medicaid and Medicare Acceptance Rates. The 

survey examines the time needed to schedule a new patient appointment in five 

medical specialties in 15 major metro markets 

The chart below shows average wait times to schedule a new patient appointment 

with a family physician in the 15 metro markets examined in the survey: 

Wait Time in Days to Schedule a New Patient Appointment With a Family Physicians in 15 Metro 

Markets 

City Shortest Time to Appointment Longest Time to Appointment Average Time to Appointment 

Boston, 2014 12 days 152 days 66 days 

Boston, 2009 6 days 365 days 63 days 

New York, 2014 14 days 38 days 26 days 

New York, 2009 6 days 61 days 24 days 

Atlanta, 2014 1 day 112 days 24 days 

Atlanta, 2009 3 days 21 days 9 days 

Seattle, 2014 3 days 129 days 23 days 

Seattle, 2009 2 days 14 days 8 days 

Philadelphia, 2014 1 day 98 days 21 days 

Philadelphia, 2009 3 days 15 days 9 days 

Los Angeles, 2014 1 day 126 days 20 days 

Los Angeles, 2009 1 day 365 days 59 days 

Houston, 2014 1 day 178 days 19 days 

Houston, 2009 1 day 29 days 17 days 

Denver, 2014 1 day 62 days 16 days 

Denver, 2009 1 day 45 days 14 days 

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Wait Time in Days to Schedule a New Patient Appointment With a Family Physicians in 15 Metro 

Markets—Continued 

City Shortest Time to Appointment Longest Time to Appointment Average Time to Appointment 

Detroit, 2014 1 day 74 days 16 days 

Detroit, 2009 3 days 31 days 14 days 

Wash., D.C., 2014 1 day 62 days 14 days 

Wash., D.C., 2009 3 days 365 days 30 days 

Portland, 2014 3 days 45 days 13 days 

Portland, 2009 3 days 16 days 8 days 

Miami, 2014 1 day 56 days 12 days 

Miami, 2009 1 day 25 days 7 days 

Minneapolis, 2014 1 day 30 days 10 days 

Minneapolis, 2009 2 days 23 days 10 days 

San Diego, 2014 1 day 17 days 7 days 

San Diego, 2009 1 day 92 days 24 days 

Dallas, 2014 1 day 10 days 5 days 

Dallas, 2009 1 day 27 days 8 days 

Total, 2014 2.87 days 79.3 days 19.5 days 

Total, 2009 2.47 days 99.6 days 20.3 days 

As these numbers indicate, average family physician appointment wait times exceed 14 days in ten of the markets, and equal or exceed 21 days in five of the markets. In other markets with fewer physicians per capita, it is likely that wait times 

may be more protracted. It is therefore not just VA patients who are experiencing 

protracted physician appointment wait times. 

Today, a proliferating number of sites of service are competing for a limited pool 

of physicians, PAs and NPs, as healthcare delivery transitions from a hospital based 

model to an outpatient and ‘‘convenient care’’ based model. Thousands of urgent 

care centers, ambulatory surgery centers, retail clinics, FQHCs, free-standing emergency rooms, major employers, and insurance companies are actively recruiting physicians, along with more traditional types of employers, including hospitals, hospital 

systems, academic medical centers, and government facilities such as the VA. 

The type of physicians that VA facilities historically have been able to recruit, including active military and former military physicians, are increasingly being contacted and recruited by a wide range of private sector facilities. 

Due to this competitive climate, it is important for healthcare facilities to have 

a strategic recruiting plan, to accurately forecast their needs, to be nimble and responsive, to offer competitive incentives, an attractive work environment, and, of 

most importance, to bring a consistent sense of urgency to the recruiting process. 

VA Facility Recruiting Methods and Challenges 

In Merritt Hawkins’ 2015 Statement of Record referenced above we outlined various physician recruiting challenges faced by VA facilities. 

To recap, the first and most challenging is the recruiting process itself, as administrated by the various VA facility human resource departments. A sense of urgency 

and the ability to be agile is critical in today’s physician recruiting market. 

Physician candidates being sourced by the VA typically also are receiving job offers from many other organizations. The great majority of VA facilities with which 

we work are handicapped by the prolonged time needed to process candidates who 

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didates often can run as long as six months. By contrast, efficiently run private hospitals typically turnaround the same level of paperwork in no longer than four 

weeks. In the private sector, this process often occurs concurrently with the recruiting process. 

These waiting times do not include the process required to approve candidate 

interviews before a job offer is made. The process to approve candidate interviews 

may be channeled through four or five individuals who have a variety of duties and 

may not appreciate the urgency of approving physician interviews quickly. In Merritt Hawkins’ experience, it may take up to three months to schedule two to three 

interviews for the same position. It also may be difficult for candidates to submit 

required information, and their applications may be rejected for lacking certain 

basic information without the candidate’s knowledge. They simply do not hear back 

and assume they did not get the job. 

In recent physician recruitment efforts in Alaska that Merritt Hawkins conducted 

on behalf of the VA, we were successful in placing 10 physicians in the Wasilla, Anchorage and Fairbanks areas. All ten physicians accepted offers with the VA but the 

contract approval process was so protracted and laborious that nine of the ten physicians withdrew from consideration. 

A key part of the problem in Merritt Hawkins’ experience is that VA facilities 

tend to follow the same recruiting process for all types of personnel. The same HR 

systems and processes used to recruit an administrative support position are used 

to recruit a neurosurgeon, though the urgency of recruiting a neurosurgeon may be 

considerably greater than the urgency of recruiting other positions. As a third party, 

Merritt Hawkins is unable to contact VA HR personnel to help facilitate interviews 

or help ensure candidates have the information they need to make a decision. Moreover, the same person at the VA managing the recruitment of administrative personnel also may be managing the recruitment of highly trained medical professionals, despite the fact that the skill sets required for these two disparate tasks 

vary considerably. 

Without an efficient, timely method for screening, credentialing and responding 

to candidates, the VA is losing well qualified and motivated physicians and other 

professionals to employers who do have such systems in place. 

This is particularly unfortunate as the VA offers a style of practice that is appealing to many of today’s physicians. The VA typically offers set hours, generous vacation times, the security of government employment, an absence of reimbursement 

and other practice management challenges physicians face in the private sector, 

freedom from the stress of malpractice, a rewarding sense of mission and various 

attractive locations. Many physicians are not aware of this, as a stigma about VA 

practice still is prevalent among some doctors, but these perceptions can be overcome. Indeed, none of the key physician recruiting challenges facing the VA are related to an inability to persuade candidates to accept VA employment. The key challenges lie in candidate sourcing and processing. 

Compensation and Incentives 

It also may be necessary for the VA to allocate resources to enhance physician 

compensation packages. In the private sector, base salaries for primary care physicians, including family physicians and internists, average approximately $200,000, 

not including signing bonuses, production bonuses, relocation allowances, and benefits. At VA facilities, compensation for primary care physicians varies, but can be 

considerably less than what is common in the private sector. In addition, due to VA 

policies, it often is difficult to be clear with candidates regarding the level of compensation being offered. Primary care salaries may start with a baseline of $70,000, 

which immediately creates a negative impression, then move up base on merits, but 

obtaining clarity on compensation often is difficult. 

When an offer is made, there are many logistical obstacles in place before an offer 

letter or other documentation confirming the offer/terms can be obtained, which can 

undermine the process. 

While VA physician salaries may never equal those to be found in the private sector, and it is not necessary that they do so given the other incentives the VA can 

offer, it is important that they at least be competitive in today’s evolving physician 

market. It also is necessary to communicate effectively to candidates that VA opportunities have advantages that make them attractive even if salaries are not always 

commensurate to those in the private sector. 

Statement Regarding the Draft Bill 

The draft legislation to improve the authority of the Secretary of Veterans Affairs 

to hire and retain physicians and other employees dated February 26, 2016 includes 

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new language that appears to address some of the VA’s physician recruiting challenges cited above. 

In particular, Section 15 (B) ‘‘Information on Hiring Effectiveness’’ includes language that addresses the need for ‘‘special hiring authorities and flexibilities to recruit most qualified applicants.’’ Though these authorities and flexibilities are not 

defined, we take this language to mean appropriate personnel at the VA will be 

given the authority to reduce candidate processing times and needed clearances and 

possibly reduce the number of individuals who now currently vet physician candidates. We see increased flexibility in VA recruiting processes as an essential step 

in allowing the VA to become more nimble in response to a market where physicians 

are receiving multiple job offers and commonly move on if not communicated within 

a timely manner. 

We also believe the language in Sec. 15 (G) authorizing the capture of data regarding ‘‘the length of time between the date on which a first offer of employment 

for a position is made and the date on which a new hire starts in the position’’ is 

constructive. This will allow the VA to track its relative success in reducing candidate processing times and increasing process flexibility and effectiveness. 

Similarly, Sec. 15 (I) in which the legislation mandates that the VA track ‘‘the 

number of offers accepted compared to the number of offers made for permanent positions’’ may have the constructive outcome of allowing the VA to measure its recruiting success internally and compared to private sector standards. Tracking this 

data should help determine whether the VA is, in fact, becoming more nimble in 

its candidate vetting processes and therefore securing a higher percent of candidates 

to whom it has made offers. 

Further positive new language is included in Sec. 15 (3) in which the VA is 

charged with tracking the ‘‘Satisfaction of employment applicants with the hiring 

process including.user-friendliness of the application process, communication regarding status of application, and timeliness of hiring decision.’’ Tracking this data will 

further allow the VA to determine if it is streamlining it processes and identify barriers that may be preventing it from doing so. 

New language in Sec. 14 regarding a ‘‘General Study on Succession Planning’’ also 

may prove useful in requiring VA facilities to be more proactive in their physician 

recruiting, anticipating needs and marshalling the resources needed to address 

them on the front end. This strategy has proven effective for many of the private 

sector healthcare facilities with which Merritt Hawkins works. 

Not currently addressed in the draft legislation is the need to reassess physician 

compensation amounts and structures in order to put VA facilities on a more equal 

footing with the private sector facilities with which they compete. 

In addition, language may be needed to more clearly define the VA personnel assigned to the task of physician recruitment and their required training. In today’s 

market, ‘‘physician recruiter’’ is a specialized position and the great majority of private sector hospitals (excluding some Critical Access Hospitals) use both in-house 

physician recruiting personnel dedicated to that activity and outside resources such 

as recruiting firms like Merritt Hawkins. The skill set and knowledge level needed 

to recruit physicians, as noted above, is different from those needed to recruit other 

types of personnel. 

Merritt Hawkins also recommends that the draft legislation (or implementing regulations) more specifically define how physician candidates will be processed 

throughout the recruiting effort, specifying who the decision makers are (and limiting their number) and the time frame in which they are required to turnaround 

candidate applications. 

CONCLUSION 

As stated in our December, 2015 Statement of Record, while the institutional 

challenges the VA is facing in physician recruitment are daunting, they are not confined to the VA. Academic medical centers and increasingly large and consolidated 

healthcare systems in the private sector also struggle with implementing streamlined systems for processing physician candidates. The healthcare facilities that are 

able to do so are the most likely to achieve consistent physician recruiting success, 

which is attainable even in today’s rapidly evolving healthcare system. 

FOR ADDITIONAL INFORMATION, PLEASE CONTACT: 

TRAVIS SINGLETON 

SENIOR VICE PRESIDENT 

459 09524 091630 

TRAVIS.SINGLETON@MERRITTHAWKINS.COM 

f 

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PARALYZED VETERANS OF AMERICA 

Chairmen Benishek and Wenstrup, Ranking Members Brownley and Takano, and 

members of the Subcommittees, Paralyzed Veterans of America (PVA) would like to 

thank you for the opportunity to present our views on the pending legislation impacting the Department of Veterans Affairs (VA) employment authority. No group 

of veterans understand the full scope of care provided by the VA better than PVA’s 

members-veterans who have incurred a spinal cord injury or disease. Most PVA 

members depend on VA for 100% of their care and are the most vulnerable when 

access to health care, and other challenges, impact quality of care. Elements of this 

bill will help ensure that veterans receive timely, quality health care and benefits 

services. 

In order to accomplish VA’s strategic goal, ‘‘to be an employer of choice in the national labor market,’’ VA must be able to recruit and retain qualified professionals, 

and administrative, technical and other staffs, by providing competitive compensation, and opportunities for professional and technical development. The Association 

of American Medical Colleges estimates the United States will have a shortage of 

130,600 physicians by 2025. Today, the most vulnerable populations, including rural 

communities and veterans with specialty needs are the first to feel the effects. While 

VA recruitment efforts are improving, the inexcusably long process it takes to bring 

an employee onboard continue to turn away highly qualified candidates. VA must 

provide its human resources management staff with the resources and training necessary to correct these issues. 

Section 2 of the proposed draft bill would eliminate the current statutory requirements that the Medical Directors of VA Medical Centers (VAMCs) and directors of 

Veterans Integrated Service Networks (VISNs) be a doctor of medicine or dentistry. 

Rather, it would require they be, to the ‘‘extent practicable’’ a qualified medical professional. Further, it would allow these directors to receive market pay in addition 

to base pay, with the market pay reviewed by the secretary on a case by case basis. 

PVA supports any effort intended to recruit and retain the highest quality health 

care providers. Our nation’s veterans deserve no less than the very best. Congress 

should also consider other incentives, such as child care, flexible scheduling, and 

continuing education. 

In 2004, Congress passed P.L. 108 09445, the ‘‘Department of Veterans Affairs 

Health Care Personnel Enhancement Act.’’ The act was intended to aid VA in recruitment and retention of VA physicians, especially scarce subspecialty practitioners, by authorizing VA to offer highly competitive compensation to full-time physicians oriented to VA careers. VA has fully implemented the act, but PVA suspects 

the act may not have been sufficient enough. PVA urges Congress to provide oversight and to ascertain whether VA has adequately implemented its intent in enacting P.L. 108 09445. 

Section 3 would allow the Secretary to modify the hours of employment for personnel of VHA so they can have more or less than 80 hours in a biweekly pay period 

as long as their total hours per calendar year do not exceed 2,080 hours. PVA supports this modification. Currently, VA emergency room physicians work inflexible 

12-hour shifts within the required 80 hours per pay period that denote full-time status. This rigidity does not exist in the private sector. Irregular work schedules are 

needed to provide high quality patient care. Additionally, the Veterans Health Administration (VHA) antiquated system interferes with recruitment and retention efforts. 

Section 4 would allow the Secretary to pay for 66 percent of the Yellow Ribbon 

Program under the Post-9/11 G.I. Bill for a graduate degree in the mental health 

field as opposed to only ‘‘up to 50 percent.’’ The applicant would have to be eligible 

for the Post-9/11 G.I. Bill and eligible for the Yellow Ribbon Program and intend 

to become a mental health professional for VA. PVA supports this provision. 

Currently, the Veteran Access Choice and Accountability Act requires the VA Office of Inspector General (VAOIG) determine annually the five occupations within 

VHA that had the highest staff shortages. Section 5 of this draft would require the 

VAOIG to evaluate staffing shortages for five clinical occupations and five nonclinical occupations within each VISN. PVA supports this provision as it would add 

clarity to the staffing capacity where care is directly provided. 

Section 6 would repeal the compensation panels to determine market pay for physicians and dentists. PVA currently has no official position on this provision. 

Section 7 would require the Secretary to select at least 18, but no more than 30, 

employees to participate in a one year fellowship with a private sector company or 

entity that administers or delivers health care or other services similar to those provided within VBA and VHA. PVA generally supports this idea. In the current environment there could be a benefit to sending VA senior executives into the private 

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sector to better understand best practices from both sides. At the same time, sending already limited resources and talent outside of VA could further undermine the 

existing training programs within the Department. 

Section 8 would require the Secretary to conduct an annual performance plan of 

VA’s political appointees. The plan would be similar to those employees who are 

members of the Senior Executive Service and would assess recruitment and retention of qualified employees, engagement and motivation, and performance and accountability. While surprised there is not already a performance plan for VA political appointees, PVA considers this a reasonable provision. 

Section 9 would expand veterans preference to reservists by counting their cumulative service rather than consecutive. PVA supports offering the preference in hiring to those not currently eligible and hopes such an expansion would allow VA to 

hire more veterans. 

Section 10 would allow the Secretary to noncompetitively reappoint a former VA 

employee to any position within the Department as long as the position is not more 

than one grade higher than their former position and as long as the employee left 

the Department voluntarily within the prior two years and maintained necessary 

licensures and credentials. PVA has concerns about bringing back a former employee to a higher grade through a noncompetitive process. Such a hiring pathway 

allows for personal relationships to dictate placement. While PVA supports the intent to easily fill critical vacancies, we are not convinced hiring former employees 

through a noncompetitive process is the most appropriate. 

Section 11 would require the Secretary to create a single recruiting database to 

list any vacant positions the Secretary determines are critical to the mission of VA, 

or difficult to fill, or both. It would keep information on applicants not selected for 

initial positions but who are qualified for other positions in the department. The 

Secretary would be required to use the database to fill any vacant positions. PVA 

does not believe a recruiting database is necessary. Given the current condition that 

is VA and its relationship to IT, we are unsure how the creation of a new apparatus 

will quicken the Department’s efficiencies. Presumably, the ‘mission critical’ positions the proposed database would house are currently residing in the existing system, if not USAJobs.gov. Why these are not suitable means for discovering their 

listing we would wish to know before offering a final opinion. 

PVA generally supports Section 12 that would require the Secretary to provide 

the proper training for human resources (HR) professionals for recruiting and hiring 

Title 38 employees within VHA. Currently, most HR professionals are primarily 

trained for hiring under Title 5, while a majority of VHA’s hiring is for Title 38 employees. VA must reduce the amount of time it takes to bring new employees on 

board and provide its HR staff with adequate support through updated hiring processes and proficiency training. The development and implementation of defined 

goals for recruitment and retention (to include promotions, continuing education, 

etc.) should be components of HR staff’s performance plans. VA HR management 

staff are not accountable to direct service providers. PVA believes they should be 

held accountable. HR performance is not measure by the degree to which they meet 

hiring and recruitment goals. As a consequence, failure to fill a critical vacancy in 

a timely manner carries no adverse effect on the involved HR staff. 

PVA thanks the Subcommittees for their work to recruit and retain excellent employees at VA. However we are unsure how all of the aims of this draft bill would 

be meeting the needs of the Department. This concludes PVA’s statement for the 

record. We would be happy to answer any questions for the record that the Committee may have. 

Information Required by Rule XI 2(g)(4) of the House of Representatives 

Pursuant to Rule XI 2(g)(4) of the House of Representatives, the following information is provided regarding federal grants and contracts. 

Fiscal Year 2016 

Department of Veterans Affairs, Office of National Veterans Sports Programs & 

Special Events - Grant to support rehabilitation sports activities - $200,000. 

Fiscal Year 2015 

Department of Veterans Affairs, Office of National Veterans Sports Programs & 

Special Events - Grant to support rehabilitation sports activities - $425,000. 

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1 1A85.5 percent of SES; 91.2 percent of Title 38 SES; 85.9 percent of Chiefs of Staff; 77.6 

percent of Nurse Grade V; 48.3 percent of Associate, Assistant, and Deputy Directors. 

Fiscal Year 2014 

No federal grants or contracts received. 

Disclosure of Foreign Payments 

Paralyzed Veterans of America is largely supported by donations from the general 

public. However, in some very rare cases we receive direct donations from foreign 

nationals. In addition, we receive funding from corporations and foundations which 

in some cases are U.S. subsidiaries of non-U.S. companies. 

f 

DISABLED AMERICAN VETERANS 

ADRIAN M. ATIZADO 

Mr. Chairman and Members of the Subcommittees: 

Thank you for inviting DAV (Disabled American Veterans) to submit testimony 

for the record to discuss our views on draft legislation aimed at improving the authority of the Secretary of Veterans Affairs (VA) to hire and retain physicians and 

other VA employees. As you know, DAV is a non-profit veterans service organization 

comprised of nearly 1.3 million wartime service-disabled veterans and is dedicated 

to a single purpose: empowering veterans to lead high-quality lives with respect and 

dignity. 

According to VA, between FY 2013 and FY 2019, nearly 41 percent of the Veterans Health Administration (VHA) workforce will become eligible for regular retirement, with over 23 percent projected to actually retire. Among senior leaders, the 

rates of retirement eligibility are staggering, with more than 75 percent of the Senior Executive Service (SES), Title 38 executives, chiefs of staff, and nurse executives, 

and about half of Associate, Assistant, and Deputy Network Directors eligible for 

retirement within the next 7 years. 1A1 This scenario highlights the need for this 

hearing and we applaud the work of both Subcommittees’ to improve the VA Secretary’s authority to recruit and retain VA physicians and other employees. 

Section 2 of this draft bill seeks to address the lack of specific authority to make 

appointments or set rates of pay under title 38 for VA Medical Center Director and 

Network Directors. 

It appears that pay for these directors would be based on the methodology of a 

compensation system similar to that which is used for VHA physicians and dentists 

(38 U.S.C. § 7431) P.L. 108 09445. Notably, changes to the VHA physicians and dentists compensation system is proposed in Section 6 of this bill. We draw the Subcommittees’ attention to our comments and concerns on Section 6 as it applies to 

Section 2 of this measure. 

Section 3 would align VA practice with the private sector, facilitating the recruitment and retention of emergency physicians and the recruitment, retention and operation of a hospitalist physician system in VA medical centers. 

To accommodate the need for continuity of efficient hospital care, emergency medicine (EM) physicians often work irregular schedules. This measure would modify 

the hours of employment for a full-time physician or physician assistant to more or 

less than 80 hours in a biweekly pay period provided the employee’s total hours of 

employment in a calendar year would not exceed 2,080. Consequently, VA medical 

centers would gain the ability to implement flexible physician and physician assistant work schedules that could accommodate hospitalist and EM physicians’ schedules and practices. 

DAV does not have a resolution calling for this specific legislation; however, because of the measure’s beneficial nature, we would not oppose its favorable consideration. 

As part of the ‘‘Yellow Ribbon G.I. Education Enhancement Program,’’ Section 4 

of the bill would require the VA Secretary to carry out a program in partnership 

with an institution of higher education (IHE) and agree to cover the full cost not 

covered by the post-9/11 G. I. Bill incurred by veterans who are pursuing advanced 

degrees in the mental health field at the IHE and intend to seek employment as 

mental health professionals in VA. 

DAV Resolution No. 122 calls on Congress and VA to establish scholarships for 

future VA mental health practitioners. We are pleased to support this important 

provision which seeks to make program improvements related to suicide prevention 

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and would improve access to appropriate mental health services for service members 

and veterans who need such services. 

Section 5, would add to the five clinical occupations an additional five nonclinical 

occupations for which the Office of Inspector General (OIG) must annually determine are the largest staffing shortages throughout the Department as calculated 

over the five-year period preceding the determination. 

We urge the Subcommittee include in this context of determining capacity of the 

VA health care system other directly related factors such as space shortages and 

requirements to meet the goals of the Secretary for timely access to care for veterans. Section 6 would eliminate the compensation panel recommendation process required under 38 U.S.C. § 7431(c)(4)(B) to determine market pay for physicians and 

dentists. We understand that VA believes the current compensation panel process 

is time consuming and yields no additional value to other reviews conducted prior 

to the appointment. 

We understand the ability for the Secretary to exercise flexibilities in pay is a 

vital recruitment and retention tool. The Secretary today has discretion over two 

components of compensation for VA physicians and dentists under the title 38 pay 

system - market pay and performance pay. Market pay combined with basic pay 

(which set by law) is meant to reflect the recruitment and retention needs for the 

specialty of assignment of the particular physician or dentist in a VA facility. Performance pay, which the Secretary also has discretion over, is a statutorily authorized element of annual pay paid to physicians and dentists for meeting goals and 

performance objectives. Furthermore, Congress has granted VA other pay flexibilities involving discretion, including premium pay, on-call pay, alternate work schedules, Baylor Plan, special salary rates, and recruitment and retention bonuses. 

It appears that market pay is the only part of VA compensation that is determined through a peer-review process composed of a group of physicians and/or dentists and based on factors such as the prospects experience, qualifications, complexity of the position and difficulty recruiting for the position. There is risk eroding 

the effectiveness of market pay by eliminating this role without assurances that the 

local peer-perspective, which ensures consistency and appropriateness of pay proposals, will continue to be an important part of the approving official’s final decision. 

Section 7 would establish a one-year fellowship program to provide private sector 

claims processing training and experience for certain Veterans Benefits Administration (VBA) and VHA executives. The private sector entity would be engaged in the 

administration and delivery of health care or other services similar to the benefits 

administered by the Secretary. 

We note that the eligible employer under this section of the bill would be both 

VBA and VHA. However, the agreement under the proposed new Section 721(e) between VA and the fellow is incongruous, which appears to afford the opportunity 

for employment only in VBA and not VHA, which we urge the Subcommittee to correct. 

Section 8 proposes a new requirement for the Secretary to conduct an annual 

performance plan for political appointees within the Department similar to the annual performance plan conducted for a career VA Senior Executive Service appointee. 

Delegates to our most recent National Convention approved Resolution No. 214, 

calling for the imposition of meaningful employee accountability measures in VA, 

but with due process for employees targeted for such sanctions. This section meets 

the intent of DAV’s resolution; therefore, DAV supports enactment. 

Section 9 would modify veterans’ preference in hiring for employment in the federal government by including in the active duty service requirement those veterans 

who have performed 180 days of cumulative service and all military retired. The application of such preference would also extend to the hiring of senior executive positions in the VA. 

DAV supports this provision based on Resolution No. 130, calling, for among other 

things, a broader utilization of veterans and service-disabled veterans hiring preferences and supporting federal, state and local veterans’ preference laws. 

Section 10 would allow the Secretary to noncompetitively appoint a qualified 

former employee to any position within the competitive or excepted service positions 

that is one grade higher than the grade of the position at the Department most recently occupied by the employee. A former employee may not be appointed to a position that is more than one grade (or equivalent) higher than the position at the Department most recently occupied. The term ‘‘qualified former employee’’ means any 

individual who formerly occupied any VA position within 2 years before applying for 

re-employment at the Department; voluntarily left such position, or was subject to 

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a reduction in force, and had a satisfactory performance record while occupying such 

position; and since leaving such position has maintained relevant licensing requirements, if any, and gained skill, knowledge, or other factors related to the position. 

Section 11 would authorize the establishment of a single database that lists each 

vacant position in the VA that the Secretary determines is critical to the mission 

of the Department, difficult to fill, or both. If an applicant for a vacant position listed in the database is qualified but is not selected for the position, the Secretary, 

at the election of the applicant, shall consider the applicant for other similar vacant 

positions listed in the database for which the applicant is qualified. 

Section 12 would require VA human resources professionals training on how to 

best recruit and retain Title 38 employees, including any recruitment and retention 

matters that are unique to the VHA. The training would be provided in a manner 

deemed appropriate in light of budget, travel, and other constraints. The Secretary 

shall ensure that each VHA human resources professional receives the training as 

soon as practical after being hired as a human resource professional; and annually 

thereafter. 

Section 13 would require VA to establish a promotional track system for VA employees determined to be technical experts within one year of it being enacted. The 

developed promotional track would provide qualifying employees the opportunity to 

advance within VA without being required to transition to a management position; 

it would provide for the establishment of new positions within VA; and notwithstanding any other provision of law, would provide for increases in pay. 

DAV does not have a resolution calling for the provisions in sections 10 through 

13. 

Section 14 would require the Government Accountability Office to conduct a 

study on the succession planning at each VA medical facility, the VBA, and the National Cemetery Administration. For each entity, the study must include: A determination of the mission-critical positions and the vacancy risk of such positions; An 

analysis of the future needs for mission critical positions and gaps within the existing talent pool of the entity; A description of strategies to close skill gaps through 

the use of training for existing staff, targeted recruitment, and hiring; A plan to regularly evaluate progress of staff and update existing succession plans using clear 

and measurable metrics and benchmarks; A demonstration of the capacity to execute succession plans with successful succession management strategies, and; Any 

other matters the Comptroller General determines appropriate. 

The Comptroller General shall submit a report detailing each study conducted to 

the House and Senate Committees on Veterans’ Affairs no later than one year after 

enactment. 

We thank the Subcommittees attention to address one of VA’s most significant 

challenges is dealing effectively with succession an succession planning-especially in 

the health sciences and technical fields that so characterize contemporary American 

medicine and healthcare delivery. 

Section 15 would require the VA to measure and collect detailed information on 

indicators of hiring effectiveness including satisfaction of employment applicants 

and new hires. Personally identifiable information of applicants and employees will 

be kept private. The Secretary will submit a report of information collected to the 

House and Senate Committees on Veterans’ Affairs, and will annually make the information collected publicly available in a consistent and machine-readable format 

to allow for a comparison of hiring effectiveness and experience by VISN or comparable public or private sector organization. 

DAV has been calling attention to VA’s human resources policies, which in recent 

hearings on VA mental health in the Senate, confirm that the lack of responsiveness 

of human resources offices and management policies are contributing to deficits in 

VA’s mental health programs. Sadly, unresponsive human resources practices are 

also affecting all of VA’s key missions. While we believe the collection of this information may be useful, we urge the Subcommittee to carefully examine VA and Office of Personnel Management appointment authorities in statute and how they are 

being applied within VA to determine whether additional legislation would offer any 

helpful resolution. VA should develop and track measures of performance in human 

resources recruitment, on-boarding and retention of clinical staff. Almost as important, the Committee should provide targeted oversight in examining why VA human 

resources programs are so weak and unaccountable at a time when they should be 

acting forcefully and supportively to ensure VA programs in VHA, VBA and Memorial Affairs are properly staffed to meet their missions. With help from Congress, 

we believe this aspect of VA’s challenges can be solved with better leadership and 

more responsiveness, beginning at the local level and extending throughout the system. 

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Section 16 VA would allow for excepted service appointments of students and recent graduates leading to conversion to career or career conditional employment of 

a student or recent graduate of a qualifying educational institution. The conversion 

authority shall be applicable to individuals in good standing who are employed in 

a qualifying internship or fellowship program at the Department; are employed in 

the Department in a volunteer capacity and performing substantive duties comparable to those of individuals in internship or fellowship programs and meet the 

required number of hours for conversion; or who are employed in the Department 

under a contract or agreement with an external non-profit organization and performing substantive duties comparable to those of individuals in internship or fellowship programs. 

DAV has no resolution on this specific provision; however, we continue to hear 

from VA medical facility leaders on too many lost opportunities due to the lengthy 

hiring process for medical students who train in VA. As these medical professionals 

train in VA, they gain institutional knowledge, which becomes and tremendous advantage in successful transition. Thus, we would not oppose the favorable consideration of this section in this regard. 

Section 17 would require VA develop and carry out a standardized, anonymous, 

and voluntary exit survey to be completed by career and non-career employees and 

executives of the Department who voluntarily leave. Data collected will be 

anonymized and personally identifiable information will be removed, and the results 

of the survey would be shared annually with directors and managers of VA facilities 

and the VISN. Within one year after the date of the enactment, and annually thereafter, the Secretary will submit a report containing the aggregate results of the exit 

survey to the House and Senate Committees on Veterans’ Affairs. 

DAV does not have a resolution calling for this section of the bill. 

Mr. Chairman and Members of the Subcommittees, this concludes DAV’s testimony. We appreciate the invitation to submit testimony for the record, and are prepared to respond to any questions on the positions we have taken with respect to 

the bill under consideration. 

f 

IRAQ AND AFGHANISTAN VETERANS OF AMERICA 

Lauren Augustine 

Chairman Wenstrup, Chairman Benishek, Ranking Members Takano and 

Brownley, and Distinguished Members of the Subcommittees, on behalf of Iraq and 

Afghanistan Veterans of America (IAVA) and our more than 450,000 members and 

supporters, we would like to extend our gratitude for the opportunity to share our 

views on the draft legislation to improve hiring practices at the Department of Veterans Affairs (VA). 

As all in the veteran community are well aware, the need for greater accountability at the VA is paramount to successfully restoring veterans’ trust in the system. However, just as important is the need to employ and retain highly qualified, 

motivated professionals willing to support the VA’s mission. The VA has asked for, 

and should receive, many of the provisions within this draft legislation, which are 

necessary changes to their current hiring practices to support such goals. IAVA is 

pleased to see many additional provisions within the draft legislation that aim to 

meet those same needs among other key changes to better the VA’s hiring and retention process. 

While the vast majority of VA employees serve veterans with outstanding care 

and professionalism, the few underperforming or negligent employees that discredit 

their service must be held accountable in a swift manner that brings justice to the 

system while also protecting whistleblowers and maintaining a culture professionals 

want to work within. IAVA fully supports the measure within the draft legislation 

to appoint Directors of Veterans Integrated Service Networks (VISN) and Veterans 

Affairs Medical Centers (VAMC) under title 38, which has been requested specifically by the VA, to ensure less bureaucracy and more accountability as it relates 

to disciplining wrongdoing. This measure will also provide the VA greater flexibility 

in offering competitive pay and compensation to attract and retain the most qualified candidates for such positions. We cannot expect VA Directors to perform at levels that meet or exceed their private-sector counterparts if we are not willing to 

compensate them fairly. 

Additional contributions to greater accountability in the legislation require the VA 

to conduct an annual performance plan for all political appointees in a similar manner Senior Executive Service are evaluated. The evaluation would include measLeonard.horne on VACREP0180 with DISTILLER

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uring appointees’ ability to recruit and retain qualified employees, engage and motivate employees, train employees and hold them accountable for any potential performance issues. The ability for all VA leaders, including political appointees, to successfully meet and exceed the requirements of such tasks will continue to be a key 

aspect to ensuring quality leaders exhibit the highest standards of professionalism. 

In its efforts to institute better hiring practices, the VA must also become more 

acutely aware of the actual need and capabilities of its workforce in addition to instituting policies to support its existing workforce. IAVA supports the measures 

within the draft legislation to provide the VA better insight its hiring capabilities. 

Specifically, IAVA supports the requirement to measure and collect information on 

hiring effectiveness and to adjust the current requirements to identify the five occupations with the highest staffing shortages to include the five highest staffing shortages for both clinical and nonclinical occupations. Understanding what the staffings 

needs are coupled with a greater understanding of hiring effectiveness will help 

streamline the process for those looking to serve within the VA. Building on that 

is the need to ensure continued training and growth opportunities for existing VA 

employees. The promotional track for technical experts that eliminates a requirement to accept managerial positions created within the legislation will help retain 

those professionals looking to utilize their expertise without adding unwanted responsibilities. Leveraging the existing expertise and talent within the VA supports 

a greater continuity of institutional knowledge and professional satisfaction. 

Providing professional development and training opportunities for VA employees 

are practices IAVA has frequently advocated for as a means to support the VA 

workforce. As such, IAVA strongly supports the one year private-sector fellowship 

for select Veteran Benefits Administration (VBA) and Veterans Health Administration (VHA) employees. Gaining best-in-practice knowledge, policies and procedures 

from the private sector can only help strengthen the capabilities of VA employees 

and their capacity to meet the VA’s mission. Likewise, IAVA supports the provision 

to provide training for human resources professionals within the VA for recruiting 

and hiring Title 38 employees. Since Title 38 employees make up many of the occupations with the VHA, understanding the nuances of the hiring process for these 

employees will create a more efficient process. 

The provisions within the draft legislation that consider adjustments to education 

benefits through the Yellow Ribbon program and modifications to veteran preference 

are both measures IAVA supports as a means to increase both the number of applicants seeking to serve at the VA and the number of veterans serving within the VA 

system. IAVA is particularly supportive of incentivizing veterans to seek education 

that will lead to becoming mental health care professionals within the VA. As our 

members continue to express a need for greater access to care and cultural understanding, IAVA recognizes the potential of such incentives will help meet that need. 

At IAVA, we believe our members, and all veterans, deserve the very best our nation can offer when it comes to fulfilling the promises made to them upon entry into 

the military. To support that cause and the critical mission of the VA, IAVA fully 

supports equipping the VA with the necessary authority to provide best-in-class hiring practices. 

As the Committee works to finalize this legislation, IAVA strongly recommends 

not paying for its provisions by cutting critical benefits that our nation’s 23 million 

veterans and their families have come to rely upon. We look forward to reviewing 

the final language of the legislation, continuing to work together as partners, and 

finding veteran-centric solutions to the challenges facing the VA and the veteran 

community. 

f 

RESERVE OFFICERS ASSOCIATION 

The Reserve Officers Association of the United States (ROA) is a professional association of commissioned, non-commissioned and warrant officers of our nation’s 

seven uniformed services. ROA was founded in 1922 by General of the Armies John 

‘‘Black Jack’’ Pershing during the drawdown years following the end of World War 

I. It was formed as a permanent institution dedicated to national defense, with a 

goal to inform America regarding the dangers of unpreparedness. Under ROA’s 1950 

congressional charter, our purpose is to promote the development and execution of 

policies that will provide adequate national defense. We do so by developing and offering expertise on the use and resourcing of America’s Reserve Components. 

The association’s members include Reserve and Guard Soldiers, Sailors, Marines, 

Airmen, and Coast Guardsmen who frequently serve on active duty to meet critical 

needs of the uniformed services. ROA’s membership also includes commissioned offiLeonard.horne on VACREP0180 with DISTILLER

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cers from the United States Public Health Service and the National Oceanic and Atmospheric Administration who often are first responders during national disasters 

and help prepare for homeland security. 

President: Col. James R. Sweeney II, USMC (Ret.) 202 09646 097706 

Executive Director: Jeffrey E. Phillips 202 09646 097726 

Legislative Director: Lt. Col. Susan Lukas, U.S. Air Force Reserve (Ret.) 202 

09646 097713 

DISCLOSURE OF FEDERAL GRANTS OR CONTRACTS 

The Reserve Officers Association is a member-supported organization. ROA has 

not received grants, contracts, or subcontracts from the federal government in the 

past three years. All other activities and services of the associations are accomplished free of any direct federal funding. 

STATEMENT 

ROA appreciates the opportunity to discuss proposed legislation for improving the 

authority of the Secretary of Veterans Affairs to hire and retain physicians and hire 

Guard and Reserve members. This statement addresses a legislative priority developed by ROA as a result of feedback from ROA members and Reserve Component 

service members. 

SEC. 9. MODIFICATION TO VETERANS PREFERENCE 

The Reserve Officers Association urges Congress to support SEC. 9. MODIFICATION TO VETERANS PREFERENCE, which changes title 5, USC 

2108(1)(B) and (D) to strike the word ‘‘consecutive’’ and change it to ‘‘cumulative’’ in each instance. 

Reserve Component Participation 

During the present war, nearly a million Guard and Reserve members have been 

mobilized, proving essential to the war effort. The reliance of the nation on its Reserve Components will not diminish. 

Since September 11, 2001, more than 900,000 members of our reserve components 

- the National Guard and Reserves of our Army, Navy, Air Force, Marines and 

Coast Guard - have served in support of the war on terrorism. More than 1,200 have 

died in that fight. 

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‘‘War is a national challenge, and, for our part, we cannot execute without the 

Guard and the Reserve,’’ said Army Chief of Staff Gen. Mark Milley. You can’t talk 

to a general or admiral for more than five minutes without hearing a variation on 

that theme. 

The chart below shows that the Guard and Reserve have been used in increasingly higher amounts per year. While usage is dropping it will not go down to previous peacetime levels because threats to the nation and world have increased. 

Usage of the Reserve Components 

Fiscal Year Man-Days Per Year 

1986 091989 1 million 

1996 092001 13 million 

2002 41.3 million 

2005 68.3 million 

2012 25.8 million 

Data from the Office of the Assistant Secretary of Defense for Reserve Affairs (OASD/RA). 

Background 

According to Jeff Phillips, ROA Executive Director, in a recent op-ed, ‘‘It was over 

my first Philly cheesesteak sandwich - in Philadelphia - that I learned Maj. Bonnie 

Carroll was not a veteran despite her extraordinary service to our country.’’ 

Reservists today serve virtually everywhere, alongside their ‘‘active component’’ 

comrades. In battle, the performance of these trained and courageous citizen-warriors of all ranks, specialties, and any other category has been recognized as indistinguishable from the ‘‘regulars.’’ They ask to serve; they deserve equity for that 

service. 

Inequity is written into law; most of the legislation governing the military was 

written before and during the Cold War. The reserves in those days were a strategic 

reserve and not used much - that’s where the ‘‘one weekend per month and two 

weeks in the summer’’ model evolved. 

Desert Shield, Desert Storm and the present war changed all that. The reserves 

are now considered ‘‘operational.’’ They are used continually, like the active force. 

In the late 1980s, usage of the reserves was 1 million man-days per year; it is now 

about 25 million man-days. But the law hasn’t kept up as important benefits are 

limited only to those who serve in ‘‘active military, naval, or air service.’’ 

By ‘‘important benefits,’’ we are talking about who you are in the eyes of federal 

law when it comes to being considered for hiring preferences accorded to veterans. 

We are talking about helping young, dynamic new professionals - who understand 

service and dedication to higher cause - renew our graying and often hidebound federal bureaucracy. 

Bonnie stunned me when she told me she wasn’t a veteran. 

‘‘But, of course you are, you’ve served in the Air Force,’’ I countered, momentarily 

forgetting my cheesesteak sandwich. 

No, she told me, she had never amassed enough days on ‘‘active duty’’ to qualify 

to be a veteran under titles 5 and 38 for federal hiring preference. To be a veteran 

for hiring preferences, she needed 180 or more consecutive days on active duty - and 

that did not include active duty while she was training. In those days, getting nearly six consecutive months on active duty was tough. 

As the operational tempo of the recent past changes and fewer members of the 

Guard and Reserve deploy (a situation that will last only until the next war) achieving 180 or more consecutive days on active duty will become even more difficult. But 

it will always be much more likely for these reservists to amass 180 or more cumulative days on active duty. Inequity is an enduring theme unless we make this simple change. 

Both the Department of Veterans Affairs and the top leaders of our reserve forces 

informally indicated to ROA there is no cost and they would not object to such a 

change the law. 

Recent legislation sought to grant ‘‘honorary’’ veteran status to reservists with 20 

or more years of service - legislation ROA supported. These reservists are a fraction 

of the whole. We are here urging a simple reform that would substantively help the 

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vast majority of reservists who are still serving as citizen-warriors or who separated 

before military retirement. 

Changing one word would provide significant equity to members of our Guard and 

Reserve who affirm the wisdom of our founders in their willingness to serve boldly, 

selflessly, and with great fidelity in the defense of our way of life. They balance military service - a consuming and uncompromising business - with the demands of a 

civilian work life and the care of their families. 

According to SGM (Ret) Frank Yoakum, Executive Director, EANGUS, ‘‘Major 

Bonnie Carroll (retired) is one of thousands of National Guard and Reserve retirees 

who were part of the 1% of America who served in our military—not only served, 

but gave a lifetime of service—only to find out that our Congress and our government, based on a technicality, does not consider them veterans. In their careers, 

they were available to go to war; they were trained to go to war; they were ready 

to go to war; but the timing and placement of their service placed them in support 

but not direct warfight roles. They should not continue to be penalized for exemplary service. The time is now; the technical change is simple; the personal reward 

and thanks of a grateful nation is priceless. We strongly encourage Congress to do 

the right thing and make this correction to the law on behalf of thousands of retirees who really are veterans.’’ 

Unemployment of the Guard and Reserve 

Unemployment during the Gulf War steadily increased higher for veterans than 

nonveterans, especially those from the current war. Of that group, 30 percent of 

both Gulf War-era I and Gulf War-era II veterans were reported to be current or 

past members of the Reserve or National Guard. 

‘‘In 2014, 21.2 million men and women were veterans. Of these, 10.2 million veterans were employed, 573,000 were unemployed, and the rest, 10.5 million, were not 

in the labor force (neither employed nor seeking employment).’’ http://www.bls.gov/ 

opub/ted/2015/veteran-unemployment-decreases-in-2014.htm 

UNEMPLOYMENT RATES OF PERSONS 18 YEARS AND OVER BY VETERAN STATUS, PERIOD

OF SERIVCE, SEX, RACE, AND ETHNICITY, 2014 ANNUAL AVERAGES

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As of March 23, 2015 

Since 2014 unemployment overall has decreased, in part because the government 

increased their efforts to hire more veterans in the federal government to reduce 

veteran homelessness. By the end of fiscal year 2014, the government was able to 

employ 516,075 veterans out of 1,990,033 employees. However, most agencies are 

below the average percentage of 25.9 percent once you exclude the Departments of 

Defense and Veterans Affairs (27.4% to 48.5%). The remaining agencies average 

only 13.8 percent 

Total On-Board Employees - Veterans with Preference 

All Employees Veterans with Preference % 

Agriculture ............... 95,917 10,519 11.0% 

Commerce ............... 45,380 4,633 10.2% 

Education ................ 4,195 369 8.8% 

Energy ..................... 14,992 2,879 19.2% 

HHS ......................... 84,588 5,714 6.8% 

Homeland Security .. 189,341 43,736 23.1% 

HUD ......................... 8,444 1,142 13.5% 

Interior ..................... 69,955 10,203 14.6% 

Justice ..................... 113,240 21,751 19.2% 

Labor ....................... 15,940 3,093 19.4% 

State ........................ 12,694 2,195 17.3% 

Treasury ................... 92,619 8,629 9.3% 

AID ........................... 1,698 235 13.8% 

EPA .......................... 15,852 1,068 6.7% 

GSA .......................... 11,501 2,088 18.2% 

NASA ........................ 17,691 1,555 8.8% 

NSF .......................... 1,425 92 6.5% 

OPM ......................... 4,977 1,025 20.6% 

NRC ......................... 3,871 652 16.8% 

SSA .......................... 64,684 8,181 12.6% 

SBA .......................... 4,549 677 14.9% 

https://www.fedshirevets.gov/hire/hrp/reports/EmploymentOfVets-FY14.pdf 

Changing the language for federal preference would provide a pool of Guard and 

Reserve veterans for agencies to consider, thereby, increasing their veteran hires. 

In 2012, the Center for New American Security released a report, titled, Employing 

Americans Veterans that said, ‘‘Hiring veterans is good business, according to detailed and lengthy interviews with 87 individuals representing 69 companies. The 

companies reported 11 reasons they hire veterans, with an emphasis on veterans’ 

leadership and teamwork skills, character and discipline...’’ The reasons include: 

• Leadership and teamwork skills. Veterans typically have led colleagues, accepted direction from others and operated as part of a small team. • Character. Veterans are perceived as being trustworthy, dependable, drug-free 

and having a strong work ethic. • Structure and discipline. Companies, especially those that emphasize safety, appreciate veterans’ experience following established procedures. • Expertise. Companies value veterans’ occupational skills, job-specific experiences and understanding of the military community. http://www.cnas.org/files/documents/publications/CNAS—EmployingAmericasVeterans—HarrellBerglass.pdf 

These and the other reasons discussed in the report should equally apply to why 

hiring a Guard or Reserve veteran makes sense for the federal government. 

Not unlike her citizen-warrior comrades, Bonnie is a remarkable woman. Self-effacing and dedicated to the service of others, she asks nothing for herself. ROA is 

urging this reform for today’s reservists now being shortchanged, and for the benefit 

of a nation that needs them serving the public as civil servants. 

In 1994 Bonnie founded Tragedy Assistance Program for Survivors after her husband, an Army officer, was killed in a military plane crash. TAPS supports those 

who have lost a loved one in military service, but provides expertise to all who need 

that kind of help. They are known for their unparalleled expertise in the care and 

recovery of survivors. 

For her work with surviving families, President Obama awarded Bonnie the Presidential Medal of Freedom in November. 

Maj. Bonnie Carroll ultimately retired after 32 years in both the Air National 

Guard and the Air Force Reserve. 

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But according to federal law, she’s not a veteran for federal hiring benefits and 

did not get a 5-point preference that would have increased her chances to be hired 

earlier in her career. 

It’s time that changed for the men and women serving today. 

CONCLUSION 

The Reserve Officers Association, the Enlisted Association of the National Guard 

of the United States and the National Guard Association of the United States supports legislation that would extend federal preference to the deserving men and 

women of the Reserve Components. 

f 

AMERICAN PODIATRIC MEDICAL ASSOCIATION 

Testimony of Dr. Phillip E. Ward, President 

Chairmen Benishek and Wenstrup, Ranking Members Brownley and Takano and 

members of the Subcommittees, I welcome and appreciate the opportunity to submit 

testimony to you today on behalf of the American Podiatric Medical Association 

(APMA). I commend these Subcommittees for their focus to assist and direct the 

Veterans Administration (VA) to effectively and efficiently recruit and retain qualified medical professionals to treat veteran patients and improve access to quality 

health care in the VA system by addressing the lengthy and burdensome 

credentialing and privileging process. 

I am Dr. Phillip Ward, member and president of the American Podiatric Medical 

Association (APMA). I represent APMA and the podiatric medical profession, and 

specifically our members currently employed, and those seeking to be employed, by 

VA. While I do not represent VA, I do speak for those with first-hand experience 

and knowledge of hiring practices within VA, as well as knowledge of the widespread disparity between podiatric physicians and other VA physicians. 

APMA is the premier professional organization representing America’s Doctors of 

Podiatric Medicine who provide the majority of lower extremity care, both to the 

public and veteran patient populations. APMA’s mission is to advocate for the profession of podiatric medicine and surgery for the benefit of its members and the patients they serve. 

Mr. Chairmen, as you know the Veterans Health Administration (VHA) qualification standards for podiatry were written and adopted in 1976. Podiatric education, 

training and practices in 1976 starkly contrasted with that of other physician providers of the time, and with podiatric medicine as it is today. Unlike forty years ago, 

the current podiatric medical school curriculum is vastly expanded in medicine, surgery and patient experiences and encounters, including whole body history and 

physical examinations. In 1976, residency training was not required by state scope 

of practice laws. Today, every state in the nation, with the exception of four, requires post-graduate residency training for podiatric physicians and surgeons. In 

1976, podiatric residency programs were available for less than 40 percent of graduates. Today there are 609 standardized, comprehensive, three-year medicine and 

surgery residency positions to satisfy the number of our graduates, with 77 positions 

(or 13 percent) housed within the VA. In contrast to 1976, today’s residency programs mandate completion of a broad curriculum with a variety of experiences and 

offer a direct pathway to board certification with both the American Board of 

Podiatric Medicine (ABPM) and the American Board of Foot and Ankle Surgery 

(ABFAS). These certifying bodies are the only certifying organizations to be recognized by the Council on Podiatric Medical Education (CPME) and VA. These bodies 

not only issue time-limited certificates, but they participate in the Centers for Medicare and Medicaid Services (CMS) Maintenance of Certification (MOC) reimbursement incentive program. Unlike the residency curricula in 1976 (which were not 

standardized, nor comprehensive), today’s residency curriculum is comparable to 

MD and DO residency training and includes general medicine, medical specialties 

such as rheumatology, dermatology and infectious disease, general surgery and surgical specialties such as orthopedic surgery, vascular surgery and plastic surgery. 

CPME-approved fellowship programs did not exist in 1976, but since their creation 

in 2000, they offer our graduates opportunities for additional training and sub-specialization. Today, podiatric physicians are appointed as medical staff at the vast 

majority of hospitals in the United States, and many serve in leadership roles within those institutions, including but not limited to chief of staff, chief of surgery, and 

state medical boards. Many of my colleagues have full admitting privileges and are 

responsible for emergency room call as trauma and emergency medicine are now 

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also incorporated into post-graduate training. The competency, skill and scope of today’s podiatric physicians are vastly expanded and truly differ from the podiatrist 

that practiced before 1976. Because of this, CMS recognizes today’s podiatrists as 

physicians, and Tricare recognizes us as licensed, independent practitioners. 

The total number of VA enrollees has increased from 6.8 million in2002 to 8.9 million in 2013 (1). While we are slowly losing our Vietnam veteran population, we are 

gaining a solid base of Operation Enduring Freedom (OEF) and Operation Iraqi 

Freedom (OIF) patients, returning from war with their unique lower extremity 

issues. The projected patient population of Gulf War Era veterans is expected to increase from 30 percent in 2013 to approximately 55 percent in 2043 (1). The number 

of service-connected disabled veterans has increased from approximately 2.2 million 

in 1986 to 3.7 million in 2013 (1). Over 90 percent of disabled veterans were enrolled in VHA in 2012 (1). The likelihood of service-connected disabled veterans 

seeking VA health care generally increases with the veteran’s disability rating (1). 

The majority of male veterans who are currently seeking care from VA served during the Vietnam era (1). 

As a matter of fact, veteran patients are ailing and have more comorbid disease 

processes than do age-matched Americans (2, 3, 4, 5, 6). This includes major amputation, where age-specific rates are greater in the VHA compared to the US rates 

of major amputation (7). Elderly enrolled veterans have substantial disease burden 

with disproportionately poor health status compared to the same age enrolled in 

Medicare (8). The prevalence of diabetes is substantially greater among veteran patients compared to the general population, and unfortunately, the prevalence is 

trending up (6). While diabetes affects 8 percent of the US population, 20 percent 

of veteran patients carry this diagnosis (9).The aging veteran population combined 

with these increased rates of diabetes has increased the burden of diabetic foot ulcers and amputations (10). Veteran patients with one or more chronic diseases account for 96.5 percent of total VHA health care (9). In addition to diabetes, some 

of the most common chronic conditions documented in our veteran patients manifest 

in the lower extremity such as hyperlipidemia, coronary artery disease, chronic obstructive pulmonary disease, and heart failure.(9). 

Socioeconomic and psychosocial issues often plague our veterans and further complicate disease management. Veteran patients statistically have lower household incomes than non-veteran patients (1). Sadly, many of our veterans are homeless and 

suffer from comorbid conditions such as diabetic foot ulcers, sometimes with a level 

of amputation, so management of this patient population can be extremely challenging. Health care expenses combined with disability and compensation coverage 

account for the majority of VA utilization and have demonstrated significant growth 

since 2005 (1). 

This is the VA patient population, Mr. Chairman. Our VA provider members 

serve patients who are statistically comorbid with psychosocial and socioeconomic 

issues, all of which play a role in the delivery of care and final outcome. I know 

that the veteran population is far more complex to treat than patients in the private 

sector, as a whole. Greater than 90% of the veteran podiatric patient population is 

44 years and older, with the majority of our patients of the Vietnam era, who are 

plagued by the long-term effects of Agent Orange. Because of this and because of 

the increasing number of OEF, OIF, and Operation New Dawn (OND) veterans with 

lower extremity conditions, one of our major missions as providers of lower extremity care is amputation prevention and limb salvage. The value of podiatric care is 

recognized in at-risk patient populations. Podiatric medical care as part of the interdisciplinary team approach reduces the disease and economic burdens of diabetes. 

In a study of 316,527 patients with commercial insurance (64 years of age and 

younger) and 157,529 patients with Medicare and an employer sponsored secondary 

insurance, there was noted a savings of $19,686 per patient with commercial insurance and a savings of $4,271 per Medicare-insured patient, when the patients had 

at least one visit to a podiatric physician in the year preceding their ulceration (11). 

Nearly 45,000 veterans with major limb loss use VA services each year. Another 1.8 

million veterans within the VA Healthcare Network are at-risk of amputation. 

These at-risk veterans include 1.5 million with diabetes, more than 500,000 with 

sensory neuropathy, and more than 80,000 with non-healing foot ulcers (12). Despite 

having a large at-risk patient population from the Vietnam era, VA podiatric physicians are seeing increasing numbers of OEF, OIF and OND patients who are atrisk for amputation. Given the magnitude of amputation reductions, podiatric physicians not only provide a cost-savings to VA, but we also play an integral role in the 

veteran quality of life (12). 

While limb salvage is a critical mission of the podiatry service in the VA, the care 

delivered by the podiatric physician is of much broader scope. As the specialist of 

the lower extremity, we diagnose and treat problems ranging from dermatological 

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issues to falls prevention to orthopedic surgery. As one of the top five busiest services in VA, we provide a significant amount of care to our veteran patients and the 

bulk of foot and ankle care specifically. In fiscal year 2015, the foot and ankle surgical procedures rendered by the podiatry services totaled 28,300, while foot and 

ankle surgical procedures performed by the orthopedic surgery service was a sum 

total of 4,047. 

The mission of VA health providers is to maintain patient independence and keep 

the patient mobile by managing disease processes and reducing amputation rates. 

Podiatric physicians employed by VA assume essentially the same clinical, surgical, 

and administrative responsibilities as any other unsupervised medical and surgical 

specialty. Podiatrists independently manage patients medically and surgically within our respective state scope of practice, including examination, diagnosis, treatment 

plan and follow-up. In addition to their VA practice, many VA podiatrists assume 

uncompensated leadership positions such as residency director, committee positions, 

clinical manager, etc. Examples include: 

• Steve Goldman, DPM, Chief of Podiatry and Director of Podiatric Medical Education at Department of Veterans Affairs, Northport, NY; • William Chagares, DPM, Research Institutional Review Board Co-Chair, Chair 

of Research Safety Committee and Research Integrity Officer and Chair of Medical 

Records Committee at the James A. Lovell Federal Heath Care Center; • Aksone Nouvong, DPM, Research Institutional Review Board Co-Chair at the 

West Los Angeles VA; • Lester Jones, DPM the former Associate Chief of Staff for Quality at the VA 

Greater Los Angeles Health Care System for eight years, and podiatric medical community representative while serving on the VA Special Medical Advisory Group; 

Despite this equality in work responsibility and expectations, there exists a 

marked disparity in recognition and pay of podiatrists as physicians in the VA. 

These discrepancies have directly resulted in a severe recruitment issue of experienced podiatrists into the VA, and unfortunately have also been the direct cause of 

retention issues. The majority of new podiatrists hired within the VA have stories 

just like these. They have less than ten years of experience and they are not board 

certified. As a result of the disparity the VA is attracting less experienced podiatric 

physicians. After hiring, the majority of these new podiatrists that hire into the VA 

separate within the first 5 years. 

Compounding the recruitment and retention issues, there exists lengthy employment vacancies when a podiatrist leaves a station. The gap between a staff departure to the time of filling the position is in excess of one year. Because of employment gaps as a consequence of the inherent and chronic recruitment and retention 

challenges, wait times within the VA for lower extremity care are unacceptably long. 

Since October 2014, 22,601 of the 191,501 (11.8 percent) established patients suffered a wait time of greater than 15 days, with some greater than 120 days. During 

this same time period, 23,543 of the 25,245 (93 percent) new patients suffered a 

wait time of the same magnitude. The prolonged vacancy exists partly because the 

VA is not capable of attracting experienced candidates, but also because the 

credentialing process is ineffectively burdensome. There have been no reported improvements in on-boarding since our last testimony was submitted on this issue in 

May of 2015. 

It is precisely because of the aforementioned issues that legislative proposals to 

amend Title 38 to include podiatric physicians and surgeons in the Physician and 

Dentist pay band, have been submitted by the Director of Podiatry Services annually for the last ten years. These proposals have been denied every single year. Additionally, several requests for an internal fix have been denied, despite written letters of support for this movement from the former Under Secretary of Health, Robert Petzel, MD. 

Six years ago the APMA’s House of Delegates passed a resolution making this 

issue a top priority. Since then we have alerted the VA to our knowledge of this 

issue. In response, former Under Secretary Petzel created a working group composed of Dr. Rajiv Jain, now Assistant Deputy Under Secretary for Health for Patient Care Services, Dr. Margaret Hammond, Acting Chief Officer for Patient Care 

Services, and Dr. Jeffrey Robbins, Chief of Podiatry Service. We have participated 

in several meetings with members of the working group and, most recently, we have 

received written support of Patient Care Services and Podiatry Service for a legislative solution to address this issue. 

Occam’s razor is a problem solving principle whereby the simplest solution is 

often the best. I submit testimony to this committee today to respectfully request 

that Congress help the VA and its patients by passing legislation to recognize 

podiatric physicians and surgeons as physicians in the physician and dentist pay 

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band. We believe that simply changing the law to recognize podiatry, both for the 

advancements we have made to our profession and for the contributions we make 

in the delivery of lower extremity care for the veteran population, will resolve recruitment and retention problems for VA and for veterans. Mr. Chairmen and members of the Subcommittees, thank you again for this opportunity. 

1.National Center for Veterans Analysis and Statistics, Department of Veterans 

Affairs http://www.va.gov/vetdata/index.asp 

2.Singh JA. Accuracy of Veterans Affairs databases for diagnoses of chronic diseases. Prev Chronic Dis. 2009 Oct;6(4):A126. 

3.Olson JM, Hogan MT, Pogach LM, Rajan M, Raugi GJ, Reiber GE. Foot care 

education and self management behaviors in diverse veterans with diabetes. Patient 

Prefer Adherence. 2009 Nov 3;3:45 0950. 

4.Powers BJ, Grambow SC, Crowley MJ, Edelman DE, Oddone EZ. Comparison 

of medicine resident diabetes care between Veterans Affairs and academic health 

care systems. J Gen Intern Med. 2009 Aug;24(8):950 095. 

5.Agha Z, Lofgren RP, VanRuiswyk JV, Layde PM. Are patients at Veterans Affairs medical centers sicker? A comparative analysis of health status and medical 

resource use. Arch Intern Med. 2000 Nov 27;160(21):3252 097. 

6.Miller DR, Safford MM, Pogach LM. Who has diabetes? Best estimates of diabetes prevalence in the Department of Veterans Affairs based on computerized patient 

data. Diabetes Care. 2004 May;27 Suppl 2:B10 0921. 

7.Mayfield JA, Reiber GE, Maynard C, Czerniecki JM, Caps MT, Sangeorzan BJ. 

Trends in lower limb amputation in the Veterans Health Administration, 1989 

091998. J Rehabil Res Dev. 2000 Jan-Feb;37(1):23 0930. 

8.Selim AJ, Berlowitz DR, Fincke G, Cong Z, Rogers W, Haffer SC, Ren XS, Lee 

A, Qian SX, Miller DR, Spiro A 3rd, Selim BJ, Kazis LE. The health status of elderly veteran enrollees in the Veterans Health Administration. J Am Geriatr Soc. 2004 

Aug;52(8):1271 096. 

9.Neugaard BI, Priest JL, Burch SP, Cantrell CR, Foulis PR. Quality of care for 

veterans with chronic diseases: performance on quality indicators, medication use 

and adherence, and health care utilization. Popul Health Manag. 2011 Apr;14(2):99 

09106. 

10.Johnston MV, Pogach L, Rajan M, Mitchinson A, Krein SL, Bonacker K, Reiber 

G. Personal and treatment factors associated with foot self-care among veterans 

with diabetes. J Rehabil Res Dev. 2006 Mar-Apr;43(2):227 0938. 

11.Carls GS, Gibson TB, Driver VR, Wrobel JS, Garoufalis MG, Defrancis RR, 

Wang S, Bagalman JE, Christina JR. The economic value of specialized lower-extremity medical care by podiatric physicians in the treatment of diabetic foot ulcers. 

J Am Podiatr Med Assoc. 2011 Mar-Apr;101(2):93 09115. 

12.Preventing Amputation in Veterans Everywhere (PAVE) Program 

Æ 

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