AFGE: Understaffing at VA Hospitals

May 30, 2014
By Neal Tepel

Washington, DC –  The American Federation of Government Employees (AFGE) points to understaffing and inadequate funding of frontline services as main causes of long wait times for veterans seeking care at Department of Veterans Affairs (VA) facilities. The agency made promises and set standards that, in many locations, may have been impossible to fulfill, given the inadequate allocation of resources to frontline caregivers. In such an environment, instances of wait list gaming become almost inevitable.

AFGE members report shortages of providers and support personnel to provide timely access to veterans seeking care at most VHA facilities. The shortages in primary care and a number of specialties, including psychiatry, are directly linked to management's manipulation of wait list data at many VA medical facilities. Scheduling clerks consistently report that they lack the sufficient provider slots to make timely appointments. But VA's performance standards provide strong financial incentives for managers to hide underlying staffing and resource problems by "scrubbing wait lists".   

"When we look deeper into this issue of extended wait times for veterans to receive an appointment, we have to recognize that understaffing is a major culprit," said AFGE National President J. David Cox Sr. "All around the country, medical facilities are understaffed, with numerous frontline care positions going unfilled. How can the VA expect to keep up with the growing needs of our nation's heroes if it doesn't properly staff its facilities?"

Congress has made earnest efforts to provide the agency with the resources it needs to carry out its mission, but it has not gone far enough. According to the Independent Budget for the Department of Veterans Affairs, developed each year by leading veterans groups, funding levels will remain an estimated $2 billion short in FY 2015 and approximately $500 million short for FY 2016. Making matters worse, far too many precious dollars are spent on unnecessary layers of management and administration, rather than direct patient care. The growth of middle management positions within the agency has ballooned to unprecedented levels, from fewer than 300 in 1995 to more than 1,700 by a recent count, costing taxpayers $203 million annually.

"Understaffing has a strong, negative impact on employees' ability to do their jobs," said AFGE National VA Council President Alma Lee. "Our medical professionals are dealing with excessive caseloads and insufficient support staff. This is the reason why there are problems scheduling patient appointments. These dedicated public servants try to do more with less because the agency has not allocated the proper resources to needed services, but they cannot manufacture extra hours in a day. When they do try to speak out about staffing shortages and list manipulation, they are often faced with harsh management retaliation. It's time for the agency to reexamine where its dollars are spent and put them where they are needed most: patient care."

AFGE also points to the ever-increasing reliance on federal contractors as a key driver of growing costs at the VA. According to the Project on Government Oversight, the cost of hiring a contractor is 1.83 times more expensive on average than hiring a federal employee in the same position. Despite this vast cost-gap, the VHA system has spent billions on contract services in recent years, including a $9.3 billion contract with private health providers for its Patient Centered Community Care (PC3) initiative.

"Our nation's vets deserve world-class care, free of extended wait times and unnecessary bureaucracy," said Cox. "We challenge the VA to keep its promise to our nation's heroes. Let's fill these vacant positions, recruit the best and the brightest to provide exceptional care and end the toxic culture that prevents employees from speaking out about patient care problems."

***The American Federation of Government Employees (AFGE) is the largest federal employee union, representing 670,000 workers.


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