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VA is on hiring spree to improve military veteran healthcare, but can it keep jobs filled?

By ADAM ASHTON AND HAL BERNTON | The News Tribune (Tacoma, Wash.) (TNS) | Published: December 21, 2014

Veterans Affairs Puget Sound Health Care System is pushing to hire more doctors, therapists and other employees to cope with a growing patient load that has strained staff and contributed to frustrating health-care delays for military veterans.

That effort is starting to show some success.

As of November, the overall vacancy rate for nurses, a key hospital position, was 6 percent, compared to nearly 16 percent back in June. Many other open positions in other fields also are drawing strong interest.

“We see record higher numbers of applicants applying for all of our jobs,” said Julie Wilkerson, director of human resources at VA Puget Sound.

But the VA’s challenges extend beyond recruiting and hiring; administrators also must retain these employees once they’re on the payroll.

Nationally, the VA loses up to 32 percent of all new hires within the first five years of employment, and more than 20 percent of doctors and nurses drop out within their first two years on the job, according to a VA strategic plan document released earlier this year.

Last year, 10 primary care physicians at the American Lake Division in Lakewood departed, worsening a backlog in care and leading the VA to postpone patient appointments.

Low job satisfaction and morale may be one factor driving turnover. VA Puget Sound has scored poorly on job satisfaction, satisfaction with the organization and nurse turnover compared to other VA networks, according to quarterly internal reviews.

Though VA officials cite retirements as a major cause of turnover, some former medical staff say the demands of the job can take a big toll.

“I loved every job I ever had, but I just burned out at the VA,” said Bruce Buchanan, a physician who until 2010 supervised doctors and nurses at the American Lake DivisonVA in Lakewood.

Buchanan had worked for the VA for a decade, and said he relished working with veteran patients. But he grew frustrated in his dealings with administrators, whom he said delayed the hiring of new staff.

Other former employees also cite battles with bureaucracy that eventually wore them down.

“There is so much more red tape that they circle around 10 or 20 times before they solve something,” said a nurse who left the Puget Sound VA after two years on the job. “My thinking was, ‘I can’t work in this environment for 20 years, so why stay here?’ ”

With high turnover and long lead times on hiring, it can be tough to replace staff as fast as they leave. This past year, VA Puget Sound made 304 hires but saw 325 workers retire or resign.

Meanwhile, the numbers of veterans seeking care keeps increasing.

VA Puget Sound — with major hubs in Seattle and American Lake and seven clinics around Western Washington — ranks as one of the department’s fastest-growing healthcare networks. During the past year, the staff provided care for 97,000 patients, which is 4,000 more than 2013 and 30,000 more than in 2007.

Administrators forecast more years of growth as aging Vietnam veterans seek more care and more Iraq and Afghanistan veterans enter the system. By 2018, the VA Puget Sound expects to have about 110,000 patients in its network.

Understaffing fuels scandals

The recruiting drive at VA Puget Sound is part of a broader effort by the Department of Veterans affairs to fill positions and improve access.

VA Secretary Bob McDonald, in congressional testimony in September, estimated that some 28,000 new hires are needed across the country to catch up with backlogs in healthcare.

He also singled out staff shortages as a factor in the VA scandals over the past year as staff in Phoenix manipulated wait lists to try to mask the extent of wait times.

“Demand outstripped supply. This contributed to an environment that led to violations of our mission and our values,” McDonald said.

Congress last summer set aside $5 billion to hire more VA medical staff and help the department make more competitive offers.

Local recruiters do have some strong selling points.

The Puget Sound region is viewed by many medical personnel as an attractive region. Though the VA is not a pay leader in the industry, the department can offer a solid benefits package and pitch the opportunity for research and service to veterans.

But in Western Washington, medical professionals have plenty of other options for employment.

“There are a lot of top-notch nationally recognized health care centers here, and we’re all competing for the same pool of talent,” said Chad Hutson, a spokesman for VA Puget Sound.

Job vacancies decline

VA officials say they have made substantial progress filling vacant positions for medical staff.

For doctors, VA Puget Sound in November reported 27 vacancies among the staff of about 200 physicians. That vacancy rate of 13.5 percent was substantially lower than the more than 17 percent rate reported in a 2013 survey of all U.S. hospitals by AMN Healthcare.

Recruiting and hiring may get a boost from legislation approved by Congress last summer in the aftermath of the VA scandals.

One measure doubled the value of debt forgiveness the agency can offer to doctors. Now, the VA can pay for $120,000 of a new doctor’s loans – a powerful incentive for those needing to pay off medical school costs.

Sen. Patty Murray, D-Wash., who keeps a close watch on VA Puget Sound, praised McDonald’s outreach but said she worries that officials at regional hospitals still underplay the problems they face.

“I would give him credit for standing up,” she said. “Not only is he making this clear to Congress, he’s out making phone calls to people saying, ‘We want you to work here.’”

Murray also has met with VA Puget Sound Director Michael Murphy, who also has put a big focus on ramping up staffing.

Morale sags

Over the long haul, the morale of the VA workforce will be one key to holding on to employees.

VA Puget Sound employees say morale started to decline during a four-year period of wage freezes that began in 2009 while the VA network was growing by thousands of patients each year.

At American Lake, administrators ordered medical providers to see more patients while lagging at hiring new staff, according to Buchanan, the former American Lake physician who’s now retired.

“No solution was provided. No additional personnel were allowed,” he said. “There was always, always a delay in allowing us to hire someone when someone retired or left.”

In June 2009, the problems at American Lake prompted a petition among workers pleading for more employees.

“We have been told time and time again that upper management is hearing our cry for help and yet the primary care situation continues to worsen month by month,” the petition stated. “We should no longer sit back and watch our patients get poor access to healthcare, (and) the employee morale continue to plummet — including employee flight and early retirement.”

The pressure to do more with less made employees feel underappreciated, said Michael Freeman, a VA employee for more than 30 years. He’s now president of the union that represents nurses and hundreds of other frontline employees at the American Lake campus.

Open-door policy

VA Puget Sound officials do not concede any major morale problems and say they’re always willing to hear from employees.

“I have an open-door policy so if a nurse is having an issue he or she can see me at anytime,” said Karen Allen, Puget Sound’s associate director of nursing, who has worked for the VA for more than 40 years. She says she loves the “camaraderie and family-like atmosphere.”

Officials also say they’ve been working to improve the hiring process.

In the past, that might have taken half a year, or even longer: One former nurse said it took nine months to get a job offer, then another six weeks to have the correct pay rate calculated.

Wilkerson, the VA Puget Sound human resources director, said that the goal now is to have tentative offers within 60 days.

“We have come very close to that time frame” she said.

©2014 The News Tribune (Tacoma, Wash.)
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