Top officials of the U.S. Department of Veterans Affairs say they are directly monitoring a staffing shortage that has left a Topeka facility unable to provide emergency care for more than a year.
Speaking at a health journalism conference last week in Santa Clara, Calif., VA Secretary Robert McDonald outlined the host of challenges he faces in reforming the embattled medical system.
Among them is restoring Topeka’s Colmery-O’Neil VA Medical Center’s physician staffing to a level that will allow the facility to reopen its emergency department, which currently functions as an urgent care unit.
“We’re working on it,” McDonald said. “There is an issue in getting physicians to locate in rural areas. It’s a national issue. It’s a VA issue. I’ve been to over a dozen medical schools trying to recruit people.”
Colmery-O’Neil began diverting emergency patients to other hospitals some nights in 2013 because of a physician shortage. By January 2014, the emergency department was shifted entirely to urgent care until more doctors could be hired.
That same year, revelations of secret patient appointment waiting lists at other VA facilities plunged the system into scandal and McDonald’s predecessor, Gen. Eric Shinseki, resigned under pressure in May.
A year later Colmery-O’Neil’s emergency department remains closed, despite a shake-up in its medical leadership and the hiring of a full-time physician recruiter .
Patience is running thin for some in Kansas’ Congressional delegation, including U.S. Rep. Lynn Jenkins and U.S. Sen. Jerry Moran.
In a recent interview, Moran said he understands that it isn’t easy to recruit specialists to VA facilities in rural areas. But he said he doesn’t believe VA officials are working hard enough to fill the vacancies.
“What seems different to me than five years ago is that the VA seemed as if they had the hope of solving the problem,” Moran said. “Today when you take a problem to the VA, it’s more of a shrug of the shoulders and no sense that they have any plan to fix the problem.”
Gavin West, a doctor who is the VA’s assistant deputy undersecretary for health and clinical operations, said he is well aware of the problem in Topeka and working on solutions.
West said he and Gary Tyndall, the VA’s national program director for emergency medicine, are meeting with Colmery-O’Neil’s leadership every two weeks to talk about how to sufficiently staff the emergency department.
“It’s a tough one,” West said while participating in a panel discussion at the Association for Health Care Journalists conference.
West said compensation plays a role in recruiting physicians, because Colmery-O’Neil is at the low end of the system’s “pay bands.”
More problematic, West said, is the VA’s reputation for rigidity. Doctors don’t want to feel constrained by edicts from above.
“Money isn’t everything for physicians,” West said. “Lifestyle is a big part of it — and really the freedom to take care of your patients the way you want to take care of your patients.”
West said he and others are working to change the bureaucracy. As an example, he pointed to a successful push for legislation allowing more flexible scheduling for VA doctors.
“Those are the ways we’ve tried to directly look at issues in Topeka,” West said. “Hopefully it’s getting a lot better there. They’ve done some good work there.”
McDonald said he has visited 125 VA sites, and employees nationwide have expressed similar frustrations about their lack of autonomy.
A former Procter & Gamble CEO as well as a U.S. Army veteran, McDonald said he intends to deploy corporate training techniques to change that mentality.
“What employees have told me is that they feel like they’re prisoners of a system they can’t change,” McDonald said. “What I’m telling them is they can change it, and I’m going to train them on Lean Six Sigma and teach them how to do that.”
West said more should be done to cut through red tape, especially in the VA’s hiring process, which he called “way too slow.”
He said that as a primary care doctor in good standing, he probably could land a job within three days if he floated his resume out into the open market. That presents a problem for a VA system in which human resources requires months to vet potential candidates.
“If it takes you eight months to get somebody a contract, ain’t nobody going to be around because they’re all going to be sucked up by these other places — competitors,” West said. “That’s something we’ve got to do a much better job of: being agile in H.R.”
Though the closing of the ER is unusual, Colmery-O’Neil’s physician shortage is indicative of a national problem.
McDonald said recruitment of new doctors is a challenge across the country, inside and outside the VA system. Rural areas are especially strapped for staff.
“It’s hard to get primary care physicians in the northwest corner of Montana,” McDonald said.
The Cabinet secretary said he’s visiting medical schools to try to recruit young doctors in person.
McDonald said he requested a 7.5 percent budget increase to hire new staff and upgrade facilities to handle an influx of new patients from a combination of 10 years of war in Iraq and Afghanistan and the aging of the Vietnam veterans.
The U.S. House of Representatives voted to cut that request significantly, he said.
McDonald said the current demand on the VA system gives a glimpse of what the national medical system will face as the baby boomer generation ages and what the VA is likely to need in the future, when an estimated 2.5 million veterans of the most recent conflicts become frail.
“We’ve got to build the capability today for the Afghanistan and Iraq veterans for when they’re turning 60 years old,” McDonald said.
McDonald said he’s trying to partner VA services with veterans’ advocacy organizations outside the system and make the federal agency more accessible to the media. He and West took questions from reporters for more than a half hour.
“We’re trying to change a culture from kind of a Kremlin-esque, ‘there’s-a-moat around-the-building,’ to transparent, open,” McDonald said.
Andy Marso is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team.