Less Firing, More Hiring

The VA shouldn’t focus on cleaning house. What the agency needs is truckloads of doctors and nurses.

U.S. Secretary of Veterans Affairs Robert McDonald.
Veterans Affairs Secretary Robert McDonald speaks on Nov. 9, 2014, in Arlington, Virginia.

Photo by Win McNamee/Getty Images

Veterans Affairs Secretary Robert McDonald is promising a massive overhaul of the embattled agency, a restructuring that he has billed as the largest in its 84-year history. The West Point grad and former CEO of Procter & Gamble took over the department this summer after his predecessor resigned due to a scandal that involved VA staff manipulating records to hide the fact that veterans were waiting months longer for medical appointments than the hospitals claimed. “As VA moves forward, we will judge the success of all our efforts against a single metric: the outcomes we provide for veterans,” McDonald vowed Monday, on the eve of Veterans Day.

As that quote suggests, McDonald’s plan is ambitious in scope and short on details. The secretary has conceded his remake is still in the early stages, and the department has given no timetable for how long the reorganization will ultimately take. The most high-profile change that’s been announced thus far would be to create a single customer service bureau to make it easier for veterans to navigate a sprawling department that provides veterans with health care, but also benefits, burial, and even home loans.

That modification notwithstanding, Washington’s immediate focus remains where it has been since the scandal broke this summer—on cleaning house, not fixing it. “We can’t change this department unless we change the culture,” McDonald told CNN on Tuesday. “Primary to changing the culture is holding people accountable when they violate our values.” But the search for scapegoats won’t help the agency face perhaps its biggest challenge: staffing up to ensure that veterans are getting the health care they deserve. Yes, there are undoubtedly people who work for the VA who deserve to be fired. The agency’s fundamental problem, though, is the same one that it’s faced for years: It needs to hire a whole lot more doctors and nurses.

That message has been part of the VA’s recent media blitz, but it has been largely buried beneath Washington’s focus on firing. Time and time again, McDonald has rattled off the number of staffers who are being targeted for firing or other disciplinary action. During a 60 Minutes interview that aired Sunday, McDonald said that he has given congressional leaders a list of 35 employees that the VA wants to oust as a result of the health care scandal and suggested that he has a second list with the names of more than 1,000 employees who also face disciplinary action, up to and including termination. This past Friday, meanwhile, the secretary estimated that 5,600 employees have been subjected to disciplinary review in the past year, although aides later clarified to the Associated Press that most of those actions were unrelated to this summer’s scandal.

The department’s most vocal critics want less talk of firing and more actual firing. The VA is handcuffed by the letter of the law, which requires a judge to sign off on each termination and gives the employee a chance to appeal. Congressional Republicans say that’s no excuse for the fact that to date only one high-ranking agency official has been fired over the scandal. (Several others, meanwhile, have either retired or are currently appealing.) “New plans, initiatives, and organizational structures are all well and good, but they will not produce their intended results until VA rids itself of the employees who have shaken veterans’ trust in the system,” House Committee on Veterans’ Affairs Chairman Jeff Miller said Monday.

Veterans’ groups that have been largely supportive of McDonald’s new customer-centric approach likewise want to see heads roll. “Even if reform is happening, and I really think it is, I think they want blood—they want to see people are really being punished,” Louis Celli, the American Legion’s legislative director, told the New York Times last month.

In many regards, that makes sense. Even if you fix a system, that system is unlikely to function properly if you can’t trust the people running it. The VA needs to assure skeptical veterans and angry lawmakers that employees who acted improperly are being held accountable and that the very worst have been removed from their jobs. Mass firings—or declarations that mass firings are in the offing—also make for good PR, allowing McDonald to offer (vague) numbers as evidence of action that’s more easily understood that his still-in-the-works revamp.

But firing a whole bunch of employees won’t address the VA’s basic problem. By cooking the books, medical staff may have stood to gain financially via bonuses and performance review–driven raises. Nearly everyone agrees, though, that a shortage of doctors was one of the scandal’s root causes. J. David Cox Sr., the president of the American Federation of Government Employees, estimated earlier this year that many VA primary care doctors were treating upward of 2,000 patients each, roughly 800 more than they were supposed to be. VA staff shouldn’t have been papering over the shortage for the sake of their salaries, but the shortage itself—not just the cover-up of said storage—was clearly a major issue.

McDonald has said that he hopes to address the shortage by hiring as many as 28,000 doctors, nurses, and other additional medical staff—a total that doesn’t appear to include the hundreds or maybe even thousands of employees they may need to replace once the agency is done cleaning house. That’s a staggering number, one that would be nearly impossible to fill in the best of times—and these are not the best of times. The Association of American Medical Colleges estimates that the U.S. will face a shortage of more than 130,000 physicians over the next decade. The Bureau of Labor Statistics, meanwhile, predicts that the total number of job openings for nurses will stand at more than 1 million by 2022.

McDonald has been touring medical schools to sell skeptical candidates on joining the much-maligned department and has already begun bringing VA salaries closer in line with those in the private sector. Still, the secretary acknowledges, that won’t fix the agency’s larger branding problem. On Monday, he recounted to NPR how during a trip this summer to the Phoenix facility at the center of the scandal he found himself talking with a fellow airline passenger who was an Air Force vet with a daughter in med school. “He talked to her about working for the VA,” McDonald said. “And she said, ‘Dad, haven’t you been listening to the radio—or don’t you know what’s going on? Why would I want to work for the VA?’ ”

“I knew immediately I had to change the tenor,” McDonald concluded. “So I have to get out there, and I’ve got to tell the positive stories about what the VA does.”

That’s a fair goal, but it’s an impossible one to reach as long as Washington stays focused on those VA employees that need to be shown the door. McDonald might make Congress happy by saying that he’s going to fire 1,000 people. If he wants to do right by veterans, he’ll focus a lot more on the 28,000 he needs to hire.