VA built dozens of new veteran health centers but can’t find enough doctors and staff

Keith Isaacs/US Department of Veterans Affairs

When the Department of Veterans Affairs opened a new, state-of-the-art clinic with ribbon-cutting fanfare last year in his hometown of Fredericksburg, Virgina, Michael Dunlap was thrilled to have care so close.

Dunlap, 63, has been treated in recent years for a ruptured disk in his back, skin cancer, shoulder and neck issues, and respiratory problems. But at the Fredericksburg VA Health Care Center about an hour south of Washington, DC, he’s already gone through four primary care doctors in about a year-and-a-half.

“You get a form letter that just says, you know, ‘Appreciate serving you. I won’t be there anymore,’” said Dunlap, who spent 23 years in the Marines as a master gunnery sergeant. “You build up a rapport with a doctor, and now you lose a little bit of confidence because now you’ve got to explain everything all over again.”

Touted by the VA as “the nation’s largest VA health care clinic,” the 470,000-square-foot, $300 million facility is still struggling to adequately staff up more than 18 months after opening, according to veterans; health care providers; and members of Congress who represent the area, which has one of the highest concentrations of veterans in the United States.

They describe a vast parking lot and gleaming hallways – much of the space empty – and difficulties getting appointments or being seen by a medical professional, even in urgent care situations.

It’s a scene playing out across the country where the VA has built or updated about 40 health care facilities after legislation enacted under President Joe Biden expanded benefits, and there was a surge of veterans enrolling for care.

That effort has run headlong into a national health care crisis, especially in rural America , driven by critical workforce shortages and funding pressures that led to widespread hospital closures. The VA is facing similar staffing problems – and having trouble competing with the private sector to fill jobs.

Last month, the department’s inspector general found that 97% of VA facilities reported severe shortages of candidates for doctor occupations, and 86% had severe shortages of candidates for nursing positions, a sign of the widespread trouble they have filling jobs. The report says these facilities do not necessarily all have vacancies, but rather that the facilities have identified those jobs as ones that are difficult to fill.

While the Fredericksburg clinic has undergone a phased, rolling opening, it still has a staffing vacancy rate of nearly 40%, which means more than 350 positions haven’t been filled, according to VA data obtained by CNN. Roughly half of the new facilities had double-digit vacancy rates as of July, the data shows.

“That means that veterans are not getting the services they require,” Rep. Eugene Vindman told CNN. The Virginia Democrat represents the district where the Fredericksburg clinic is located.

Vindman, a former Army paratrooper and JAG officer whose district includes about 72,000 veterans, said his staff has been fielding calls from frustrated veterans complaining about services at the facility, which is near Marine Corps Base Quantico and US Army Garrison Fort A.P. Hill.

“It is the fact that they can’t keep staff, that they can’t hire staff, that it’s taking too long. That’s making wait times too long,” Vindman said. “That’s making it impossible for veterans to actually get in the door. And that’s what needs to get fixed.”

The VA staunchly defends its operations at the Fredericksburg clinic and the care offered to veterans. VA press secretary Quinn Slaven, in a statement to CNN, said that the clinic has “met its hiring goals” so far as the phased opening continues, but did not elaborate on what the goals were.

“In less than two years since opening, the clinic has already completed more than 245,000 appointments and is ahead of schedule for enrolling new patients,” Slaven said.

Slaven said all eligible veterans have the choice to get care at the Fredericksburg clinic or at other nearby VA locations. Or veterans can opt to get care at community providers in the private sector at the VA’s expense, he said.

Slaven also stressed what he called “dramatic improvements” in how well America’s veterans have been served overall during the second Trump administration. For instance, he said there’s been a drastic reduction in the backlog of veterans waiting for VA benefits.

One health care provider at the Fredericksburg health care center, who asked to remain anonymous for fear of retribution, as well as other sources familiar with the facility, painted a different picture.

They said a staffing crunch there has led to burnout, departures and the need to shuttle employees from a larger VA medical center in Richmond, Virginia, about an hour to the south.

“It’s overload. They’re exhausted. They’re leaving,” the provider said about doctors and other caregivers, describing employees not taking lunch breaks and a work atmosphere akin to a “car production line.”

Katharine Cunningham-Carlot, a 52-year-old Army veteran who lives in Fredericksburg, said she had trouble getting appointments for neurology, ENT, psychiatry and physical therapy.

She said she recently sought urgent care for an ear infection at the Fredericksburg facility, only to be told there was no provider to see her.

“There was nobody in the waiting room. It was completely empty. I said, ‘Could I see anybody?’” she said, relaying her conversation with reception. She said she was told no. When she asked if she could see a nurse, she said, again, she was told no.

Cunningham-Carlot said the parking lot was just as empty. “I actually thought this would be a good place to practice teenage driving,” she joked.

Ashley Carothers didn’t even get in the door. The 40-year-old Air Force veteran, who lives in Woodbridge, Virginia, had long battled traffic on the I-95 corridor to get care at the VA Medical Center in Washington, DC. She thought it would be far easier to go to the Fredericksburg facility.

“And so, I made a phone call. I was told on the phone, ‘Actually, you’re better off, because of staffing shortages, just to keep your care at DC,’” she told CNN.

The health care sector has been sounding the alarm for years. The Health Resources and Services Administration, part of the Department of Health and Human Services, projected in December that the US would experience an overall shortage of more than 141,000 physicians by 2038.

“There’s a shortage of radiologists. There’s a shortage of primary care practitioners. There’s a shortage of mental health practitioners”, said Suzanne Gordon, senior policy analyst for the progressive-leaning Veterans Healthcare Policy Institute.

“We are seeing a worsening of the health care shortages across the country,” said Dr. David Shulkin, who served as VA secretary in the first Trump administration and was an undersecretary for health during the Obama administration.

“Burnout is not isolated to the VA,” he added. “This is a big problem in health care in general. We’re seeing nurses and doctors, in particular, leaving the workforce at earlier ages because of the stress of the environment.”

But Shulkin added that the VA is constrained by factors that are not of its own making – including restrictions on what it can pay health care providers and an unwieldy bureaucracy. He said it can take weeks longer to hire and credential a doctor at the VA than it would take in the private sector.

“This is asking the VA to do something with several hands tied behind their back,” Shulkin said. “They are limited in their ability to be able to attract qualified health care professionals with the authorities that they’re given, in terms of salary and the flexibility to be able to pay market rates.”

Under a current salary cap, doctors at the VA cannot earn more than the salary of the president of the United States, or $400,000 per year. Under legislation passed during the Biden administration, the VA can use waivers for 300 doctor positions to pay above that amount.

But Shulkin says 300 waivers are inadequate for the VA health care system that includes 170 medical centers and nearly 1,200 outpatient sites. Moreover, the current VA administration has not used all of those waivers, according to congressional sources familiar with the matter.

Slaven, the VA press secretary, told CNN that the “VA is in the process of assigning all 300 of the salary cap waivers,” and noted that only about 1% of VA’s doctors get the exemption.

“It takes considerable time and effort to allocate them in a way that doesn’t negatively impact morale and retention among the department’s broader physician workforce — most of whom will not receive waivers,” Slaven said.

Slaven added: “VA’s ability to recruit and retain health care personnel is hindered by statutory pay caps for physicians, who in many instances can make several hundred thousand dollars more per year in the private sector.”

Gordon says the VA under the leadership of Doug Collins, Trump’s VA secretary, is not blameless for the staffing problems.

Gordon points to cutbacks under Collins. The VA workforce has been reduced by about 30,000 employees this year and last, and the agency has eliminated tens of thousands of vacant positions.

“The word on the street now … is that, you know, ‘Don’t work at the VA,’” Gordon said. “It’s an unstable work environment. It’s a hostile work environment.”

基思·艾萨克斯/美国退伍军人事务部

去年，退伍军人事务部在他的家乡弗吉尼亚州弗雷德里克斯堡举行了盛大的剪彩仪式，开设了一家全新的、最先进的诊所，迈克尔·邓拉普对此感到非常兴奋，因为他可以在家附近就医。

现年63岁的邓拉普近年来接受了背部椎间盘突出、皮肤癌、肩颈疾病和呼吸系统疾病的治疗。但在位于华盛顿特区以南约一小时车程的弗雷德里克斯堡退伍军人医疗中心，他在一年半的时间里已经换了四位家庭医生。

“你会收到一封格式化的信，上面写着，‘感谢您的惠顾。我以后不会再为您服务了，’”邓拉普说道，他曾在海军陆战队担任了23年的一级炮兵军士长。“你和医生建立了良好的关系，现在你会失去一些信任，因为你又得重新解释一遍所有的事情。”

据退伍军人、医疗保健提供者和代表该地区的国会议员称，这座占地 47 万平方英尺、耗资 3 亿美元的设施被美国退伍军人事务部吹捧为“全国最大的退伍军人事务部医疗保健诊所”，但在开业 18 个月多后，仍然难以配备足够的人员。该地区是美国退伍军人最集中的地区之一。

他们描述了一个巨大的停车场和闪闪发光的走廊——大部分空间都是空的——以及预约或看医生都很困难，即使在紧急护理情况下也是如此。

在乔·拜登总统颁布的扩大福利的法案生效后，退伍军人事务部 (VA) 新建或更新了大约 40 家医疗保健设施，全国各地都出现了类似的景象，而且前来就诊的退伍军人人数也激增。

这项努力遭遇了全国性的医疗保健危机，尤其是在美国农村地区，这场危机是由关键岗位人员短缺和资金压力造成的，导致大范围医院关闭。退伍军人事务部也面临着类似的员工短缺问题，并且在与私营部门竞争填补职位空缺方面举步维艰。

上个月，该部门的监察长发现，97%的退伍军人事务部（VA）机构报告称医生岗位严重短缺，86%的机构报告称护士岗位严重短缺，这表明这些机构普遍面临招聘难题。报告指出，这些机构并非都存在空缺职位，而是这些机构已将这些职位认定为难以招到合适人选。

据CNN获得的退伍军人事务部数据显示，弗雷德里克斯堡诊所虽然采取了分阶段、滚动式开放的方式，但其员工空缺率仍接近40%，这意味着超过350个职位尚未填补。数据显示，截至7月份，大约一半的新诊所的空缺率都达到了两位数。

“这意味着退伍军人无法获得他们需要的服务，”弗吉尼亚州民主党众议员尤金·温德曼告诉CNN。温德曼代表的选区正是弗雷德里克斯堡诊所所在的选区。

文德曼曾是一名陆军伞兵和军法署军官，他的辖区内约有 72,000 名退伍军人。他说，他的工作人员一直在接到沮丧的退伍军人的电话，抱怨该设施的服务。该设施位于匡蒂科海军陆战队基地和美国陆军驻军 A.P.希尔堡附近。

“问题在于他们留不住员工，招不到员工，办事效率太低。这导致等待时间过长，”温德曼说。“这使得退伍军人根本无法获得服务。这才是需要解决的问题。”

美国退伍军人事务部（VA）坚决捍卫其在弗雷德里克斯堡诊所的运营以及为退伍军人提供的医疗服务。VA新闻秘书奎因·斯莱文在给CNN的一份声明中表示，随着分阶段开放的进行，该诊所目前“已达到招聘目标”，但并未详细说明具体目标是什么。

斯拉文说：“诊所开业不到两年，就已经完成了超过 245,000 次预约，并且在招募新患者方面也提前完成了计划。”

斯莱文表示，所有符合条件的退伍军人都可以选择在弗雷德里克斯堡诊所或其他附近的退伍军人事务部（VA）机构接受治疗。他还说，退伍军人也可以选择在私营社区医疗机构接受治疗，费用由退伍军人事务部承担。

斯拉文还强调，在特朗普第二任期内，美国退伍军人的整体服务水平有了“显著提高”。例如，他表示，等待退伍军人事务部福利的退伍军人积压数量已大幅减少。

弗雷德里克斯堡医疗中心的一名医护人员（因害怕遭到报复而要求匿名）以及其他熟悉该机构的消息人士，描绘了一幅不同的景象。

他们表示，当地人员短缺导致员工倦怠、离职，并且需要从位于弗吉尼亚州里士满市（距此约一小时车程）的一家规模更大的退伍军人医疗中心接送员工。

“工作量太大了。他们都筋疲力尽了。他们都离开了，”这位医疗服务提供者谈到医生和其他护理人员时说道，并描述了员工不休息吃午饭，工作氛围就像“汽车生产线”一样。

居住在弗雷德里克斯堡的 52 岁陆军退伍军人凯瑟琳·坎宁安-卡洛特表示，她在预约神经科、耳鼻喉科、精神病科和物理治疗方面遇到了困难。

她说，她最近因耳部感染前往弗雷德里克斯堡的医疗机构寻求紧急护理，却被告知没有医生可以接诊她。

“候诊室里一个人也没有，空空荡荡的。我问：‘我可以见个人吗？’”她转述了她与接待处的对话。她说，接待处告诉她不行。当她问是否可以见护士时，她说，接待处再次拒绝了她。

坎宁安-卡洛特说停车场也空空荡荡。“我还以为这里是青少年练习开车的好地方呢，”她开玩笑说。

阿什利·卡罗瑟斯甚至都没能进门。这位40岁的空军退伍老兵住在弗吉尼亚州伍德布里奇，长期以来，她都要忍受95号州际公路的拥堵，才能前往位于华盛顿特区的退伍军人医疗中心就诊。她原本以为去弗雷德里克斯堡的这家医疗中心会方便得多。

“于是，我打了个电话。电话里有人告诉我，‘实际上，由于人手短缺，你最好还是留在华盛顿特区接受治疗，’”她告诉 CNN。

医疗保健行业多年来一直在发出警告。隶属于美国卫生与公众服务部的卫生资源和服务管理局在去年12月预测，到2038年，美国将面临超过14.1万名医生的总体缺口。

“放射科医生短缺，初级保健医生短缺，心理健康医生短缺，”进步派退伍军人医疗保健政策研究所的高级政策分析师苏珊娜·戈登说道。

“我们看到全国各地的医疗保健短缺问题日益恶化，”曾在特朗普第一届政府担任退伍军人事务部长、并在奥巴马政府担任卫生部副部长的戴维·舒尔金博士说。

他补充说：“职业倦怠并非退伍军人事务部独有的问题，而是整个医疗保健行业普遍存在的大问题。我们看到，尤其是护士和医生，由于工作环境压力过大，越来越早地离开工作岗位。”

但舒尔金补充说，退伍军人事务部受到一些并非其自身造成的因素制约，包括对医疗服务提供者支付费用的限制以及臃肿的官僚机构。他表示，在退伍军人事务部聘用和认证一名医生所需的时间可能比在私营部门要长数周。

舒尔金说：“这相当于要求退伍军人事务部在双手被束缚的情况下做事。在薪资和支付市场价格的灵活性方面，他们被赋予的权限有限，难以吸引合格的医疗保健专业人员。”

根据现行的薪资上限规定，退伍军人事务部（VA）医生的收入不得超过美国总统的年薪，即40万美元。但根据拜登政府时期通过的法案，退伍军人事务部可以通过豁免300个医生职位，支付超过该上限的薪酬。

但舒尔金表示，300项豁免对于拥有170家医疗中心和近1200个门诊点的退伍军人事务部医疗保健系统来说远远不够。此外，据熟悉此事的国会消息人士透露，现任退伍军人事务部管理层尚未动用所有豁免名额。

退伍军人事务部新闻秘书斯拉文告诉 CNN，“退伍军人事务部正在分配全部 300 个工资上限豁免名额”，并指出只有大约 1% 的退伍军人事务部医生获得了豁免。

斯莱文说：“要以不影响部门广大医生士气和留任率的方式分配这些资源，需要花费大量的时间和精力——其中大多数人将无法获得豁免。”

斯莱文补充道：“由于法定医生薪酬上限的限制，退伍军人事务部招募和留住医护人员的能力受到了阻碍，因为在很多情况下，医生在私营部门每年可以多赚几十万美元。”

戈登表示，在特朗普的退伍军人事务部长道格·柯林斯的领导下，退伍军人事务部对人员配备问题并非完全无辜。

戈登指出，科林斯上任后大幅削减了开支。退伍军人事务部今年和去年共减少了约3万名员工，并取消了数万个空缺职位。

戈登说：“现在坊间都在传，‘别去退伍军人事务部工作’。那里的工作环境不稳定，而且充满敌意。”