This Veterans Affairs hospital in Phoenix is at the center of a management scandal at the Department of Veterans Affairs involving the doctoring of records to hide chronic delays in providing medical and mental health care to veterans.(Photo: Christian Petersen, Getty Images)

About one in three jobs are vacant at eight of the nation’s regional Veterans Affairs health care systems, leaving veterans waiting weeks to get care.

Nationally, one in six positions — nearly 41,000 —  for critical intake workers, doctors, nurses and assistants were unfilled as of mid July, in part due to complex hiring procedures and poor recruitment, according to critics of the nation's network of 139 hospitals and clinics that treat veterans.

The vacancy data obtained by USA TODAY through the Freedom of Information Act offers the first look at how serious staffing issues are at some VA hospitals and clinics. It also shows that at many locations, unfilled jobs are driving up appointment wait times. USA TODAY's analysis found that even a 1% increase in job vacancies contributes to more appointments being pushed past a month-long wait.

Some of the highest vacancy rates are for psychologists. In 13 regional health care systems, 40 to 64% of psychologist positions are vacant. Nationally, about 21% of such positions are vacant.

“It is unacceptable,” said Sen. Jon Tester, D-Montana, a member of the Senate Veterans Affairs committee.  “This is a problem under bright sunlight now, and it needs to be fixed.”

In Fayetteville, N.C., 59 of its 187 physician positions were open in mid July, and the hospital and its outpatient clinics had only half of the psychologists needed to be at full staff. Overall, a third of medical jobs within that system are vacant. A quarter of patients with pending appointments are waiting more than a month past their requested appointment time.

“This is something we’ve been dealing with for more than a year,” said Fayetteville spokesman Jeffrey Melvin, referring to the long wait times. “A lot of that stems from lack of space, lack of providers.”

Melvin said Fayetteville had a hard time recruiting medical professionals to move to the area. And the hospital has high turnover because many employees are spouses of military members at nearby Fort Bragg, and leave when their partners are transferred to other bases.

Fayetteville is one of eight facilities with clinical employee vacancy rates over 30%. The others are Roseburg, Ore.; Long Beach, Calif.; Walla Walla, Wash.; Memphis; Reno; Togus, Maine, and Montgomery, Ala.

Scheduling assistants also face critical shortages, with nearly 21% of positions unfilled nationally. Physician assistants, who fill critical primary-care and specialty positions, have a 23% vacancy rate.

The data show more than 5,100 additional physicians are needed across the VA system. Tester has proposed a bill to increase the number of medical residencies by 1,500, in the hopes those doctors stay on.

On the House side, Rep. Dan Benishek, R-Mich., a surgeon who worked part-time as a contractor at a VA facility for 20 years, also has proposed legislation to streamline hiring and improve accountability.

“Frankly, it’s a management problem,” Benishek said in July. Over the past 30 years, the VA Inspector General's office has repeatedly said the agency should have a national recruitment plan to attract and retain physicians. It still doesn’t exist, he said.

“When you have to recruit 41,000 people — there has to be a coordinated plan,” Benishek said. “And when you ask them, there’s nobody in charge. You hear ‘that’s not my job.’ No one’s held responsible.”

VA leadership says hiring in the past year matched the 9% attrition rate, and actually added new employees. The agency hired an additional 1,000 physicians and 2,700 nurses in a 13-month period ending on May 1.

The Choice Act passed last August also created 10,000 new medical positions to fill, making vacancy figures appear worse, a spokesman said.

But critics say the agency’s hiring practices have mired regional facilities in red tape.

“The whole hiring process is ridiculous,” said Laurie Butler, who temporarily served as acting chief of Human Resources in Phoenix before retiring last year. There, a quarter of all clinical jobs are vacant, including 218 nurses, 163 medical schedulers and 35 physicians as of mid-July.

According to Phoenix VA spokeswoman Jean Schaefer, the process to hire one person for a clinical position can involve up to 18 steps — from getting approval for the job posting to running credential checks — and can take from four to eight months to complete. By that time, candidates have often accepted a job elsewhere, others said.

“It’s a bureaucratic nightmare,” Tester said. “We do not have to recreate the wheel every time we hire a damn nurse, or psychologist, or a medical director.”

Tester said he was particularly concerned about mental health needs. Data from the Veterans Health Administration show that the health care system in Fort Harrison, Mont., which Tester represents, has a vacancy rate of 44% for psychologists.

“Those slots are so important,” Tester said. His proposed bill, which is co-sponsored by five other Democrats, would also give the VA more flexibility to hire family therapists and marriage counselors to fill some mental health jobs. Studies have found as many as 20% of the veterans returning from Iraq and Afghanistan suffered post-traumatic stress disorder or major depression, and suicide rates for veterans are about triple that of the general public.

Physician assistants, who manage a caseload of patients, have prescribing duties and often are called to run rural clinics or serve as first-assist on surgeries, have slowly been seeing vacancy numbers rise for the past two decades, said Rubina DaSilva, president of the Veterans Affairs Physician Assistant Association.

By next year, 37% of PAs in the VA system will be eligible for retirement. If they all took it, DaSilva said, it would reduce the VA’s caseload capacity by 1.1 million appointments a year.

That’s particularly troubling to DaSilva because the military gave birth to the role of physician assistants, as skilled military medics and corpsmen returning from Vietnam were steered toward that level of medical training. Graduates from the country’s first PA program worked at a Veterans Affairs hospital. But as the private sector has bought in to the idea of PAs serving as an economical primary medical care, demand has grown, and now salaries and benefits in private medical practices outpace what the VA can offer in most locations, she said.

The group has recommended the VA do a local pay scale survey and universally cover more licensing and professional development costs, things DaSilva said were “easy fixes” that could go a long way in retaining talent. PAs have the highest turnover rate of all the medical positions deemed as critical needs by the Inspector General.

DaSilva, a veteran herself, said she was optimistic that attention to the problem this year could turn things around.

“It’s not just an occupation — it’s a calling. It’s being with veterans, and taking care of veterans," she said. “There’s a reason we’re at the VA. But you can only do that for so long.”

Over the past year, the VA has addressed wait time troubles with extended clinic hours at some locations, taxing its staff. Vacancies can be addressed by hiring temporary workers, or, in worst-case scenarios, closing beds if there aren't enough staff on hand, said Joan Clifford, immediate past president of the Nurses Association of Veterans Affairs.

The Department of Veterans Affairs also paid for 1.5 million veterans to see doctors outside the agency in the past year. Those private visits have cost U.S. taxpayers more than $7.7 billion, the VA said.

In Phoenix, Interim VA Health Care System Director Glenn Grippen acknowledged the huge shortage of clinical staff at a press conference in early August, saying it was contributing to veterans' waits. Staffing at the facility, however, has started to rise overall in recent months, he said.

“We’re trying to get more staff to meet the needs of veterans,” he said. “We’re not there yet, but we are working real hard.”

In the West Texas Health Care System, a 22% of all medical positions were unfilled as of mid-July — one of the highest rates in the VA health care systems. The vacancies, which are at the George H. O'Brien, Jr. VA Medical Center in Big Spring, Texas, and six clinics in nearby cities, included roughly a third of all nursing and 42% of all physical therapy positions. With 425 total medical jobs across all specialties, the system had openings for 48 nurses alone, data show.

No one at the facility could speak to a reporter about the openings. The reason: the network’s public information officer had retired, leaving that position empty, a receptionist said.

Contributing: Dennis Wagner, The Arizona Republic; Mark Barrett, Asheville Citizen-Times

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