- Contact the Committee

Mr. Chairman and Members of the Subcommittee, thank you for inviting me to appear before your committee today to discuss physician and dentist compensation issues.
I am sure you are aware that the Boston Metropolitan area is one of the premier centers of medical Excellence in the United States. In a recent US News and World Report feature, many Boston facilities were ranked at or near the top in many specialties. Facilities such as Brigham and Women’s Hospital, Massachusetts General Hospital, Boston Medical Center, Massachusetts Eye and Ear Infirmary, Dana Farber Cancer Institute, and Beth Israel Deaconess Hospital were all prominently mentioned. These are all affiliates of the Boston Healthcare System and their expertise are available and accessible by VA patients throughout New England.
Veterans expect, as do I, that the care provided by the VA Boston Healthcare System will be the equivalent of that practiced in those prestigious institutions.
We have met those expectations, but parity has become very difficult to maintain as competition for the best and brightest clinicians has been severely hampered by pay limitations that do not reflect the realities of the competitive clinical marketplace.
I mentioned earlier that we had met the challenge to this point. I believe we have done so, because our senior physician staff, while they have a deep-seated commitment to our veterans, choose to stay until they can exercise benefits offered them under the Civil Service Retirement System (CSRS). We have also exercised every available method and means (hiring traditional staff, contract, Fee basis, locum tenens; and supporting H1B visas) to obtain the services of physicians in critical care areas. In our critical care occupations we have two goals – to recruit quality staff and to retain the staff we have. Given the current salary rules, this presents us with significant challenges. Vacancies in certain specialties remain unfilled for many months – if not years. For example, positions in anesthesiology, infectious disease, radiology, oncology, cardiovascular surgery, thoracic surgery, gastroenterology and cardiology are often vacant for nine (9) to twelve (12) months. In anesthesiology, 62% of our physicians are on time-limited appointments due to their immigration status. While these H1-B visa holders are a good source of candidates, the number of these visas available through the Immigration and Naturalization Service are more limited than in the past. Though committed to the VA in the short term due to their immigration status, most leave their clinical positions for more lucrative opportunities at the earliest possible opportunity. In anesthesia, our inability to recruit has also required us to meet workload demands through the use of scarce medical contracts at prevailing market rates. The disparity in compensation has become a morale issue when staff, working side-by-side, have markedly different levels of income.
The attrition rate for physicians in the radiology specialty for FY’03 at the Boston Healthcare System was 50%. These losses were clearly salary driven. Whereas the average VA salary of these radiologists was approximately $170,000 to $190,000, all left for compensation in the range of $250,000 to $300,000.
For the last three fiscal years physician losses at the VA Boston Healthcare System have out-paced our physician gains primarily due to pay disparity. In addition, a growing number of physicians are converting to part-time or reducing their part-time hours in order to obtain additional compensation from secondary employment. This has the potential to adversely affect the continuity of care to our patients and reduces the commitment, I believe, that accompanies full time clinicians.
When recruiting attractive prospects, our typical pay offering is invariably at the top step of the top grade available to us. This, in combination with all flexibilities authorized by law and regulations, including retention allowances, may allow us to offer a salary package in the approximate range of 130 thousand to 190 thousand dollars. If the proposal exceeds 190 thousand dollars, the Secretary would need to approve, which hinders rapid action. Although approval is rarely denied, it cannot be assumed during the recruitment process.
In reviewing the proposal, I commend VA’s efforts to address these impediments. Perhaps the most exciting feature of the proposed bill is the “market pay” aspect, which would now offer us a vehicle to respond to local market forces, as well as offer us an ability to remain competitive. It would also have the benefit of stabilizing our workforce in the future and would serve to minimize the emotional conflict that physicians experience having to trade-off a true commitment to the veteran, versus earning compensation commensurate with their educational level, training and skill.
This bill would also prohibit senior clinical staff at, and above, the Chief of Staff level from receiving any compensation from the affiliates. While this prohibition on supplements is understandable in light of the proposed provisions to substantially upgrade the remuneration for the Chief of Staff position, there are physicians holding these positions who have unique skills that are invaluable to the community that should be allowed to continue their activities. I am pleased that the draft bill includes waiver authority for VA to consider these and other unique situations. I am also pleased that the proposal would allow physicians in leadership positions to continue interactions with the medical schools, to participate in research and involvement in academic activities on a non-compensated basis. Such activities should be promoted assuming, of course, that existing rules and regulations involving ethics and conflict of interest are respected. It has been my experience that Chief of Staff involvement at many levels of the Medical School(s) has been crucial in preserving the interests of the VA and maintaining the synergy necessary for growth.
With respect to the proposal for increasing the compensation for nurse executives, I feel the proposal is well thought out. At the Boston Healthcare System, the nurse executive is responsible for nearly 1000 employees and a myriad of patient care issues. In and of itself, our Nursing Service is larger than many facilities in both the VA and the community.
With respect to the proposed flexibility regarding Nurse schedules, employee satisfaction surveys indicate that the lack of flexible tours ranks at our near the top of employee dissatisfaction. Implementation of a tour schedule as proposed should help stabilize employment levels on special units and prove to be a significant recruitment and retention tool.
In conclusion, I strongly support initiatives that provide us the tools to attract and retain competitive medical staff. I thank you for the opportunity to address the committee and would be glad to answer any questions.