Mr. Chairman and Members of the Subcommittee:

Thank you for inviting the Disabled American Veterans (DAV) to testify on human resources challenges within the Department of Veterans Affairs’ (VA) Veterans Health Administration (VHA). 

The human capital needs of VHA are driven by needs of the population VA serves.  VA is experiencing a gradual slowdown in the growth of its enrollees due to declining veteran population, mortality in the Priority 8 enrollee population since the suspension of enrollment, and deaths in the pre-enrollee population.  New enrollments of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans do not reverse the trend.  Further, the reliance and utilization rates of veteran enrollees from prior conflicts are more established and better defined than the medical care consumerism of the OEF/OIF enrollee population. 

A number of undefined variables, such as duration of the conflict, demobilization requirements, and impact of outreach efforts, will influence the number and types of services that VA will need to provide OEF/OIF veterans.  What is known today is that the current OEF/OIF veterans appear to have different utilization patterns than the rest of the VA enrollee population, needs that will demand greater flexibility in human resource management within the VA.  Specifically, initial findings indicate OEF/OIF enrollees use half as much inpatient surgery and acute medicine, but it is expected that they will need three times the number of PTSD residential rehabilitation services, and have greater needs for physical medicine, prosthetics and outpatient psychiatric and substance abuse services.  Correspondingly, enrollees from previous wars making up the vast majority of the population continue transitioning to higher enrollment priorities, and the aging morbidity of this population are driving the type and intensity of health care needs—even with the acknowledged declining reliance on VA once they qualify for Medicare.

In the general civil service arena, the Office of Personnel Management (OPM) estimates about one-third of full-time government workers will retire by 2012, but some occupations are more sensitive to external forces and agency initiatives than others.  In April 2007, VHA conducted a national conference, titled, VHA Succession Planning and Workforce Development.  The conference report indicated the average age of all VHA employees in 2006 was 48 years.  It estimated that by the end of 2012, approximately 91,700 VHA employees, or 44% of current full time and part time staff, would be eligible for full civil service retirement.  The report also indicated approximately 46,300 VHA employees are projected to retire during that same period.  In addition, a significant number of healthcare professionals in leadership positions would also be eligible to retire by the end of 2012.  With regard to the three mission critical occupations - registered nurse, pharmacist and physician, a startling finding in the report concluded that 97% of VA nurses in pay band “V” positions would be eligible to retire, and that 56% were expected to retire; and, that 81% of VA physicians in pay category 16—including many current Chiefs of Staff, would be eligible to retire, with 44% projected to actually retire from Federal service. 

Furthermore, the supply of healthcare providers poses an added hurdle for VA to be a patient-centered and integrated health care organization for veterans providing excellence in health care, research, and education; an organization where people choose to work; an active community partner and a back-up for national emergencies.  In recognition, VA’s more recent commonly used description is that, “[t]here is a growing realization that the supply of appropriately prepared health care workers in the Nation is inadequate to meet the needs of a growing and diverse population.  This shortfall will grow more serious over the next 20 years.  Enrollment in professional schools is not growing fast enough to meet the projected future demand for health care providers.” 

Without question, recruitment, management, and providing direction for VA employees on such issues as compensation, hiring, performance management, and organizational development are critical to the success of VHA’s mission to provide safe, high quality health care services to sick and disabled veterans.  While the most recent actions by Congress to affect the compensation package VHA may offer to prospective employees necessitates additional implementation oversight, an equally important problem within the realm of recruitment that requires attention is the federal hiring process itself.

Hiring a new wave of federal employees to succeed those that leave is paramount given the frequent civil-service hiring freezes of the past two decades due to cross-government rescissions and dictated “management efficiency” savings, inadequate funding levels, and the unpredictable nature of the discretionary appropriations process.  Moreover, the passive approach to recruiting applicants by federal agencies including VA puts themselves on unequal footing compared to the recruitment and retention programs used by many competitive private employers.  With over 100,000 health care trainees receiving clinical learning experiences annually in VA facilities, hiring from this pool should provide VHA with an increased advantage over private health care facilities.  Unfortunately, there is the perennial and widely acknowledged complaint by applicants for federal employment about cumbersome federal hiring procedures and practices, which require too much time and excessive paperwork.  Of those who do submit applications, many say they never receive feedback from agencies of interest. 

According to a survey conducted by the Merit Systems Protection Board (MSPB), supervisors and upper level new employees reported that the hiring process is complex and takes too long.  The most recent MSPB survey of entry-level hires and upper-level hires showed that substantial numbers had to wait five months or longer before being hired—much too long to expect a high-quality applicant to wait.  These findings harkens back to the 2002 survey indicating an average of about three months are required for the government to hire anyone, while seventy percent of college students say that they are unwilling to wait more than four weeks for a job offer. 

OPM has publicly acknowledged this problem in federal hiring and has agreed that the process has become cumbersome.  To address this, it has urged federal agencies to take advantage of recent laws that encourage quick hiring decisions and permit the use of bonuses to recruit and retain federal employees.  Unfortunately, a myriad of rules and procedures are still in place to restrict the use of these tools.  These restrictions in federal hiring decisions were designed to ensure equity, consistency, and accountability, while also protecting against fraud, waste and abuse.  This design does not compete well with private sector recruitment practices. 

While federal job applications are only the first tedious part of the process, agencies require approval from their personnel departments, which in turn cannot go beyond the level of appropriated or designated funds.  If the agency, department, or facility does get approval, its managers must produce a proper position description, get the vacancy announcement approved and posted, rate the applicants, interview the candidates, get higher-level approval for the hire, then conduct boarding, and finally complete any required background checks, (and for professionals, complete credentialing and privileging).  Each step adds more time to the process. In some cases security and background checks have caused several months delay due to increased security requirements.  Candidates for the top tier career appointments to the Senior Executive Service (SES must pass yet another review board, composed of SES members.  The five month average for the government to hire anyone is infeasible for many applicants--especially younger job-seekers.

VA recently testified on streamlining its cumbersome hiring process stating the Human Resource Committee of the VHA National Leadership Board, chartered a workgroup last year to streamline the recruitment process for title 5 and title 38 positions within VHA.  This included an analysis of the recruitment process and identification of barriers and lengthy processes that could be streamlined.  The recommendations were piloted in Veterans Integrated Service Network (VISN) 4 (generally, Pennsylvania) with the implementation and results of the pilot rolled out nationwide.  During the spring and summer of 2008, training in systems redesign will be offered nationally at Human Resources Cluster meetings.  At these sessions, VA testified it will focus on new strategies and systems redesign elements that can be used to help meet the daily challenges of attracting and retaining critical health care professionals.

In addition to time, there is often poor communication between federal managers and HR professionals on the qualities and skills needed in a candidate.  Attrition of experienced VHA human resources employees has had a direct impact on the quality of recruitment and retention efforts as well as providing needed assistance to train new and inexperienced staff to successfully hire needed VA health care providers.  In the end, those individuals who make it to the end of this process are often not the optimum candidates, nor the best qualified for the position.  In fact, in the 2006 Federal Human Capital Survey, less than half of government workers said that their work unit is able to hire people with the right skills.

VHA’s workforce is covered under Title 5, Title 38, and Congress has provided VHA a unique Title 38 “hybrid” authority, combining elements of both titles.  As the greater majority of VHA employees fall under Title 38 and Title 38 hybrid systems, personnel rules under both were designed to allow greater flexibility and expedite VHA’s hiring and promotion processes.  The Title 38 hybrid model requires Professional Standards Boards to make recommendations on employment, promotion and grade.  This model is viewed as more subjective due to the level of transparency than Title 38, where professionals are hired, promoted and retained based solely on their professional qualifications.  Moreover, the reality of the hiring and promotion processes under Title 38 hybrid is facing extraordinary delays particularly in the boarding process across health care disciplines from nurses to psychologists. 

The federal hiring process is so daunting that it often reinforces applicants’ worst fears of government as an ineffective, unresponsive and incomprehensible bureaucracy.  Only by insisting that agencies make recruiting talent a top priority and that both agency leaders and managers be held responsible for results can we ensure that the government recruits the talent it needs to meet the challenges ahead.  A simple practice (but time consuming due to inadequate VHA human resources staffing) that could be employed is to ensure that the human resources staffs responsible for recruiting applicants provide some meaningful and timely feedback to job applicants.  Feedback, which puts some personal touch to an impersonal process, can help maintain applicants’ interest in the agency as well as throughout a hiring process that can be lengthy as I have indicated.

Again, we thank you for this opportunity to testify.  This concludes my testimony, and I will happy to address any questions from the Chairman or other Members of the Subcommittee.