The Veterans Health Administration (VHA) is the nation’s largest health care provider, servicing millions of veterans ranging in age from late teens to late 90s – nearly 5 million of whom live in rural and highly rural areas. With a nationwide shortage of doctors and nurses, VHA also holds the numerical lead in shortages of primary care physicians, mental health professionals, registered nurses, licensed practical nurses (LPNs), etc.

But raw numbers can be deceiving.

“Our recruitment challenges mirror private-industry health care. There is an overall shortage in physicians and nurses, [and] our hiring needs are greater than anyone else’s. Due to our sheer size, our vacancy numbers do appear large, but there is always a shortage because everyone is competing for the same pool of people,” according to David Perry, acting chief officer for VHA Workforce Management & Consulting.

“Each year we identify the staffing shortages, both clinical and non-clinical. And every year, nurses, LPNs, pharmacists, and especially diagnostic radiology technicians are the ones we focus on as primary hiring needs. These shortages are in both full- and part-time staff. So, recruitment is our primary challenge. But our vacancy numbers are just one piece of a larger puzzle.”

“Our recruitment challenges mirror private-industry health care. There is an overall shortage in physicians and nurses, [and] our hiring needs are greater than anyone else’s.”

For the VHA, that challenge is more complicated than just competing with all other health care groups, especially when it comes to finding enough of the right specialties to deal with their far-flung rural cohort.

“It’s hard to find [specialists] in the rural areas or to get those we recruit to work in those areas. There also are challenges in the higher urban areas as we compete against universities, large health care providers, etc., with a limited resource from a budget perspective in terms of what we can pay,” he explained.

“Our pay scales are comparable until you get into some highly specialized disciplines, such as cardiology, so we look at ways to share resources, such as interim staffing providers and shared resources. We just can’t get to what they can make in the private sector, so we have to be creative in other ways. We can use the Mission Act to leverage community care to help offset some of those gaps.”

The VA Mission Act of 2018 provides for community care for veterans otherwise entitled to VA care that cannot be scheduled in a timely manner to avoid lapses in health care services and ensure continuity of care, to provide care where traditional VA services are more than 40 miles away, or if a veteran’s referring clinician believes furnishing care or services in the community would be in the veteran’s best medical interest.