During a Senate Veterans Affairs' Committee hearing in July, Sen. Jerry Moran (R-KS) asked Nominee to be Under Secretary for Health at the Department of Veterans' Affairs John Bartrum about staffing needs of the VA.
00:00Presence here, and more importantly, thank you for your service as outlined by you and by Senator Shahidi.
00:06Thanks for protecting and serving our nation.
00:11Mr. Bartram, in response, and I want to tell you that how you respond to this question is really important to me.
00:18This is not a throwaway question in any way.
00:21In response to your pre-hearing questions, you referenced having, quote,
00:25an opportunity to revisit the balance of direct care and community care, end quote.
00:32In my view, that balance belongs with a veteran.
00:35The veteran gets to decide under the eligibility criteria established by Congress in the Mission Act,
00:40and it's the VA's responsibility to work continuously to make certain that eligible veterans can freely choose
00:47between high-performing VA direct care and high-functioning VA community care.
00:54Do you agree?
00:56Why or why not?
00:57Would you explain your view on this topic?
01:01I fully agree with you.
01:03It is the veteran's choice on how we work to balance that care.
01:08Right now, the bureaucratic process that has been put in place before this administration
01:16takes an enormous amount of time, and it takes a lot of hoops for a veteran to get community care.
01:22One of the things that you did is you passed the best medical interest, and we implemented that.
01:31And in the policy statement that Secretary Collins put when he implemented it, part of his words were,
01:36we don't need a congressional law to tell us to do what's common sense.
01:41And what's common sense is that if the doctor and the veteran decide that they need to have a referral to community care,
01:48that the referral to community care should occur, and it doesn't take another doctor or another technician or somebody else to review it.
01:56It's just like it is in your private sector.
01:58When you and your doctor decide you need a referral and you need to go somewhere, then you get the referral and you go.
02:04So that has been implemented.
02:07Those are the things that I'm talking about.
02:08I'm balancing the community care with the direct care.
02:12If you think about our health care system in the VA, when I worked for the VA years ago, we were essentially a single engine motor.
02:19We had one cylinder, and it was direct care.
02:23We now have community care, referral care, whatever you'd like to refer to it, and we have direct care.
02:29And we need to balance those care activities for our veterans based on our veterans.
02:35In the VA, there's things that we do that veterans want to keep coming back and using us over and over,
02:41especially if they live within the area where they can get to us.
02:44If they don't live within that area, they need to be able to use community care without jumping through a thousand hoops.
02:50But if they want to use our prosthetic care, which I would argue is second to none,
02:54or some of our primary health mental care, or some of our primary care, and they live in that area,
02:59they should be able to do that and have the choice to do that.
03:02But if they need to use while they're in that area based on a referral because we don't have the specialty care,
03:08they should be able to get the specialty care that they need where they need it.
03:11So that's what I say when we need to balance it is its form and functions or its structure.
03:16It's basic, you know, leadership 101.
03:19And having been a leader in both the civil service side as an SES and on the military side as a general officer,
03:27that's what I intend to do is to lead the organization to look at the processes
03:32and how to better affect the veterans' patient outcome.
03:35When you say balance or rebalance, it's based upon, I'm paraphrasing or telling you what I heard from your answer,
03:44it's based upon the best interest of the veteran, not any other criteria.
03:50Yes, sir.
03:51It's the best interest of the veteran and what the law allows us to do.
03:55Yeah, there is the law.
03:56Mr. Bartram, over the past five years, we've seen a major swing in VA workforce from a record hiring in 22 and 23
04:04to a planned decrease of 10,000 employees in 24
04:10and now further reductions in the overall workforce this year.
04:14There has not been a VA staffing strategy in recent history that takes a long-term view
04:21despite the necessity of high-performing workforce for the delivery of timely, high-quality care.
04:28If confirmed, what data points and trends will you look at to determine the VHA's workforce needs?
04:35What are your goals when it comes to the VHA workforce?
04:38And how will you work with this committee to develop a coherent and sustainable VHA staffing strategy moving forward and longer term?
04:49And that's a great question, sir, and I really appreciate that.
04:52On the strategy of the workforce, as you know, VA has about 470,000 employees
04:57and about 350,000 of those are at VA healthcare facilities facing the healthcare, the veterans and providing care at the veterans.
05:09And most of those 350,000 were exempt from the hiring freeze that a ranking member, Blumenthal, had identified early on in the discussion.
05:19But one of the things that I've committed to working with and I'd love to work with your staff on it once I'm confirmed or if I'm confirmed
05:26is also with our HR Assistant Secretary, Mark Engelbaum, on setting up a workforce structure with manning documents
05:38so that we understand what positions and what manning documents you should have
05:42and setting up standard staffing models so that we understand how many staff you need for certain types of activities.
05:49We don't have good staffing models in the VA.
05:52And the way that when I've looked at some of the numbers and I'm only a senior advisor so I don't dig into all the different things every day at VHA
05:59but when you look at some of the different numbers on their staffing model is it's not a consistent staffing model.
06:04You have inconsistent number of staffing in certain areas and not in others and we need to normalize that across the platform.
06:11So I look forward to working with you and the staff and with my other colleagues at VA
06:16to set up staffing models to ensure that we're looking at that to make sure that we're getting the throughput
06:22on patient output and we're getting the service that we need.
06:28But what I would want to say is that with all the hiring that went on during the Biden administration,
06:33there were between 2021 and 2024, there were over 52,000 full-time equivalents.
06:39But what happened during that time?
06:41The wait times didn't improve.
06:43The wait time for primary care rose from 15.7 days to 24.3.
06:48The wait time for mental health rose from 14.7 to 20.4.
06:52The wait times for specialty care went from 24 to 38 days.
06:58So the measures that I'm going to look at are what is our access
07:01and what are the things that we're doing to improve access?
07:05And I see my time's up, so I'll end.
07:08I, too, see that my time is up.
07:09Mr. Workman, I'll come back to you at the next opportunity,
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