[Senate Hearing 118-151]
[From the U.S. Government Publishing Office]







                                                        S. Hrg. 118-151

                  STRENGTHENING METHODS OF RECRUITMENT
                    AND RETENTION FOR VA'S WORKFORCE

=======================================================================

                                HEARING

                               BEFORE THE

                     COMMITTEE ON VETERANS' AFFAIRS
                          UNITED STATES SENATE

                    ONE HUNDRED EIGHTEENTH CONGRESS

                             FIRST SESSION

                               __________

                             MARCH 22, 2023

                               __________

       Printed for the use of the Committee on Veterans' Affairs




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        Available via the World Wide Web: http://www.govinfo.gov  
        
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                      U.S. GOVERNMENT PUBLISHING OFFICE 
                      
53-822 PDF                  WASHINGTON : 2023   



        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
                 SENATE COMMITTEE ON VETERANS' AFFAIRS

                     Jon Tester, Montana, Chairman
Patty Murray, Washington             Jerry Moran, Kansas, Ranking 
Bernard Sanders, Vermont                 Member
Sherrod Brown, Ohio                  John Boozman, Arkansas
Richard Blumenthal, Connecticut      Bill Cassidy, Louisiana
Mazie K. Hirono, Hawaii              Mike Rounds, South Dakota
Joe Manchin III, West Virginia       Thom Tillis, North Carolina
Kyrsten Sinema, Arizona              Dan Sullivan, Alaska
Margaret Wood Hassan, New Hampshire  Marsha Blackburn, Tennessee
Angus S. King, Jr., Maine            Kevin Cramer, North Dakota
                                     Tommy Tuberville, Alabama
                      Tony McClain, Staff Director
                 Jon Towers, Republican Staff Director   
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                            C O N T E N T S

                              ----------                              

                             March 22, 2023

                                SENATORS

                                                                   Page
Tester, Hon. Jon, Chairman, U.S. Senator from Montana............     1
Moran, Hon. Jerry, Ranking Member, U.S. Senator from Kansas......     2
Boozman, Hon. John, U.S. Senator from Arkansas...................     8
Brown, Hon. Sherrod, U.S. Senator from Ohio......................     9
Tillis, Hon. Thom, U.S. Senator from North Carolina..............    12
Hassan, Hon. Margaret Wood, U.S. Senator from New Hampshire......    14
Blackburn, Hon. Marsha, U.S. Senator from Tennessee..............    16
King, Jr., Hon. Angus S., U.S. Senator from Maine................    17
Sullivan, Hon. Dan, U.S. Senator from Alaska.....................    19
Blumenthal, Hon. Richard, U.S. Senator from Connecticut..........    21

                               WITNESSES

Tracey Therit, Chief Human Capital Officer, Department of 
  Veterans Affairs; accompanied by Jessica Bonjorni, MBA, PMP, 
  SPHR, Chief Human Capital Management, Veterans Health 
  Administration.................................................     4

                                APPENDIX
                           Prepared Statement

Tracey Therit, Chief Human Capital Officer, Department of 
  Veterans Affairs...............................................    27

                       Submissions for the Record

VA Views on S. 10 VA Clinician Appreciation, Recruitment, 
  Education, Expansion, and Retention Support (CAREERS) Act of 
  2023...........................................................    33

MilitaryTimes article dated March 21, 2023, titled ``Dept. of 
  Veterans Affairs, union spar over staffing''...................    46

                        Questions for the Record

Department of Veterans Affairs response to questions submitted 
  by:

  Hon. Jerry Moran...............................................    53
  Hon. Mazie Hirono..............................................    59
  Hon. Bill Cassidy..............................................    63
  Hon. Kyrsten Sinema............................................    66
  Hon. Tommy Tuberville..........................................    69
  Hon. Angus S. King, Jr.........................................    75

                       Statements for the Record

Hon. Kyrsten Sinema..............................................    81
Alzheimer's Association and Alzheimer's Impact Movement (AIM)....    82
American Federation of Government Employees (AFGE), AFL-CIO......    86
Irma Westmoreland, RN, on behalf of National Nurses United.......   103

 
                         STRENGTHENING METHODS 
                      OF RECRUITMENT AND RETENTION 
                           FOR VA'S WORKFORCE 

                              ----------                              


                       WEDNESDAY, MARCH 22, 2023

                                       U.S. Senate,
                            Committee on Veterans' Affairs,
                                                    Washington, DC.
    The Committee met, pursuant to notice, at 3 p.m., in Room 
SR-418, Russell Senate Office Building, Hon. Jon Tester, 
Chairman of the Committee, presiding.
    Present: Senators Tester, Brown, Blumenthal, Sinema, 
Hassan, King, Moran, Boozman, Cassidy, Tillis, Sullivan, 
Blackburn, and Tuberville.

              OPENING STATEMENT OF CHAIRMAN TESTER

    Chairman Tester. I call this hearing to order. Good 
afternoon. Today we are going to be discussing an issue that is 
the backbone of the VA, its workforce, and I want to recognize 
the VA staff for all that you do. Thank you for bringing world-
class care and benefits to our Nation's veterans and their 
families.
    We do a lot of work up here to expand access to care and 
benefits to veterans through bills like the PACT Act, and we 
often provide funding to build health care facilities in areas 
with growing veteran populations. In my state it would be a 
place like Hamilton, Montana. But the tires are never going to 
hit the road without folks to staff these efforts.
    I look forward to our conversation today about what the 
needs to build and maintain an effective workforce. I think it 
is no secret the VA's lengthy hiring process is one of those 
reasons that we lose qualified candidates. We want to hear from 
the VA on how to improve that.
    During consideration of the PACT Act, it included a number 
of critical workforce-building provision, authored by myself 
and the good Senator from Arkansas, Senator Boozman, to ensure 
that the VA had the staff to meet the needs of these veterans. 
We also included reporting requirements and guardrails to 
ensure these authorities are being properly utilized, because 
we can give you the tools that you want but the VA will never 
be able to compete in a tight labor market if it is not 
aggressively using those tools.
    The Tester-Boozman VA CAREERS Act was built directly on 
feedback from health care providers in Montana and across this 
country on what they need to staff those facilities that help 
our veterans. They might find it difficult, if not impossible, 
to keep up with local salary rates for physicians. This bill 
revamps the senior clinician pay system to more easily keep up 
with market rates, something that is critically important.
    We are giving the VA the tools to be competitive, not just 
in urban markets like L.A. but also markets like the one in my 
backyard, Great Falls, Montana.
    I know that VA's labor partners have brought up some 
concerns about changing the physician pay system. I would say 
this: we hear you and we are working closely to include 
additional guardrails to ensure this provision works as 
intended. But I am going to tell you, with the PACT Act 
implementation underway and a rapidly aging veteran population 
with increasing health care needs, we cannot delay. And for 
those folks out there that think the VA will survive without a 
competitive market for hiring employees, they are wrong. It 
will not survive.
    And so we need to do something about the way we hire folks 
and the amount of compensation we give them, moving forward, or 
the VA, quite frankly, will cease to exist.
    So with that I am going to turn it over to Ranking Member 
Moran for his opening statement.

               OPENING STATEMENT OF SENATOR MORAN

    Senator Moran. Chairman Tester, thank you. I thank our 
witnesses for joining us here today. I am interested in hearing 
what the VA can do to improve the hiring and retention of its 
workforce to deliver veterans the quality health care and 
benefits they deserve.
    The VA has several legislative proposals to simplify and 
expand the authorities for hiring and setting the pay for 
doctors. The VA has also presented plans to revamp its hiring 
on the onboarding process to shorten the time it takes for new 
providers to begin patient care, and to do so in a way that is 
as painless as possible for the new employees.
    Our Committee heard from professionals and labor 
organizations last week about just how dysfunctional the 
current onboarding process can be. We have also heard from some 
dedicated frontline VHA staff who are working through those 
challenges and implementing best practices at their facilities. 
VA Central Office should incorporate these best practices in 
any revamp of its current process, and it must engage with the 
frontline hiring managers and recruiters to know which hurdles 
need to be addressed. I also want to hear from the VA how much 
more flexibility in hiring and pay-setting authority will 
improve provider quality and reduce instances of substandard 
care.
    I remain concerned about the VA's policies that allow 
physicians with multiple reported cases of substandard care, 
resulting in patient harm, to continue seeing veterans, and in 
some cases, being promoted to supervisor. VA ought to have the 
tools it needs to recruit and retain the very best physicians, 
nurses, and other clinical providers, but having the very best 
means they cannot accept or tolerate providers who repeatedly 
demonstrate an inability to safely treat our Nation's veterans.
    On this topic of making certain that the workforce is 
supporting our veterans, making certain that our workforce is 
top notch, I want to take a moment of my opening remarks to 
comment on the career and service of our Committee's Republican 
staff director, Jon Towers. Jon has had a long, distinguished 
career--Jon, I could do this myself without reading it, but 
your capable staff have given me words in front of me. But Jon 
has had a long and distinguished career working for both the 
Senate and the House VA Committees, but after nearly 26 years 
of service, five different chairmen and ranking members, he 
will be retiring at the end of this month.
    Jon has been a leader and a resource for Senators, House 
members, and their staffs as we have negotiated serious 
challenges over the years. He was directly involved in 
addressing the wait times and the accountability scandals, and 
he provided a steady hand as Congress worked to finally address 
how the VA deals with military toxic exposures.
    I want to say thank you. I do say thank you to Jon for his 
years of dedicated service. I thank also his fiancee, Lindsee, 
and to his entire family for sharing Jon with us as we took on 
important tasks of supporting our Nation's veterans. Most 
veterans who receive VA benefits, use their GI Bill, or access 
quality health care when and where they need, will not know the 
name of Jon Towers, but nevertheless, each of them personally 
benefits from the dedication, the thoughtfulness, and the 
passion that Jon has put into his work here.
    On behalf of those veterans and on behalf of all of the 
members of this Committee and the committees which you have 
helped lead, we say thank you. Thank you for your service to 
our Nation, to our country's veterans. And from a personal 
side, Jon, it was a significant opportunity for me to be a 
better member of this Committee and to be a better chairman or 
ranking member when you arrived, and I am very grateful for all 
your help and the team that you helped assemble as we try to 
make certain that this Committee does its work on behalf of all 
who serve.
    So Mr. Chairman, on behalf of you and my colleagues in the 
Committee, thank you to Jon Towers for his time with us. Thank 
you, Mr. Chairman.
    [Applause.]
    Chairman Tester. I promised myself I would not bring up 
Towers, but since you brought him up----
    Senator Moran. I thought you promised not to cry.
    Chairman Tester. I have been weeping as you have been 
speaking. It was such beautiful words.
    But I just want to say something. Jon and I have a 
connection because he spells his first name right, and he has 
been, from our side of the aisle, Senator Moran, he has been 
great for us to work with, and he is somebody that we truly 
will miss.
    And I need to point this out for the cameras. He has two 
days left.
    [Laughter.]
    Chairman Tester. So with that I want to welcome Tracey 
Therit, VA Chief Human Capital Officer. She is accompanied by 
Jessica Bonjorni, who is the Chief of VHA Human Capital 
Management. I want to thank you both for being here.
    Ms. Therit, you may begin with your opening statement.

                   STATEMENT OF TRACEY THERIT
                ACCOMPANIED BY JESSICA BONJORNI

    Ms. Therit. Good afternoon, Chairman Tester, Ranking Member 
Moran, and members of the Committee. Thank you for inviting us 
here today to discuss the Department's hiring efforts and 
present our views on Committee Print of S. 10, the VA Clinician 
Appreciation, Recruitment, Education, Expansion, and Retention 
Support (CAREERS) Act of 2023, and discuss our legislative 
workforce priorities for the 118th Congress. Joining me today 
is the Veterans Health Administration's, Jessica Bonjorni, 
Chief of Human Capital Management.
    VA is dramatically increasing hiring, holding surge events 
to onboard staff more quickly and increasing incentives for 
recruitment and retention. The nationwide onboarding event held 
last November allowed us to hire more new staff at VHA in the 
first quarter of this fiscal year than in the same period in 
any previous year. Five months into the fiscal year, we have 
onboarded nearly 23,000 new hires, resulting in a 2.5 percent 
growth rate. These efforts well position us to meet our goal of 
52,000 new VHA employees in this fiscal year, which would 
result in a growth rate of over 3.3 percent overall size of our 
workforce.
    We are seeing the same sort of success in Veterans Benefits 
Administration hires, as we are continuing to build our claims 
processing capacity.
    We appreciate the close collaboration of the Committee 
staff addressing some of the concerns the VA identified with 
previous versions of the CAREERS legislation in the prior 
Congress, and many of the sections are similar or identical to 
legislative proposals included in VA's fiscal year 2024 budget. 
We believe the current version is much improved and is a 
demonstration of the benefits of VA and Congress working 
together.
    We want to highlight three sections that are VA's top 
priorities.
    First, VA supports Section 201 that would eliminate 
performance pay and base and longevity pay components of the 
physician, podiatrists, and dentist pay system, and add 
optometrist to the pay system. We want to make it clear that 
this elimination would not reduce pay. It will change the pay 
structure and caps for this part of VA's health care workforce. 
In its place, VHA will have a single market pay component. VA 
supports these changes to the physician, podiatrist, and 
dentist pay system as they will allow VHA to be more 
competitive with local labor markets, meet the increased demand 
for critical clinical specialties, and more efficiently and 
effectively compensate providers.
    Without these amendments to the current physician, 
podiatrist, and dentist pay system, VA risks losing high-
quality providers in complex clinical specialties to the 
private sector, impacting VHA's ability to deliver quality care 
to veterans. The physician, podiatrist, and dentist pay system 
is over 16 years old and significant improvement is greatly 
needed to keep pace with the increasing economy, demographics, 
high market rates, rapid advancements in health care, and high 
costs of critical and complex clinical specialties.
    Second, VA supports Section 202, that would establish a 
separate compensation system under Title 38 for VA occupations 
of Medical Center Director and Veterans Integrated Services 
Network Director, appointed under 38 U.S.C. 7401(4). Under this 
new system, the rates of pay for employees in these positions 
would be set and periodically adjusted by the Secretary of 
Veterans Affairs. The designated positions would remain 
eligible for performance awards in accordance with VA guidance. 
Pay would be determined based on market pay methodology, like 
the market pay authority currently in place for VHA physicians, 
dentists, and podiatrist, at 38 U.S.C. 7431.
    Annual salary for each medical center director and network 
director would consist of a single market pay component, thus 
eliminating the base pay component. Subsequent pay adjustments 
would be based on performance and would be developed 
incorporating salary adjustment features aligned to physician 
performance and other criteria such as complexity of 
assignment, marketplace factors, labor market features, 
qualifications, and experience, as determined by the Secretary. 
The compensation system will have a limit on the annual market 
pay of the basic pay of the President, currently $400,000. Pay 
for performance goals and objectives for the providers will be 
worked into their overall pay under the new pay system.
    VHA continues to face significant challenges addressing the 
rapidly evolving and changing health care industry. To be part 
of this transformation, VHA must have medical center and 
network directors with the skill set to provide enterprise-wide 
solutions to their clients, our Nation's veterans. To recruit 
top health executives, the salary structure of VHA's senior 
health care executives and medical center and network director 
positions must be addressed.
    Third, VA supports, if amended, Section 222, that would 
allow VA to consolidate any restored annual leave that covered 
employees accrued during calendar years 2020, 2021, 2022, and 
2023, under Title 5, into one annual leave account. Employees 
would be allowed to utilize the leave through January 9, 2027.
    In 2018 and 2019, pre-COVID, VA employees had roughly 
101,657 hours of restored leave. In contrast, as of January 
2023, over 29,000 VA employees have restored annual leave 
totalling 1.2 million hours. The individual balances of 
employees range between 1 to 416 hours. Employees would have 
the option to request a lump sum payout for the restored annual 
leave but have to agree to a period of obligated service in 
exchange.
    VA is recommending edits to address certain administrative 
matters concerning the use of the annual leave and 
congressional reporting requirements and updated timeframes, 
based on regulation recently issued by the Office of Personnel 
Management. For example, to ensure employees are not prevented 
from exercising the lump sum payment option due to reaching 
annual aggregate pay limits, VA seeks to provide a provision 
under Paragraph C to exclude the lump sum from the annual pay 
limit.
    With all the provisions of the VA CAREERS Act that VA 
supports, we will continue to work with Members of Congress, 
our sister agencies, our stakeholders to enhance VA's 
workforce.

    [VA Views on S. 10 VA Clinician Appreciation, Recruitment, 
Education, Expansion, and Retention Support (CAREERS) Act of 
2023 appear on page 33 of the Appendix.]

    This concludes my statement, and my colleague and I are 
happy to answer any questions that the members of the Committee 
may have. Thank you.

    [The prepared statement of Ms. Therit appears on page 27 of 
the Appendix.]

    Chairman Tester. Yes, thank you for your statement. We will 
start here.
    Would you say that improving VA's hiring and retention is a 
top priority for the Department?
    Ms. Therit. Chairman Tester, it is our highest priority.
    Chairman Tester. Okay. And by your testimony, lifting pay 
caps, revamping the VA compensation system would be included in 
those priorities?
    Ms. Therit. It would, Chairman Tester.
    Chairman Tester. Okay. The VA CAREERS Act reimagines the 
way we pay VA docs. I believe this is critical. We hear 
complaints from providers in Montana. The biggest complaint is 
probably how long it takes, and we just had a roundtable 
session here a bit ago in Montana, and I believe the last one 
was around 10 months, which is insanely, ridiculously long, and 
the other one is pay.
    How do market assessments currently work for the VA 
physicians?
    Ms. Therit. Chairman Tester, I am going to ask Ms. Bonjorni 
to answer that question.
    Chairman Tester. Sure. You bet.
    Ms. Bonjorni. Sure. So currently we are required in statute 
to do a market pay review every two years, but we do them more 
frequently depending on market conditions. So we review both 
what is going on in the local labor market and whether the 
provider has any additional certifications or experience, and 
make adjustments in concert with their longevity and base 
adjustment.
    Chairman Tester. Are you familiar with the CAREERS Act?
    Ms. Bonjorni. Yes.
    Chairman Tester. How will that change compared to what you 
are doing now?
    Ms. Bonjorni. With the changes in the CAREERS Act we will 
be able to use exclusively a market pay component and it will 
give us more flexibility in doing the pay-setting without the 
adjustments for longevity and base pay. It also removes the 
performance pay component which was put in place to allow us to 
do some very targeted performance pay. We are going to continue 
to do performance pay but just under a new system with this 
model.
    Chairman Tester. Can you briefly--we will just stick with 
you if you want--can you briefly tell me why it is important to 
pull off the caps?
    Ms. Bonjorni. Yes, absolutely. The caps are a real 
constraint for us for our high-level specialties and in high 
cost of living areas. So for specialties such as cardiology, 
neurology, radiology there are physicians coming right out of 
school who are making well over what we are able to offer right 
now to our very tenured providers, so our ability to compete in 
the market is significantly hampered by the caps.
    Chairman Tester. Okay. So we have heard from our labor 
partners that they are concerned that the new system would no 
longer incentivize longevity and performance at the VA. So my 
question to you is what new and existing systems will be in 
place to promote retention and high performance if the CAREERS 
Act were to pass?
    Ms. Bonjorni. We have existing systems to offer 
performance-based awards that we would now incorporate for our 
physician providers to replace the performance pay system. We 
also have the new authorities under the PACT Act that allow us 
to offer additional incentives on top of current pay 
authorities that do not count against the caps. Both of those 
would be used to recruit and retain.
    Chairman Tester. Okay. How does the new system compare to 
how the private sector determines clinician salaries?
    Ms. Bonjorni. It is much more in line with how the private 
sector operates. It will allow us to include different 
components in setting the pay and it gives us flexibility to 
make adjustments at a higher level.
    Chairman Tester. So I talked about the timeframes--and this 
is for either one of you--the timeframes to hire. What is the 
VA doing to reduce those timeframes to hire, if anything?
    Ms. Therit. Senator Tester, we are having onsite hiring 
events that abbreviate the time from a position being announced 
until the individual is offered a tentative job offer. The 
Veterans Benefits Administration had numerous job fairs during 
the month of February, hired over 1,000 individuals, averaging 
100 at those events, so it dramatically decreased the time to 
hire within VBA.
    On the Veterans Health Administration they are also holding 
the onboard surge events, which is the time between the 
tentative offer and the entry on duty, allowing all of the 
steps in the process--the fingerprinting, the credentialing, 
the physicals, the drug testing--to occur at one time, greatly 
abbreviating those timeframes.
    We are also using direct hire authority, which is a tool to 
streamline hiring. It is able to get us larger pools of 
candidates to be able to bring employees on faster, and we are 
seeing the time to hire for those positions between 60 and 40 
days, which is dramatically less than our average, which is 
usually around 100 days.
    Chairman Tester. So 100 days is three months. So what is 
the fastest you have ever hired a doc in the VA? Can you give 
me that answer?
    Ms. Therit. I would ask Ms. Bonjorni to answer the 
question.
    Ms. Bonjorni. Using expedited emergency authorities under 
the COVID emergency authorities we were able to onboard people 
in about two weeks for a physician.
    Chairman Tester. Right.
    Ms. Bonjorni. That means we delayed their credentialing 
until after they onboarded.
    Chairman Tester. And those riders are gone now. Correct?
    Ms. Bonjorni. Correct.
    Chairman Tester. Yes. Well, that is a whole lot different 
than 6, 8, 10 months, and I can tell you that if we are going 
to compete we have got to figure--and by the way, this is not 
just the VA. This is government-wide. If we are going to 
compete we have got to figure out how to make this selection 
process of hiring easier and more user friendly.
    With that I will turn it over to Senator Boozman.

                      SENATOR JOHN BOOZMAN

    Senator Boozman. Thank you, Mr. Chairman, and thank you for 
focusing this hearing on the hiring and retention of the VA 
workforce. Also, I would like to thank you guys for being here. 
I appreciate your hard work.
    The 2022 IG report on VHA's occupational staffing shortages 
identified more than 2,600 severe occupational staffing 
shortages across 285 occupations. This was an increase from 
2021. It is clear we are experiencing staffing challenges. That 
is why Senator Tester introduced the VA CAREERS Act to help 
with the recruiting and retention challenges that VA currently 
faces. It is imperative that we hire and retain the best and 
brightest talents that this country has because our veterans 
and their families deserve the highest levels of care and 
support for the sacrifices that they have made in protecting 
our country.
    The VA CAREERS Act is a crucial piece of legislation aiming 
to reduce vacancies and staffing shortages at the VA. The VA 
continues to be at a disadvantage when it comes to recruiting 
and retaining, as you have testified to, and the most talented 
medical professionals across the country, especially in rural 
areas, simply, it is very difficult to attract and retain.
    Ms. Therit, can you briefly speak to what this legislation 
would mean for the VA and why it is important to ensure that 
the VA has the ability to recruit and retain the best health 
care professionals?
    Ms. Therit. Senator Boozman, thank you.
    Senator Boozman. That is an easy one.
    Ms. Therit. Thank you for that question. We have really 
appreciated the opportunity to work with the staff to develop 
the VA CAREERS Act. Ms. Bonjorni had highlighted some of the 
pay authorities, the top three that we have indicated in our 
testimony. But across the board it looks at both recruitment 
and retention, being able to pay those higher salaries to 
attract the providers into those occupations as well as some of 
the continuing education which allows for occupations to be 
able to grow and evolve in those positions.
    We also add some areas of physician, pharmacist pay, of 
nurse executive pay, that would increase the limits and help us 
to be able to recruit and retain for those occupations as well.
    Ms. Bonjorni, do you have anything to add regarding the 
CAREERS Act and the benefits that it will bring to the VHA 
team?
    Ms. Bonjorni. I think you hit the key points.
    Senator Boozman. Very good. With approximately 3 million 
veterans living in rural communities and more than half of them 
over the age of 65, it is imperative that the rural medical 
facilities are properly staffed. Additionally, these veterans 
often have more complex medical conditions that involve 
specialty care, which requires specific training for VA 
providers.
    Ms. Therit, we addressed the CAREERS Act. Can you tell us, 
though, setting that aside, what initiatives and strategies are 
currently being discussed to improve staffing and training in 
these rural areas?
    Ms. Therit. Senator Boozman, we are grateful for the 
authorities that we have in the PACT Act. We have largely 
implemented all of those authorities. One that we are currently 
working on is the Rural Recruitment and Training Plan that is 
due to the Committee within 18 months of enactment. I know the 
VHA team is working on that piece of the PACT Act, and I am 
going to ask Ms. Bonjorni to elaborate further on some of the 
work that is happening there.
    Ms. Bonjorni. Sure. One of the things we are doing to 
address this is creating new positions that will be a national 
sourcing office. So that is the very first part of the 
recruitment process. And those sourcers will then find talent 
and send them out to our rural facilities so that we are able 
to generate more leads to come into those organizations. And we 
are dedicating additional resources toward our recruitment 
marketing, directly targeting rural areas.
    Senator Boozman. Ms. Therit, we have had a problem with VA 
administrators being there for short periods of time or 
detailed to other places, really having a situation where you 
have got a leaderless VA, which again, is a real problem. Can 
you talk about the importance of having a leader in place at 
our medical centers and how having a director in place leads to 
providing the best care and recruiting the best people, as 
opposed to the opposite of that, where people really just do 
not know where they are at, and it is just a difficult 
situation.
    Ms. Therit. Senator Boozman, leadership at those VA medical 
centers is critical. We appreciate Section 104 of the CAREERS 
Act, which would give us an opportunity to share with you 
information when someone is detailed out of a position, who is 
being identified to replace them, and make sure that those 
periods of time are kept to the least possible so that we have 
permanent leadership at those medical centers.
    We also acknowledge, through our all-employee survey data, 
that employee engagement is higher at those medical centers 
where they have permanent leadership. So we are going to 
continue to work with you and the Committee to make sure that 
you get information when individuals are detailed out of those 
positions and how long it is taking to get permanent leadership 
in those positions.
    Senator Boozman. Thank you very much. Thank you, Mr. 
Chairman.
    Chairman Tester. Senator Brown.

                     SENATOR SHERROD BROWN

    Senator Brown. Thank you, Mr. Chairman. Thanks for how 
seriously you take this issue. I appreciate that.
    Ms. Therit, thanks for your testimony. I want to raise an 
issue that VA employees have talked to me about, and to my 
office, about the executive leadership teams at different 
medical centers have apparently have not worked collaboratively 
enough with local union leaders. I hope that you and folks at 
the VA Central Office remind staff in the field that a strong 
labor management relationship is essential to the effective and 
efficient operation of VA and to improve the provision of care 
and benefits to veterans. And the unions, as you know, unions 
are an important component of that.
    Last year, Congress included several workforce provisions 
in the PACT Act. As I travel the state and do roundtables with 
veterans in every part of the state we can all envision this 
surge in care and the importance of scaling up hiring. So I 
know we have required VA to implement a national recruitment 
and hiring plan. I think of the hospital in Ohio, in 
Chillicothe. There are plenty of community-based outpatient 
clients too that are in rural areas.
    So talk about, given the challenge, provide us with an 
update on that plan, if you would.
    Ms. Therit. Senator Brown, thank you for that question. I 
want to reinforce our commitment to working with our labor 
partners. Our American Federation of Government Employees is in 
town this week, having their semi-annual meeting. I know the 
Secretary is addressing them as well as other leaders within 
the Department. We have also recently reached a memorandum of 
agreement with the National Federation of Federal Employees, 
continuing to find ways to improve hiring. So we are actively 
working with all of our labor partners. I know when the 
Secretary visits our facilities he meets with them and asks 
them about their labor management forums, makes sure that they 
are meeting and actively engaging.
    With respect to the PACT Act, we have implemented every 
provision except for four that are pending: the rural 
recruitment plan, that I mentioned, the one-year plan that we 
owe the Committee on human resources positions, recruitment, 
and retention, as well as the service contract buyout policy, 
which is being drafted and soon to be released. And then, 
finally, we are also working on the final provision with the 
Office of Personnel Management around pay waiver authority.
    But every other authority is available to our workforce. We 
implemented them in waves. The first wave was removing the 
restrictions on hiring housekeeping aides. We know how 
essential those positions are to our medical centers. The 
second wave was ensuring that we are bringing in the next 
generation of talent to the VA. That was expediting hiring of 
college graduates, post-secondary students, and increasing 
limits on student loan repayment program. The third wave was 
around retention, removing some of the caps on bonuses and 
awards for our hardworking VA employees as well, as Ms. 
Bonjorni had mentioned, increasing those special contribution 
award limits so that we can really recognize the great work 
that is happening across the Department.
    The fourth wave focused on our systems. As important as our 
people are, we do not want to lose good people to being 
frustrated with the systems that they have to use to perform 
their daily job. So with respect to our HR system we improved 
some enhancements so that individuals can see where recruitment 
actions are in the process. We added some employee self-service 
capabilities, so employees are able to use those systems to be 
able to do things more effectively and efficiently.
    And the last wave is implementing all of our pay 
authorities. Critical skills incentives are being processed. 
Recruitment, relocation, and retention incentives are being 
processed at the higher limits. Critical pay positions are 
being identified, as well as special salary rates implemented 
to keep up with the tight labor markets and competing with the 
private sector.
    So all of those provisions of the PACT Act are actively 
being rolled out. I know Ms. Bonjorni and her team are 
communicating them to the field so that we are leveraging all 
of these authorities to ensure that we have staff at the levels 
that we need them.
    And I think the events that have been happening in VHA and 
VBA are demonstrating that VHA, as I mentioned, has already 
brought on over 22,000 external hires in five months. That is 
record-breaking. The Veterans Benefits Administration has grown 
by 5 percent in bringing on over 2,000 new hires to process 
claims. And our retention rates are lower, half of what they 
were a year ago. We were seeing 4 percent turnover. This year 
we are about 2 percent turnover.
    Senator Brown. Retention rates are twice, not half.
    Ms. Therit. Our turnover rate is cut in half.
    Senator Brown. Thank you. Thank you. And I just want to 
remind you that this is the most pro-worker, pro-labor 
administration probably in my lifetime, as you work your way 
navigating each of these waves, as you implement the PACT Act.
    One other question, Mr. Chairman. Local VA employee medical 
center directors talk about the human resource modernization 
efforts that started in 2018. Some of us thought that was a 
wrong-headed move by the previous administration of the VA. We 
can put that aside for a moment. But it is clearly harder to 
hire people. There are other factors. I am not putting it all 
on this. It takes longer to get folks--I had never heard the 
word ``onboarded'' until you used it today. I get what that 
means. They leave for a job in the community facilities, I 
mentioned Chillicothe but others, the more urban centers too, 
have been hosting local hiring fairs to get folks hired more 
quickly.
    Tell us why we cannot just move back to a model where local 
HR professionals, who know the facilities' needs, who know the 
communities' needs, why do we not go back to their being 
directly responsible for hiring folks in these facilities?
    Ms. Therit. Senator Brown, I am going to ask Ms. Bonjorni 
to answer the question on the VHA modernization efforts.
    Ms. Bonjorni. Sure. Thank you for the question, Senator. I 
remember being here----
    Senator Brown. I am sorry to interrupt, but from Senator 
Tester's question to both of you about how long it takes a 
doctor to be onboarded. It just does not make sense to me that 
we are not driving this locally, where they know the 
community's needs, they know the facility's needs, and they can 
make it much faster, I would think, than going up to Ann Arbor, 
in my case, or even to Washington.
    Sorry I interrupted. Go ahead.
    Ms. Bonjorni. Sure. If we look at our data on how time to 
hire has trended over time, right now our time to hire has 
returned to pre-pandemic levels. When we had special 
authorities, we were able to hire faster than we are able to 
hire right now. But that is not tied to the organizational 
structure of our human resources.
    In fact, the change that we made to move to shared services 
for human resources allowed us to hire the volumes we have been 
hiring, allowed us to rapidly change policies and practices 
tied to special hiring authorities during the pandemic, and 
allowed us to shift resources. The challenge we had with 
decentralized human resources is that smaller facilities, 
especially, had a challenge keeping HR staff on board, and then 
when they had vacancies they had no one to hire. So moving to 
shared services allows us to shift across an entire region to 
facilitate the hiring process.
    Chairman Tester. Senator Tillis.

                      SENATOR THOM TILLIS

    Senator Tillis. Thank you, Mr. Chairman, and thank you both 
for being here.
    Mr. Chairman, I would like unanimous consent to send forth 
an article that was published in MilitaryTimes talking about 
this subject.
    Chairman Tester. Without objection.

    [The article referred to appears on page 46 of the 
Appendix.]

    Senator Tillis. Yes, and we will make sure you all have a 
copy because I would like you to fact check it. In your 
testimony, some of it you have already affirmed. But it talks 
about some of the structural problems, the workload for 
existing employees and challenges that you all are having. And 
I think that on one hand you have got a lot of people working 
hard serving veterans, and on the other hand we have got a lot 
of vacancies to fill.
    Senator Tester asked about, it is my understanding it is 
now, without the emergency authorities, 100 to 120 days for 
hiring, onboarding process, and I had a report it is somewhere 
close to 80 different steps along the way. I would like to get, 
specifically, what it is, because how many of those steps were 
going to job fairs or job environments, so they are pre-real 
onboarding. They are candidate selection, and then all the 
things you have to go through. Because without the emergency 
authorizations that you had--and, Mr. Chair, I think we should 
go back and say if it is working why did we stop it. I 
understand why but Congress can fix that.
    But, you know, if I am a medical professional, a clinician, 
a nurse, or somebody that you are looking for to ramp up the 
PACT Act or other things, this is a highly sought skill in the 
private sector. And even with your signing bonuses and other 
things you are going to have a very difficult time. And if 
somebody is smart and they are looking at an offer--and most of 
these people are. They are well-educated, well-trained--if they 
got an offer from you and you say, ``Now we have just got to 
complete the remaining 60 steps of the process. We are going to 
make a decision in 100 to 120 days,'' number one, they probably 
have a hedging strategy and they are looking at other 
opportunities, and number two, they are likely not going to be 
there when you need them. Not in every case but in many cases.
    And so just a quick question, for, let us say, specialties 
that you hired under the emergency authorities under COVID. How 
many of those people have you fired, proven to be unqualified 
for the position that they were hired for?
    Ms. Bonjorni. Senator, we can certainly come back to you 
with that information.
    Senator Tillis. I would like to know. My guess is only a 
handful, if any at all. And my point there is one of the 
lessons that we are not learning consistently about the 
emergency orders that we had under COVID, whether it is FDA 
emergency use approvals, whether it is hiring approvals in the 
VA. You got a chance to use it, you got a chance to stress-test 
it. If it proves to be efficacious then you all should be 
coming back to us and saying that these temporary authorities 
need to be reinstated. Because if you are still working with an 
80-step plan and a 100- to 120-day process--some of it was 
imposed by VA, and you should figure out which of those you can 
streamline, some imposed by Congress--we have got to fix it 
because you are not going to be successful no matter how hard 
you work, and I know you are all working hard. I have generally 
very good things to say about the VA, and I think my time on 
this Committee has proven it. I know you are trying to solve a 
problem.
    One thing that I think would be helpful, number one is 
timely response to questions for the record. If you go back in 
my history that are not gotcha questions. They tend to be 
geeky, technically oriented, focused on implementation. But I 
have got QFRs out there since September of last year. So if you 
want us to help you, you have got to help us and give us, at 
least in my case, and I will speak for my questions, I think we 
need a more timely response, and we have got to put a priority 
on that.
    Chairman Tester. Excuse me just for a second. Stop the 
clock. This is really, really, really important. If we have got 
a member, especially off of this Committee, that asks 
information--and look, I have been here when people have given 
you busywork. Stop the clock, because I want him to have his 
minute left.
    Senator Tillis. I had four minutes left.
    Chairman Tester. No, you did not.
    [Laughter.]
    Chairman Tester. To be sure you had 56 seconds left.
    But the truth is if a member of this Committee wants to get 
information it should be a priority. And if Senator Tillis, who 
I do not agree with all the time, by the way----
    Senator Tillis. Most of the time.
    Chairman Tester [continuing]. But I agree with him most of 
the time, has a question out from September and he still has 
not gotten an answer for it, I hate to tell you but on the farm 
they call that bull-something, Okay?
    Senator Tillis. Bull butter.
    Chairman Tester. Go ahead.
    Senator Tillis. And again, it may even be that some of that 
information is not relevant based on where we are today, but 
just a question.
    One thing that I would like to get you all to commit to is 
that in each category, each unique category you have got a 
different story to tell about potential candidates. You have 
got a different story to tell about process execution, how 
long. You have got a different story to tell about people you 
really wanted to hire but they just could not wait the 100 or 
120 days. And then you have also got a story to tell about 
where the market is just not providing enough of these people 
wherever you are going to hire them.
    And we will form it as a QFR, but I think you understand, 
strategically, what I am talking about. If you are heading the 
recruiting and the HR function, you need to know what you need 
for critical staffing levels, and you need to communicate to us 
the ones that you are simply not going to be able to do with 
the current constraints, and some of them you are not going to 
be able to do to fully implement the PACT Act and other things 
that are very important to us.
    So it would be helpful if we got that, to what extent you 
need help to achieve at least a minimum performance, and where 
we have got to think differently about staffing out the VA.
    Thank you, Mr. Chairman.
    Chairman Tester. Senator Hassan.

                  SENATOR MARGARET WOOD HASSAN

    Senator Hassan. Thanks, Mr. Chair, and thanks to our 
witnesses too for the work you do.
    I really appreciate the increased effort by VA to fill 
vacancies in the Veterans Health Administration. We have just 
been talking about some things, and I agree with my colleagues, 
we should be looking at new ways, things we have learned from 
the pandemic if we can.
    But I wanted to drill down on a bill that Senator Braun and 
I worked on that was signed into law. In 2021, we passed the 
bipartisan Hire Veterans Health Heroes Act. And it was signed 
into law. It directs the VA to recruit and hire Department of 
Defense medical personnel who are transitioning out of military 
service for open positions at the VA. Can you discuss how 
implementation of this is going?
    Ms. Therit. Senator Hassan, Ms. Bonjorni's team has been 
implementing that bill so I am going to ask her to answer.
    Senator Hassan. Great. Thank you.
    Ms. Bonjorni. Sure, and thank you for that bill. We are 
very supportive of it and have taken it very seriously in 
implementation. We are working closely with DoD. We have a 
direct marketing campaign that we use, based on the 
occupational code of people transitioning out, where we send 
them messages and encourage them to come work for us. We have 
also established a new physician provider recruiter position at 
facilities, and those are the people who go out to different 
military installations and pitch VA as an employer directly to 
people when they are transitioning out. We also have a 
dedicated location on our VA careers website, not to be 
confused with the bill, that directs transitioning military 
members to come work for the VA.
    Senator Hassan. Are you seeing results?
    Ms. Bonjorni. We are. So right now the physician provider 
recruiters are a new position, so we are waiting to see the 
impact of that. But we do anticipate that we will see more of 
that as we have that boots on the ground support.
    Senator Hassan. Yes. Okay. Thank you.
    Ms. Therit, in response to a letter that I led last year, 
the President's Pay Agent recently expanded competitive 
locality pay to areas in New Hampshire and Vermont that 
struggle to recruit and retain Federal employees. These areas 
include the VA Medical Center in White River Junction, Vermont, 
which provides services to many veterans living in New 
Hampshire.
    How does expanding competitive locality pay help VA recruit 
and retain highly skilled workers in rural areas, including at 
rural VA health facilities?
    Ms. Therit. Senator Hassan, we are members of the Federal 
Prevailing Rate Advisory Committee as well as the Federal 
Salary Council, and we are always looking for opportunities to 
promote the locations where we are seeing that our wages are 
not keeping up with the salaries in that area. So we welcome 
the opportunities to do both, in those forums and other forums, 
bring forward areas where locality pay is lagging or efforts 
need to be made to address those.
    The one challenge that we have with our wage grade 
workforce is that work is done by our Department of Defense 
colleagues, so we need opportunities to both leverage the 
Federal Salary Council as well as the Federal Prevailing Rate 
Advisory Committee so that we can find pay equity across the 
board, not just with our GS, general schedule, positions, but 
also with our wage-grade positions.
    So we welcome opportunities to work with you and other 
members where those locality pay areas need to be adjusted and 
bring those locations forward in those forums.
    Senator Hassan. I would look forward to following up with 
you on that because it is obviously a critical issue not only 
in my area but I think for a lot of the members of this 
Committee and for our constituents and veterans.
    I want to switch topics a little bit. I frequently hear 
from Granite State veterans about how much they appreciate 
their VA nurses, their doctors, their caregivers, but far too 
often they have to get care elsewhere because we have had real 
infrastructure issues in New Hampshire--failures, not just 
issues.
    The VA Medical Center in Manchester is more than 70 years 
old and its facilities are inadequate and frequently fail. 
Twice in the past year Manchester VA Medical Center closed 
portions of its campus because of burst water pipes, and that 
has forced veterans to go elsewhere for care, and reduced 
available treatment spaces, obviously, for clinicians.
    Can you discuss what impact infrastructure failures like 
these have on recruitment and retention challenges that we are 
all talking about today?
    Ms. Bonjorni. Well, Senator, I think that the wage issues 
that Tracey mentioned earlier really are where we can speak to 
that, and making sure that the people who maintain those 
facilities, some of them quite aging, need to be paid effective 
wages. So we have boiler plant operators, HVAC operators, 
engineers, folks who maintain the facilities, we need to be 
able to pay them fairly to keep the facilities running.
    Senator Hassan. Right. But look, I will tell you that no 
matter what your skill as a facility manager, when you have 
pipes that have been soldered with different materials that are 
not particularly good for cold weather, for instance, you can 
be the best manager in the world, and we really need to upgrade 
these facilities. And in my experience, having done a fair 
amount of HR-related work, people look at what their workspace 
is going to be like and whether they are going to have the 
modern tools and spaces they need to provide excellent care, 
and in New Hampshire that is getting harder and harder for our 
clinicians to do.
    So as you get feedback about that as a factor that people 
may be considering in their decisions, you know, highly sought 
after clinicians are going to have choices. And it seems to me 
that if we are providing them with very old infrastructure 
where they cannot be guaranteed that they can give quality care 
to patients, that that is going to be a recruitment problem. 
Thank you.
    Chairman Tester. Senator Blackburn.

                    SENATOR MARSHA BLACKBURN

    Senator Blackburn. Thank you, Mr. Chairman, and thank you 
all for being with us today.
    Ms. Therit, I want to ask you about how we continue to have 
providers who have as many as five documented cases of 
delivering substandard care. And as I have looked through the 
proposed market pay system I really--it is hard to square how 
we would give local leaders more flexibility when we have an 
issue with having these providers that give substandard care.
    And then what I would like to know is do you have a policy, 
is there a policy in place that removes these providers and 
puts them on a do-not-rehire list? So if you will just walk me 
through that.
    Ms. Therit. Senator Blackburn, I am going to ask Ms. 
Bonjorni to speak to the processes that are used to address 
that substandard care and how it would be applied in this 
market pay system.
    Ms. Bonjorni. Sure. Thank you for the question, Senator 
Blackburn. We do have processes in place to do ongoing 
monitoring of the competencies of our providers as well as 
focused evaluations if there is a concern raised. Those 
processes are standard and consistent with how they operate in 
the private sector. And so the number where we have substandard 
care being provided is a very low fraction of our workforce, 
and absolutely we would be making sure that we take those 
seriously and address them through normal disciplinary 
processes, through the Medical Executive Committee in each 
case.
    The compensation structure is not tied to that 
specifically. If we had somebody who was in a situation where 
they were providing substandard care we would address that 
through disciplinary processes or removing their privileges. 
The compensation system is designed to operate for the vast 
majority of providers who are providing excellent care to 
veterans, and so we would look at performance indicators, 
certainly, in that evaluation of setting pay.
    Senator Blackburn. Okay. and then how do you apply this and 
how do you get a waiver on the cap for physicians and dentists 
and professionals, medical professionals, that do not provide 
patient care but are on staff? What is your differentiation 
there?
    Ms. Bonjorni. So we would continue to use the pay table 
structure that we already have for physicians, dentists, and 
podiatrists, and potentially optometrists if the new law 
passes. Usually clinical providers are accounted for in the 
first few pay tables and then the last one is for supervisory 
type of positions that may not provide direct care. So we do an 
evaluation based on how they might be paid in the private 
sector.
    Senator Blackburn. So you use some subjectivity and 
flexibility on that table.
    Ms. Bonjorni. Yes. There are pay ranges for each one of 
them.
    Senator Blackburn. Okay. That is great. Thank you for that. 
And then I have got a question on the PACT Act, because VBA has 
talked about the number of additional claims processors that 
are going to be needed to handle this and to handle the call 
centers for what they are expecting from the PACT Act. And we 
have discussed personnel and being able to meet that demand 
some with the Secretary. And it is hard to kind of look at 
this. So many people are still working remote, and then we have 
this huge backlog, and then we are expecting to have this 
influx.
    So walk me through the hurdles that you have in hiring and 
getting people trained and what the problem is addressing this 
in a timely manner.
    Ms. Therit. So Senator Blackburn, specific to our Veterans 
Benefits Administration, they have done exceptional work with 
their onsite hiring events and being able to staff to the 
levels that they need to process the PACT Act claims. 
Productivity last year was at record levels in terms of having 
a hybrid work environment where they were able to work onsite 
as well as telework and be able to deliver those benefits to 
those who are filing those claims.
    In terms of training, we are working very closely with the 
Veterans Benefits Administration to make sure they have the 
resources that they need so that they are not taking folks off 
the lines to conduct the training and putting them back on to 
process claims. So we are actively working with them and using 
the direct hire authority that the Office of Personnel 
Management gave us over the next five years to be able to hire 
up to 15,000 claims examiners. So really working closely with 
them to make sure that they have the resources on board, using 
every authority available in the PACT Act.
    Senator Blackburn. And, of course, having people still 
working remotely, you have got this backlog that is enormous. I 
mean, I am having a tough time squaring what you all are saying 
you are doing and not getting a specific timeline, and then 
looking at this backlog that continues to grow, continues to 
grow. And it is a tremendous frustration when we have veterans 
that are waiting 100 days in Tennessee for a primary care 
appointment. It is so unacceptable when they cannot get to 
professionals within that system. And then there is hesitancy 
to do community care. We have a lot of frustrated veterans.
    But we appreciate the work that you are doing, and thank 
you, Mr. Chairman.
    Chairman Tester. Senator King.

                   SENATOR ANGUS S. KING, JR.

    Senator King. Thank you, Mr. Chairman. If you are curious 
about status on this Committee, those of us who have our own 
desk, that is a special status, just so you know.
    [Laughter.]
    Chairman Tester. You ain't kidding that is special.
    Senator King. Maybe not in the way that I meant.
    I want to follow up on Senator Brown's question. Why can't 
hiring be local? If the CBOC in Bangor needs a social worker, 
why do they have to have anything to do with Washington or 
Boston? Why can't that decision be made in Bangor? We need 
somebody, we have got the authority, we have got the budget for 
it, we want to post it and hire them. And maybe they can do 
that, but let me know.
    Ms. Bonjorni. Yes, Senator King, thank you for the 
question. They do have the authority to make all the decisions 
about the hiring process at the local level, so the decision-
making remains local. It is the processing actions that human 
resources takes that are now handled primarily at a shared 
service unit, but there is still HR staff onsite at the 
majority of our facilities.
    The challenge that we face right now in a post-pandemic 
world is it is very difficult to find HR staff who are a 
mission-critical occupation across the Federal Government in 
almost any location and especially in some of our more rural 
sites.
    Senator King. My impression is there are steps that have to 
be involved that take it back to Washington, that decisions are 
made other places other than onsite. Am I wrong about that?
    Ms. Bonjorni. Decisions made in Washington related to 
hiring would be related to executive hiring but not to any 
frontline staff hiring decision.
    Senator King. Okay. Now let me dig into the numbers a bit. 
Well, that is encouraging, by the way. I appreciate that.
    We have been talking about time to onboard someone. I take 
it that is from the time that the job is posted, this 120 days 
we have been talking about?
    Ms. Bonjorni. It is earlier than that. So the time-to-hire 
model that is used across the Federal Government is from the 
date the position is approved to recruit, so that includes 
getting ready to post the job, posting the job----
    Senator King. So I am looking for the number further back. 
How long does it take to get approval to recruit?
    Ms. Bonjorni. Within VHA, getting approval to recruit is 
taking quite some time at this point. So that is taking almost 
as much time right now as it takes to do the rest of the hiring 
process, which is why we are focusing on this full time to 
fill, which is what we call that part of it, from the time the 
vacancy occurs until the time it is no longer available.
    Senator King. So it is really not 120 days. It is 240 days 
or more.
    Ms. Bonjorni. Right now the time to fill in VHA is closer 
to 230 days.
    Senator King. That is a long time.
    Ms. Bonjorni. I agree.
    Senator King. And the other question I wanted to dig in on, 
the 120, 240, 230. I take it that is some kind of average. Are 
there different numbers for different types of jobs?
    Ms. Bonjorni. Yes. We have different targets and different 
averages for different types of jobs, and there is variability 
across the system. Some locations are hiring faster than 
others.
    Senator King. Could you give us a list of occupations and 
give us the time-to-hire number for the various billets, if you 
will?
    Ms. Bonjorni. Absolutely. Some information about time-to-
hire is already provided in the publicly reported MISSION Act 
505 data, but we can provide you with additional information.
    Senator King. Why does it take so long before you get to 
the posting? Why does it take 120 days? If you have got a 
social worker at the CBOC and they leave, why does it take so 
long to decide you need another one?
    Ms. Bonjorni. This is something that we are working through 
right now. At local facilities each have a process that they 
use to manage resources and determine when positions can be 
backfilled automatically and others have to come back to a 
review to evaluate the budget before they are allowed to 
recruit. So this is something that every single facility is 
very focused on during this fiscal year as we are just now able 
to track that data for the first time this year. So now that 
they can see the data, they can work to improve it.
    Senator King. Well, you used the word ``review.'' Who does 
the reviewing?
    Ms. Bonjorni. The reviewing of whether or not a position 
can be filled?
    Senator King. Correct.
    Ms. Bonjorni. Generally a resource management committee.
    Senator King. And where are they?
    Ms. Bonjorni. At the facility.
    Senator King. At the facility.
    Ms. Bonjorni. Yes.
    Senator King. Not in VISN 1 or----
    Ms. Bonjorni. No. It is a facility decision.
    Senator King. Thank you. Thank you, Mr. Chairman.
    Chairman Tester. Senator Sullivan.

                      SENATOR DAN SULLIVAN

    Senator Sullivan. Thank you, Mr. Chairman, and I want to 
follow up on my good friend, Senator King. We have a great VA 
workforce in Alaska, but they have asked the identical 
questions on this timeline in which you guys get to announce 
vacancies, and then the timeline in which it takes to fill 
them.
    And this was just a very specific question, the identical 
question, really, that a lot of the VA in Alaska, you guys have 
done a great job over the last 4 or 5 years to really surge big 
hiring in my state, and then it has kind of diminished. And one 
of the big challenges, when I talk to the VA employees in 
Alaska, is exactly what Senator King mentioned.
    So is there a way for you guys to look at this and maybe 
come back to the Committee and try to truncate this timeline, 
both on the posting and the time it takes in which to hire? 
Because, you know, you have got people who might be interested 
and they are kind of hanging out there for 6 or 7 or 8 months, 
and then you lose interest or they have another opportunity. 
But it seems kind of like a self-inflicted wound, and this is 
directly what I am hearing from the VA employees in Alaska. So 
can you guys come back to the Committee and maybe say, ``Hey, 
all right, we have thought about it. You have got two different 
Senators raising it. Here is what we can maybe do to kind of 
shorten this timeline to bring on more workers.''
    What do you think?
    Ms. Therit. Senator Sullivan, I would welcome that 
opportunity. We are equally frustrated. I think that is one 
thing our labor partners and we agree on is that it takes too 
long to hire.
    Senator Sullivan. Yes, and if you need statutory authority 
or--no offense, but whenever I hear you say, ``It is done by 
committee at a facility,'' I am just like, oh geez, that is 
going to be a year.
    Ms. Therit. Well, I think we are having the conversations 
that we want to have, but there is a time to fill, which is 
from the time somebody leaves until that next person arrives. 
That is really the impact at the local level. And then there is 
the time to hire, which is the Office of Personnel Management 
model, which gives you all the steps that need to be done, and 
what they say is 80 days is their model. Eighty days is still a 
long time.
    Senator Sullivan. A long time.
    Ms. Therit. And then we talked about----
    Senator Sullivan. Too long.
    Ms. Therit [continuing]. With Senator Tillis the 
authorities that we had to expedite the process, and Ms. 
Bonjorni mentioned two weeks. I mean, that is what we really 
strive for. So when we look at all of this collectively how we 
can work together to achieve that outcome is really what we 
want to do.
    Senator Sullivan. Well, why don't you guys try to come back 
to this Committee and give us your plans, and thoughts and 
ideas on it, because I think it is kind of a win-win. And if 
your employees are telling us--they are certainly telling me--
and if Senators are raising it, and if you guys agree, and if 
you need authorities we will give them to you, but it does not 
seem like you would need authorities.
    So can I get your commitment you guys will come back to the 
Committee with ideas on tightening that?
    Ms. Therit. You have our commitment, Senator.
    Senator Sullivan. Okay. And then my other quick question 
is, you know, one thing that we do on this Committee is look at 
ways in which our veterans who are getting out, who are still 
on active duty, can plug into like the labor unions, or go 
through an apprentice program with IBEW, and so they are 
plugging into a good job even before they are off active duty.
    I like that idea. We try to do that a lot in Alaska with 
our active-duty military force. But it just seems to me, do you 
guys have a program like that? So do you see what I am saying? 
Like let us say a guy has four more months on active duty. I 
know the State of Alaska actually has a program where you could 
bring in a currently serving military member and say, ``Hey, 
here is some training. Here is what we would like, if you guys 
are interested, and we will hire you the minute you walk out 
the gates of Elmendorf Air Force Base.''
    Does the VA have anything like that, because it would seem 
like that would be a no-brainer. A lot of military guys want to 
join the VA. You guys can train them and entice them while they 
are still on active duty. Do you have a program like that?
    Ms. Therit. So Senator Sullivan, we do partner with the 
Department of Defense on their SkillBridge program.
    Senator Sullivan. Yes, SkillBridge. That is exactly what it 
is.
    Ms. Therit. And we have worked with them. One example is 
with our police officers. Police officers are a shortage 
occupation. We have a law enforcement training center in Little 
Rock, Arkansas. We work with those transitioning servicemembers 
who may be interested in coming to join the VA team after they 
get out, send them through those training programs. The 
challenge is resources and the ability to run those programs.
    Senator Sullivan. Yes. But you do the SkillBridge program?
    Ms. Therit. We do.
    Senator Sullivan. Okay. Good. Thank you, Mr. Chairman.
    Senator King [presiding]. On behalf of the Chairman, 
Senator Blumenthal.

                   SENATOR RICHARD BLUMENTHAL

    Senator Blumenthal. Thank you. Thank you, Senator King. 
Thank you, Mr. Chairman, and thank you for being here.
    I know that the VA is struggling with the same challenges 
that every private employer is, and we see it in Connecticut, 
the need for training and skills and so forth. We have just 
provided you, and I know others have asked about it, with a new 
responsibility in the PACT Act. I want to ask whether you think 
there are different skills required to process these 
applications, considering that there is now a presumption in 
the PACT Act that certain facts will justify a service-
connection for certain kinds of diseases, and how much of a 
burden will it be in terms of additional skills that will be 
required to implement it?
    Ms. Bonjorni. On behalf of the VBA team, which I am not a 
part of, I think as they look at their claims examiners they 
are designing the new skills that they are going to need to 
evaluate into their training. As far as for our providers, in 
VHA we have provided all the information to them about how to 
make the appropriate evaluation of veterans when they come in, 
and we believe they already have the skill sets they need right 
now to do additional exams for veterans.
    Senator Blumenthal. Are you then equipped, being staffed up 
to do these evaluations now?
    Ms. Bonjorni. We are continuing to staff up. So getting to 
our 52,000 hire goal this year will help us meet that 
expectation, yes.
    Senator Blumenthal. By what time period?
    Ms. Bonjorni. The 52,000 goal is for this fiscal year, so 
by September 30th of this year, but we do also anticipate some 
additional needs related to the PACT Act over the course of the 
next decade. But we think so far, with our attrition rates 
trending downward, we will probably surpass our 52,000 goal 
this year, so I believe we will hit that before the end of the 
fiscal year.
    Senator Blumenthal. So you do not see personnel, that is 
recruitment, as being at all an obstacle to implementation of 
the PACT Act?
    Ms. Bonjorni. Not an obstacle for VHA. VBA, I know, is also 
continuing to recruit. We do not think that is going to be an 
obstacle. It is the same obstacle that we have, though, in 
general, separate from the PACT Act, that the labor market 
continues to be tight and especially for some of our entry-
level occupations we are still having a hard time competing at 
the lower-wage categories.
    Senator Blumenthal. Is that true in some parts of the 
country more than others?
    Ms. Bonjorni. It is but it is also a national problem that 
we are facing, as well as when you look at more entry-level 
health care positions, like nursing assistants and LPNs, that 
is an area where we are continuing to see high attrition and 
fewer people wanting to go into those careers.
    Senator Blumenthal. Why do you think that is?
    Ms. Bonjorni. The state of the health care environment over 
the last couple of years. They are stressful jobs that are very 
important but they are probably not earning enough money. So in 
the VA we will use the PACT Act to help us entice them to come 
into the occupation.
    Senator Blumenthal. The PACT Act could be a recruitment 
tool.
    Ms. Bonjorni. Absolutely.
    Senator Blumenthal. Great. Thank you very much, Mr. 
Chairman.
    Senator King. I was just making a note to close this 
hearing with a quote from Abraham Lincoln about change, that I 
think is very applicable to this situation. ``The dogmas of the 
quiet past are inadequate to the stormy present. The occasion 
is piled high with difficulty. Therefore, we must rise with the 
occasion. As our case is new so we must act anew and think 
anew, and then we shall save our country.''
    We are in a perfect storm of the PACT Act, the tight 
economy, the aging veteran population, and we have to really be 
thinking anew about how to meet that challenge, because time is 
of the essence. We are in a race with the claims coming in, 
with the aging veterans, and with the tight economy, that is 
very difficult for everyone to obtain new employees. We cannot 
let the veterans down by not meeting that challenge.
    Thank you very much for your testimony and for joining us 
today, and we look forward to continuing to work with you on 
this issue.
    Thanks again. The hearing is adjourned.
    [Whereupon, at 4:10 p.m., the hearing was adjourned.]






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