[Congressional Record Volume 162, Number 175 (Tuesday, December 6, 2016)]
[House]
[Pages H7248-H7249]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 DEPARTMENT OF VETERANS AFFAIRS EMERGENCY MEDICAL STAFFING RECRUITMENT 
                           AND RETENTION ACT

  Mr. ROE of Tennessee. Mr. Speaker, I move to suspend the rules and 
pass the bill (H.R. 4150) to amend title 38, United States Code, to 
allow the Secretary of Veterans Affairs to modify the hours of 
employment of physicians employed on a full-time basis by the 
Department of Veterans Affairs, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 4150

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Department of Veterans 
     Affairs Emergency Medical Staffing Recruitment and Retention 
     Act''.

     SEC. 2. MODIFICATION OF HOURS OF EMPLOYMENT FOR PHYSICIANS 
                   EMPLOYED BY THE DEPARTMENT OF VETERANS AFFAIRS.

       Section 7423(a) of title 38, United States Code, is 
     amended--
       (1) by striking ``(a) The hours'' and inserting ``(a)(1) 
     Except as provided in paragraph (2), the hours''; and
       (2) by adding at the end the following new paragraph:
       ``(2)(A) Upon the advance written request of a covered 
     physician, the Secretary may modify the hours of employment 
     for a physician appointed in the Administration under any 
     provision of this chapter on a full-time basis to be more or 
     less than 80 hours in a biweekly pay period, subject to the 
     requirements in subparagraph (B). For the purpose of 
     determining pay, such a physician shall be deemed to have a 
     biweekly schedule of 80 hours of employment.
       ``(B) A physician with an irregular work schedule 
     established under subparagraph (A) shall be obligated to 
     account for at least 2,080 hours of employment (through 
     performance of work or use of leave or paid time off) in a 
     calendar year.
       ``(C) The Secretary may prescribe regulations to implement 
     this paragraph, including regulations making adjustments to 
     address the annual hours requirement for physicians who are 
     covered by this paragraph for only a portion of a calendar 
     year.''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Tennessee (Mr. Roe) and the gentleman from California (Mr. Takano) each 
will control 20 minutes.
  The Chair recognizes the gentleman from Tennessee.


                             General Leave

  Mr. ROE of Tennessee. Mr. Speaker, I ask unanimous consent that all 
Members have 5 legislative days in which to revise and extend their 
remarks and to add extraneous material on H.R. 4150, as amended.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Tennessee?
  There was no objection.
  Mr. ROE of Tennessee. Mr. Speaker, I yield myself such time as I may 
consume.
  H.R. 4150, as amended, the Department of Veterans Affairs Emergency 
Medical Staffing Recruitment and Retention Act, would authorize the VA, 
upon written request, to modify the hours of employment for full-time 
physicians to be more than or less than 80 hours in a biweekly pay 
period, as agreed to by the physician and hospital management.
  Earlier this year, the VA testified that there are nearly 4,000 
physician vacancies across the VA healthcare system. The VA's ability 
to effectively recruit and retain high-quality medical professionals to 
care for our veterans is threatened by the Nation's worsening physician 
shortage, which the Association of American Medical Colleges has stated 
could grow to just under 100,000 physicians by 2025. In light of this, 
it is imperative that we provide the VA with every available tool to 
improve physician recruitment and to make efficient use of the current 
physician workforce.
  Currently, the VA's ability in both regards is hampered by a rigid 
80-hour, biweekly work schedule that is at odds with private sector 
industry standards. Typically, emergency room, ER, providers in non-VA 
hospitals across the country work flexible schedules to accommodate the 
irregular hours that emergency medicine demands. However, ER doctors in 
VA medical facilities are not afforded the opportunity to adopt the 
flexible schedules that their private sector colleagues enjoy. This 
bill would correct that discrepancy and improve the VA's ability to 
recruit and retain ER physicians.
  H.R. 4150, as amended, which has my full support, originated as a VA 
legislative proposal and is sponsored by Congressman Raul Ruiz of 
California, who is an emergency medical physician. I am grateful to him 
for his efforts in addressing this issue, and I urge all of my 
colleagues to support this needed legislation.
  I reserve the balance of my time.
  Mr. TAKANO. Mr. Speaker, I yield myself such time as I may consume.
  I rise in support of H.R. 4150, as amended, introduced by my very 
good friend, the gentleman from California (Mr. Ruiz). This legislation 
will improve the recruitment and retention of medical professionals at 
the Department of Veterans Affairs.
  H.R. 4150, as amended, allows the VA to arrange flexible physician 
work schedules to allow for the staffing and full implementation of a 
hospitalist physician system and to accommodate the unusual work 
schedule requirements for emergency medicine physicians. We all 
recognize the need for flexibility when working the rigorous and 
irregular hours that are routinely required of emergency medicine 
doctors. Giving the VA the ability to have flexible working hours that 
best suit the demand for delivering health care to the veterans who 
rely on those doctors just makes sense.
  The current 80-hour, biweekly pay period limitation for these doctors 
creates challenges at the VA medical centers to adequately and sensibly 
staff the emergency rooms. Generally, most healthcare providers work a 
traditional 40-hour workweek. However, for hospitalists and emergency 
room physicians, they may need to work more than that in a week to 
provide safe, quality health care to veterans who seek services at the 
VA.
  Ensuring access to care for veterans has been a major focus of this 
committee's, and this bill will help to eliminate the access barrier 
and provide a more efficient and effective way to ensure that the 
emergency rooms across the VA healthcare system are ready to take care 
of our veterans. Importantly, the bill also includes protections for 
physicians by requiring their consent before they can move to the 
flexible schedule.
  Mr. Speaker, I reserve the balance of my time.
  Mr. ROE of Tennessee. Mr. Speaker, I yield myself such time as I may 
consume.
  I, too, am strongly in favor of this bill. I don't know where Dr. 
Ruiz was with regard to this 40-hour week, but I wish he had been 
around when I was in training and in practice because it would have 
been a joy to have worked just 40 hours. This particular bill allows 
the flexibility that every other hospital in the world has for 
staffing, and this is with the consent of the physicians and the 
hospital. It just makes sense.
  I am so glad that Dr. Ruiz brought this up. As a practicing ER 
physician, he knows about this, and he knows exactly what it is.
  I appreciate Dr. Ruiz bringing this up and making the committee aware 
of it. This will become a new law.
  Mr. Speaker, I reserve the balance of my time.

                              {time}  1600

  Mr. TAKANO. Mr. Speaker, I yield 3 minutes to the gentleman from 
California (Mr. Ruiz), my good friend who is an emergency room 
physician and a member of the Veterans' Affairs Committee.
  Mr. RUIZ. I would like to thank the chairman and the ranking member.
  Mr. Speaker, I would say to the gentleman from Tennessee (Mr. Roe) 
that I too had 100-, 120-hour workweeks and months; and I was the scut, 
of course, during my internships and residency; so I understand the 
words that you have spoken.
  I rise in support of my bill, H.R. 4150, the Department of Veterans 
Affairs

[[Page H7249]]

Emergency Medical Staffing Recruitment and Retention Act.
  The point is this, and it is very simple: the VA needs to provide 
high-quality care that is veteran-centered. That is why I introduced 
this bill which works to address the difficulty of recruiting and 
retaining the best physicians to work within the VA healthcare system.
  The problem is that, by law, the VA is beholden to the bureaucratic 
OPM's 80-biweekly requirement for full-time physicians. This does not 
fit with the current practice of physicians in many specialties, 
including emergency medicine and hospital medicine. These specialties 
typically require more flexible, often irregular working hours--some 
weeks they work less; some weeks they work the triple amount--but it 
needs to fit their schedule in order for them to provide the best care 
that they can for the patient.
  Also, for instance, in emergency departments, it has been studied 
that the most dangerous time for a patient is during shift changes when 
a patient's care is transferred to another doctor. It all depends on 
the quality of the transfer, discussing what happened, and the follow-
up that the second doctor is going to do. Therefore, emergency 
physicians prefer to work 12-hour shifts in order to minimize that 
transfer, and many emergency physicians work beyond their 12 hours in 
order to not transfer and just close the patient's case.
  So this bill would give the VA the flexibility it needs to schedule 
physicians in a manner similar to that scene in the private sector 
while remaining OPM-compliant.
  This bill will provide VA medical centers with the ability to 
implement flexible physician work schedules that can accommodate 
hospitalists' and emergency physicians' schedules and practices.
  Our veterans deserve high-quality care. Attracting the best and 
brightest physicians to practice at the VA is a critical step in that 
direction.
  And like my other bills up for consideration today as part of other 
legislation on the floor--the Veterans Access to Speedy Review Act, the 
Veterans' Survivors Claims Processing Automation Act--this bill works 
to ensure that the VA works for veterans, to make sure that it is about 
serving the veteran.
  Let's pass this bill, Mr. Speaker, and take another step towards 
providing the highest quality care for those who have given the 
ultimate sacrifice to our Nation.
  I thank the chairman once again, and I thank the ranking member for 
his efforts in getting this to the floor today.
  Mr. ROE of Tennessee. Mr. Speaker, I reserve the balance of my time.
  Mr. TAKANO. Mr. Speaker, before I close, I want to just add how proud 
I am that we got this bill over the finish line, working together with 
the majority, working together with the stakeholders.
  I want to give special words of gratitude to the staff in my office 
and the staff on the Veterans' Affairs Committee for working extra 
hours to get this bill done.
  This makes enormous sense to do, and it should have been done sooner, 
but I am very glad we could get it done in this Congress.
  I look very much forward to working with Dr. Roe in the next Congress 
to do similar bills and bills of greater magnitude in the future.
  Mr. Speaker, I strongly support this legislation. I urge my 
colleagues to join me in passing H.R. 4150, as amended.
  I yield back the balance of my time.
  Mr. ROE of Tennessee. Mr. Speaker, I too encourage all Members to 
support H.R. 4150.
  I also want to thank both the staff of the minority and the majority 
for their incredible work. Alex Large, who is on staff in my office, 
has worked very hard on many of these bills.
  This is a time around our country where many of our young men and 
women are stationed in harm's way away from their families at the 
holidays. I too have done that, and I just appreciate very much the 
sacrifice that these men and women make for us each and every day. 
Let's not forget that there are people out there in some very dangerous 
places right now, as we speak, who are protecting our freedoms.
  With that, it is indeed a pleasure to work on this committee because 
it is a bipartisan committee, and I think that the committee is laser-
focused on doing what is right for veterans.
  With that, I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Tennessee (Mr. Roe) that the House suspend the rules and 
pass the bill, H.R. 4150, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

                          ____________________