Lawmakers and witnesses at a Senate Veterans' Affairs Committee hearing earlier this month said the federal pay system poses a significant challenge to the Veterans Affairs Department's (VA) ability to recruit and hire enough doctors and nurses to provide care for veterans. 

Witnesses told the committee that the problem is not just that salaries in the federal system are lower than the private sector but that there are fewer opportunities for medical personnel to advance up the salary ladder, making retaining qualified staff more difficult. 

"Current law only allows the General Schedule salary chart to be extended out an additional 18 steps," Sheila Cullen, medical director of the San Francisco VA Medical Center, said.  "Since most of these employees are hired in difficult-to-recruit clinical specialties, their salary is often set at the higher end of the pay range.  This limits their opportunity for future step increases."

Several witnesses cited the growing vacancy rate of certified registered nurse anesthetists (CRNA) as one example of the magnitude of the problem.  The Government Accountability Office reported that in fiscal 2005, the overall vacancy rate for CRNAs in the VA was 13 percent, and 74 percent of chief anesthesiologists said they had trouble recruiting CRNAs.  Of the 43 medical facilities the GAO surveyed, 15 reported CRNA vacancy rates of 40 percent of higher.  

The average CRNA working in a VA facility was found to be 51 years old and seven years closer to retirement eligibility than those working outside the system, suggesting that the problem will get much worse in the coming years.

The shortage of CRNAs has a direct impact of the VA's ability to deliver health care services.  Of the anesthesiologists surveyed, 54 percent said they temporarily closed operating rooms and 74 percent said they delayed elective surgeries because of vacancies among their CRNAs.

Lawmakers on the committee pointed out that the staff shortages faced by the VA reflect challenges in the US health care system as a whole, particularly in rural areas.  Sen. Richard Burr (R-NC) said that focusing only on the VA system ignores the pressure that other medical care facilities face as they compete for the same specialists.  As an example, he noted that the VA has hired nearly 3,800 mental health workers since 2005 and wondered: "What impact does this have on the supply of mental health workers in the entire medical community, both now and in the long-term?"