LegiStorm

Summary:
What GAO Found

The Veterans Health Administration (VHA)—within the Department of Veterans Affairs (VA)—primarily provided outpatient primary care and mental health services to over 7,700 veterans in the U.S. Pacific territories of American Samoa, Guam, and the Commonwealth of the Northern Mariana Islands (CNMI) in fiscal year 2021, according to VHA data. VHA employed 88 staff across the three U.S. Pacific territories as of September 2022, with the majority working in Guam. Most of the staff in these locations worked in the nurse, medical support assistant, miscellaneous clerk and assistant, and social worker occupations.

It is essential that VHA recruits and retains an adequate number of skilled staff to help it meet its mission of providing quality and timely care for veterans. Federal law allows various flexibilities in how VHA recruits, hires, and retains staff. These human capital flexibilities and incentives include exceptions to the competitive examination process traditionally used to fill federal position vacancies (referred to as hiring flexibilities.) Flexibilities also include use of incentives—such as monetary awards and programs—for recruiting, relocating, and retaining qualified staff.

GAO's analysis of VHA data found that in the U.S. Pacific territories, total employment vacancies decreased from fiscal year 2019 through 2021 (from 32 to 18 vacancies), followed by an increase to 34 vacancies in fiscal year 2022. Guam accounted for the majority (70 percent) of the vacancies across the three territories during this time. American Samoa and CNMI accounted for 25 percent and 5 percent, respectively. GAO found that the top five occupations with the most vacancies during this time frame were the (1) nurse, (2) social worker, (3) health aid and technician, (4), miscellaneous clerical and administrative occupations and (5) medical officer (i.e., physician).

GAO found that VHA used 11 hiring flexibilities to recruit, hire, and retain staff from fiscal year 2016 through fiscal year 2022 in the U.S. Pacific territories. Further, VHA primarily relied on two of those flexibilities that provide VA with the authority to hire medical providers and other medical professionals outside of the typical federal government competitive hiring process. Additionally, VHA most commonly used monetary payments or awards to retain staff from fiscal year 2016 through fiscal year 2022. VHA officials told GAO that hiring new staff is very difficult and, therefore, using retention incentives to maintain existing staff was ideal.

Why GAO Did This Study

In recent years, the VA Office of the Inspector General and GAO have raised questions about whether VHA has the appropriate clinical workforce to meet the needs of veterans in the geographically remote U.S. Pacific territories of American Samoa, Guam, and CNMI. House Report 116-445, which accompanied the Military Construction, Veterans Affairs, and Related Agencies Appropriations Bill, 2021, included a provision for GAO to review the VA hiring activities in the U.S. Pacific territories. This report describes VHA's (1) vacancy trends in the U.S. Pacific territories and (2) use of human capital flexibilities to hire, recruit, and retain staff in those territories.

GAO obtained and analyzed human resources data from VA's human resources database on the number of vacancies in these territories from fiscal years 2019 through 2022, and the human capital flexibilities VHA used to hire, recruit, and retain staff from fiscal years 2016 through 2022. GAO also reviewed VHA documentation and interviewed VHA officials about their hiring, recruitment, and retention efforts in the U.S. Pacific territories.

For more information, contact Alyssa M. Hundrup at (202) 512-7114 or HundrupA@gao.gov.