Up to 37,000 positions may be dropped.
With the VA transformed into a facilitator for outsourcing, sources tell the Prospect.
In late November, a mental health leader at a major VA medical center learned about a directive issued to the 18 Veterans Health Administration (VHA) regional offices, known as VISNs (Veterans Integrated Service Networks). Department of Veterans Affairs’ leaders in Washington were imposing lower caps on employee positions nationwide. Directors of local VA medical centers and clinics had a month to decide which vacant positions to eliminate, and which job offers to rescind. None of these identified positions would be filled because they would be swept from organizational charts entirely. At his facility, 60 percent of the unfilled positions would be lost, including 23 in mental health.
“The past nine months have been very challenging,” the mental health leader told the Prospect. “But this is really going to impact patient care.” He also worried about the effect of cuts on the VA’s critical teaching mission. “The VA trains 50 percent of psychologists in the country,” he said. “Now, we may not have enough staff to supervise trainees.” In the midst of a national mental health professional shortage, reducing VA training capacity ultimately impacts access to mental health care for both veterans and nonveterans alike.
In a follow-up virtual meeting conducted by the VA’s new interim chief operating officer (COO), Gregory Goins, the intention of this policy was made clear. Not only is the Trump administration privatizing the VA by sending more veterans to non-VA providers, but it’s moving VA policies and practices to what was called a “private-sector model,” which will transform the system into just another profit-driven business entity.
The mental health leader explained that there will be a large increase in the facility’s budget for providing private care to veterans but deficits for funding things like in-house care, facility maintenance, and other critical functions. “Essentially,” he said, “they are funding us to do community care.”
The Vacancy Problem
The VHA has long struggled with serious understaffing. The Prospect has previously reported that cumbersome hiring practices have slowed VA hiring for years. Trump-era human resources policies that continued during the Biden administration exacerbated these delays, causing positions to languish unfilled.
The VA Office of Inspector General reported in August that critical occupational staffing shortages are only getting worse, with a 50 percent increase in “severe shortages” between fiscal years 2024 and 2025. Nearly every one of the 139 VHA facilities is impacted across nearly all health-related positions, including doctors (in 94 percent of facilities), nurses (in 79 percent), and psychologists (57 percent).
In 2023, the Veterans Healthcare Policy Institute published survey results of 2,000 employees at both the VHA and the Veterans Benefits Administration (VBA). Among VHA respondents, 96 percent said they were short frontline staff, and 75 percent said more administrators were needed.
Data on VA’s workforce dashboards also confirms understaffing of physicians, nurses, and other essential clinicians. These shortages have grown month after month since Trump took office, with the agency recording a net loss of thousands of positions.
The reductions are occurring despite escalating demand for care. For example, since passage of the PACT Act—which provides services to millions of veterans who experienced toxic exposures since World War II—the VA has conducted 6.4 million toxic exposure screenings and added 739,000 new enrollees to its health care system.
VA spokesman Peter Kasperowicz told the Prospect denied that demand for care has increased. “VA health care enrollment has been flat for a decade, even as the number of VA employees has increased,” he said. “This response,” a veterans service organization (VSO) representative commented, “is typical and ignores the fact that the issue is not simply how many people are enrolled in VA but how many use it and how much they use it. Veterans who have enrolled in the VA because of the PACT tend to have serious health conditions.”
The VA’s own published numbers show that in fiscal year 2023, more than 116 million health care appointments were delivered to veterans, an all-time record. Then in fiscal year 2024, it surpassed that figure again by 6 percent, delivering 127.5 million health care appointments. Contacts to the Veterans Crisis Line continue to increase yearly as well.
Ignoring these challenges, VA Secretary Doug Collins began his tenure by firing 1,400 “probationary” employees with limited job protection, and announcing that he would terminate 83,000 more VA staff. Following protests from VA unions, veterans’ advocacy groups, and congressional Democrats, Collins reduced the cutback to 30,000 jobs. Rather than outright firings, positions would simply remain vacant when someone left the system for another job or to retire. Collins insisted “we’re not cutting VA healthcare providers,” and that care would be unaffected.
The newest announcement of caps makes a mockery of these promises.
How the Caps Will Work
The November 20th memo leaked to the Prospect informed VISN directors that each regional office has been allocated a baseline number of positions for its multiple large medical centers, outpatient clinics, nursing homes, and residential treatment programs, based on an estimated target onboard range. In total, according to the memo’s highest targets, VAs across the nation could lose up to 37,000 unfilled positions, on top of the 30,000 positions already lost this year. Many local VHA health care systems have identified 400 or more positions to be purged.
Ginger Schechter, former chief medical officer of the San Francisco VA Health Care System’s largest community clinic, told the Prospect that 60 percent of the system’s unfilled positions will vanish. Cuts would impact not only the large VA medical center in San Francisco, but outpatient clinics in Santa Rosa and rural areas like Ukiah and Eureka in the northern part of California, as well as a nursing home run by the VA in San Francisco.
In response to our inquiry, VA spokesman Peter Kasperowicz claimed that positions being eliminated are no longer necessary. “Care won’t be affected because no VA employees are being removed. VA is simply eliminating about 25,000 open and unfilled positions—mostly COVID-era roles that are no longer necessary. All of these positions are unfilled, and most have not been filled for more than a year, underscoring how they are no longer needed.”
Missing from Kasperowicz’s statement is an acknowledgment that, to meet DOGE goals in 2025, medical facilities were slow-walking or suspending recruitments—including, as one high-level official told the Prospect, for “mission-critical” or “high-demand clinical positions” (some of which became vacant due to the elimination of remote work). To compensate for fewer employees, remaining staff were saddled with excessive workloads.
The claim that these positions are “unnecessary” becomes even more unjustified considering that many job offers were extended but declined—sometimes because recruits received better offers or because President Trump’s attacks on federal employees and agencies have caused the VA to develop a reputation as a risky career choice. When the drawn-out process stretched to a year, the position was classified as “vacant” the entire time—then abolished rather than offered to a runner-up candidate or readvertised.
Kasperowicz added that “VA medical facilities are continuing to fill more than 40,000 remaining unfilled positions at VA,” implicitly acknowledging the slow hiring process and the need to deal with understaffing.
As this latest reduction got under way, Secretary Collins insisted that his directive will not result in a “significant change in overall staff levels” across the department. Senate Veterans’ Affairs Committee Ranking Member Richard Blumenthal offered a contrary assessment: “Removing these jobs will stretch thin a staff already struggling to meet rising workloads—leading to longer wait times and reduced access to care for veterans.”
Sources inside VA gave the Prospect information that matches Blumenthal’s statement. The aforementioned mental health leader said his facility would lose the ability to hire professionals to assess and treat patients, including a neuropsychologist. “These specialized psychologists,” he explained, “are trained to evaluate patients’ cognitive functioning and are crucial to assessing whether patients have dementia, or traumatic brain injuries.” Not all psychologists, he added, are able to do this kind of evaluation, which is particularly important to diagnosing and treating veteran patients, who skew older than nonveterans and may suffer from cognitive problems. Younger VA patients may also suffer from traumatic brain injuries—a signature injury of the Iraq and Afghanistan wars. Even veterans who have not been in combat may develop TBIs from exposure to concussive blasts during military training.
Without enough neuropsychologists on staff, the work of other clinicians will be impacted. A VA neurologist explained, “I depend on neuropsychologists as the first-line provider for patients with cognitive issues. Their evaluations include various cognitive tests that help me determine what kind of cognitive disorder a patient has and what further tests the patient needs like an MRI or PET scan or blood work.”
Secretary Collins and others who favor outsourcing veteran care to the private sector have dismissed these concerns, reassuring veterans they could seek care through the Veterans Community Care Program, the VA’s private-sector provider network. The mental health leader disagrees. “There are very few qualified neuropsychologists in the community who take insurance. This will mean reduced access to and delays in getting care.”
Indeed, when the Prospect played secret shopper, calling the 12 private-sector neuropsychologists listed on the Community Care provider website as accepting VA patients in the area, the results were pathetic. One listed number was for an airline lost-and-found department, another was out of service, and yet another was answered by a psychiatry clinic for children and teens. Several others were for general psychiatry clinics. Only two of the 12 numbers listed were to actual neuropsychology providers. One offered appointments ten weeks out, while the other explained that there was a six-to-eight-month wait for an appointment.
In a VA COO hotline call, held on December 5th and also leaked to the Prospect, COO Goins told virtual attendees that “if management does not move to either redescribe that position or backfill that position within a certain period of time, it will not stay on an org chart. We’re going to be moving more toward a private-sector model where the annual business cycle plan is what ultimately dictates resources.” The phrase “moving more toward a private-sector model” says all one needs to know about Collins’s intentions.
Goins also informed staff that the VA would not apply traditional methods to determine the appropriate models of staffing in health care institutions, because if those “required staffing methodologies” were applied to the VA, the system would “add about 20 percent to our workforce,” which Goins went on to say “go far beyond what we actually need to do our work.”
A “Perfect Patient Safety Storm”
One high-level VSO representative told the Prospect that these newly announced cuts are not, as the memo suggested, a response to budget shortfalls. “Congress just approved a budget that allocates funding for these positions. The line items went up for VA this year, presumably to pay for people to fill positions,” he said. “So why did VA ask for this budget allocation if they weren’t going to fill them?” The representative then speculated that “the only intention for this seems to be to dump enormous amounts of patients in the laps of non-VA providers.”
“The policy implementation,” one former high-level VA central office official said, “is totally ass backwards. You don’t plan cuts for FY2026 in the middle of FY2026.”
Nor, says Ginger Schecter, do responsible agency leaders impose critical manpower decisions on facility leaders in such a short time frame. “People are panicking because they have to figure out how to meet the expected numbers and do the least amount of harm to the overall level of care provided at the facility in just three weeks. It’s absolutely outrageous.” Under those circumstances, determining where staff could be trimmed is nearly impossible, and the reality, Schecter says, “is that in VA there is almost nowhere staff are not crushed by escalating workloads.”
This chaos is occurring just as the VA plans to expand the rollout of a new electronic health record (EHR). During Trump’s first term, Cerner, a private provider owned by Oracle, won the contract without competitive bidding to replace the VA’s publicly built VistA program. Since 2021, Cerner’s EHR has been piloted in six sites, and in 2026, 13 more will be added in Michigan, Indiana, Ohio, and the entire state of Alaska.
Introducing even the most well-designed EHR, says Ross Koppel, a professor at the University of Pennsylvania’s Perelman School of Medicine and expert in health information technology, can slow down care delivery as nurses, doctors, pharmacists, and others adjust to the technology and adapt it to their local context. In the best of circumstances, “staff are pulled away from delivering patient care to implement the technology and must exercise extreme vigilance to catch and mitigate errors,” Koppel explains. As documented in reports to Congress, including a report just published by the Government Accountability Office, this EHR rollout has been particularly problematic. A December article in the Spokane Spokesman-Review and The Washington Post revealed that the new EHR was linked to 4,601 cases of harm as well as being “a potentially causal factor” in six patient deaths.
The VA maintains that these problems will be solved because it is hiring 400 new staff to help with system expansion. While these hires are sorely needed, they will not compensate for significant shortages of other VA staff. “One of the apparent vulnerabilities of their thought process is that they view this primarily as a technological problem, when in reality it’s much more of an operational problem,” says former VA Under Secretary for Health Kenneth W. Kizer. “You can hire all kinds of technological people but that will not address the fundamental problem of there not being enough doctors, nurses, and pharmacists to deal with the inevitable operational problems that arise when implementing a new technology in a real-world health care delivery system.”
With even more cuts looming, Koppel warns, this expansion represents “a perfect patient safety storm.”
Frontline caregivers in the new rollout sites are worried they will be caught in the storm. A physician at the VA in Indiana told the Prospect that he is very worried that “the combination of staffing shortages and the new EHR could harm a lot of patients as well as leave them so frustrated they will leave the VA for community care, which will drain more VA resources and can feed a vicious spiral where the VA exists only to pay for community care.” He said he is also apprehensive that even more exasperated doctors and nurses will take early retirement or simply move to another job.
Stopping the Juggernaut
While Collins’s new initiative represents another Trumpian exercise in shock and awe, there is reason to believe it can be stopped. When legislators agreed to end the government shutdown in November, the legislation they passed barred any government agency from using appropriated funds to “initiate, carry out, or otherwise notice a reduction in force to reduce the number of employees within any department, agency, or office of the Federal Government.” Reductions in force are then defined by very complicated formulas that make it easy for the Trump administration to argue, as it does, that eliminating vacant positions is not a reduction in force and thus does not violate the law.
If Congress wants to protect the VA from drastic staffing losses, says Eloise Pasachoff, professor of law at Georgetown University, then “when Congress revisits this legislation when the continuing resolution expires on January 30th, it could expand this prohibition to clearly include a prohibition against cutting unfilled positions.”
Veterans’ advocacy organizations who are serious about current and future cohorts of veterans should pressure Congress to follow this suggestion. As the high-level VSO representative said, VSOs need to act more forcefully to protect the VA from assaults that could jeopardize their current members, not to mention future cohorts of veterans.
