The U.S. Department of Veterans Affairs has 49,000 jobs to fill, a major reason for the problems plaguing the military healthcare system, a report by the Inspector General indicated Tuesday.

The report says the largest staffing shortage are within VA facilities, with the VA experiencing a lack of qualified applicants because salaries are so low. The Veterans Access, Choice and Accountability Act was passed in 2014 to address concerns about VA care like excessive wait times and scheduling practices at the nation’s 152 VA facilities.

“Lack of qualified applicants and non-competitive salary continued to be the two most frequently cited reasons for severe occupational staffing shortages across VHA [Veterans Health Administration]. The same occupations and the same reasons continue to pose severe staffing issues for facilities,” the report says, and efforts to address the problem are inadequate.

Nearly all VA facilities (96%) reported at least one severe occupational shortage and 39% reported at least 20 occupational gaps. Medical officer and nurse shortages were the most critical with psychiatry topping the list of medical specialties. More than half of facilities (54%) said they were short on primary care doctors.

Among non-clinical shortages, human resources management topped the list followed by police and engineers.

Another problem was the revolving door among medical directors.

“Having effective and stable leadership at VHA medical centers is critical to the facilities’ overall success. Medical center directors make key decisions affecting veterans’ healthcare and shape the careers of staff through mentoring and leadership development,” the report says. “The OIG [Office of Inspector General] found that since 2015, more than 46 facilities annually saw at least one change in medical center directors.”

Frequent changes in directors result in delayed decisions, deteriorating culture and “a workforce that feels abandoned and that nobody cares enough for them to get stable leadership.” Among the reasons cited for leaving were pay and career risks because of heightened public scrutiny.

“The OIG determined that 131 of 140 facilities had severe shortages for medical officers and 102 of 140 facilities had severe nurse shortages. Sixty percent of the facilities noted severe occupational shortages for psychiatry, … and about half of the facilities noted severe occupational shortages for human resources management,” the report says, with the human resources shortages amplifying the other staffing shortages.

Rep. Mark Takano, D-Calif., called the number of vacancies “astounding.”

“We need to know what actions VA is taking to address long-standing staffing challenges and the extent to which VA has made full use of numerous new [hiring] authorities Congress has authorized in recent years,” he said.

In addition, he said, “We need to understand why VA is struggling to use this and other tools Congress has provided.”

“While VA has employees and applicants who are willing to accept a lower salary to be part of an organization with such an important mission [the VA] faces increasing challenges in its ability to attract or retain quality health care professionals when the salary gap continues to increase,” said Daniel R. Sitterly, a VA assistant secretary.

A bipartisan bill has been introduced in Congress that would reform VA hiring practices. The VA Hospitals Establishing Leadership Performance Act would more closely align VA practices to those found in the private sector.

“Human Resources management is a critical part of delivering the high-quality and timely care our veterans deserve,” Rep. Joe Cunningham, D-S.C., said in announcing the legislation along with Rep. Mike Bost, R-Ill. “The VA HELP Act ensures we are attracting and retaining the best possible employees to meet the needs of … veterans.”

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