The Department of Veterans Affairs has lost employee managers at a growing rate in recent years, which has negatively affected some agency hospitals' efforts to recruit clinical staff.

The impact of the VA hospital network's "systemic, long-standing" challenges with human capital is spelled out in a new report by the nonpartisan Government Accountability Office, and represents one of multiple issues facing the agency under the new administration of Donald Trump.

"VA faces serious and long-standing problems with veterans' access to care and management failures, including ongoing appointment scheduling problems, unreliable appointment wait time data, and inadequate coordination of veteran care between VA and non-VA medical providers," the GAO wrote in a letter to Congress about the audit of the agency's human resources capacity. "A key starting point for addressing VHA's challenges is with its workforce, an agency's most important asset."

Auditors determined that attrition of human resources staff at VA hospitals increased between fiscal years 2013 and 2015, which resulted in "gaps" in care for veterans because of staffing shortages, according to testimony from hospital officials.

"[For example,] HR officers and HR staff with whom we spoke reported that the volume of work and staff turnover has led to delays in the hiring process. Specifically, HR staff at three of the medical centers we visited stated that vacancies in the HR office have led to clinical positions not being filled and resulted in gaps in services provided to veterans," auditors wrote.

"Similarly, HR officials at two of the VISN offices with whom we spoke stated that a lack of HR staff has impacted medical centers' ability to address important clinical hiring initiatives, such as hiring mental health providers."

According to GAO's analysis, more than eight in 10 VA medical centers across the country did not meet agency staffing goals for human resources employees responsible for recruiting new talent and engaging current hospital employees.

VA health care has undergone consistent scrutiny for nearly three years since veterans were found to have died waiting for care at an agency hospital in Phoenix, which prompted Congress to pass sweeping reform legislation. Many Republicans have since called for an expansion of VA's firing powers to punish bad employees and more private care options for veterans, to build on reforms implemented under the Obama administration.

An independent assessment produced in September 2015 assessed the VA as needing "system-wide reworking," precipitating a host of recommendations from a congressional commission to implement wide-reaching reform across the agency's hospital network.

Trump revealed earlier this month that he had selected David Shulkin, a physician who served as VA undersecretary for health under Obama, to serve as VA secretary after meeting with several potential candidates for the job. Shulkin, who is expected to face a confirmation hearing next week, would be the first non-veteran secretary of veterans' affairs. He will replace Robert McDonald, the most recent VA secretary under the Obama administration.

Investigations by government watchdogs have routinely spotlighted management and care shortfalls at VA facilities across the country. A VA inspector general report published last week, for instance, spotlighted persisting environmental issues at the VA hospital in St. Louis, Missouri.

As of mid-January, more than 520,000 veterans were waiting over 30 days for care, down from nearly 550,000 at the beginning of the month, according to internal data released by the agency on Thursday.

Shulkin, when confirmed, will inherit the VA's wait-time and management shortfalls and will oversee Trump's plan to bring reform to the agency. Trump has indicated that he will make it easier for the VA to fire employees for misconduct, create a commission to investigate fraud and wrongdoing by agency employees, and allow all veterans the option to seek care outside the VA, among other reforms.

"We will get our veterans the care they need wherever and whenever they need it," the White House website states. "There should be no more long drives. No more wait lists or scheduling backlogs. No more excessive red tape. Just the care and support our veterans have earned through sacrifice and service to our country."

A director at Concerned Veterans for America, a conservative group that has advocated for radical reform at the VA, told the Free Beacon that Shulkin will have to map out a vision for the VA to reorient agency resources to serve a declining veterans population and make good on Trump's pledges.

"Veterans will be looking to Dr. Shulkin to build upon President Trump's vision of private-public partnerships and pursue a choice-based model for those who wish to use their benefits outside of VA facilities," said Mark Lucas, executive director at Concerned Veterans for America.

"Dr. Shulkin's intimate familiarity with the problems within the VA could be his biggest advantage, if he uses that knowledge to enact smart reforms," Lucas said. "On the other hand, if he chooses to continue the dysfunctional status quo, the incoming administration's promises to veterans will quickly be broken."