Kala Kachmar

Montgomery Advertiser

Part of the reason the Central Alabama Veterans Health Care System's facilities can't see patients in a timely manner is that it doesn't have the personnel to see them.

The facility is only about 78 percent staffed, according to a June 27 report from its human resources department.

There are 441 open positions. Of these, about 157 are considered "active recruitments," meaning they've been authorized for hire. There are an additional 282 open positions that aren't being recruited, and two that are considered pending recruits, according to the report.

Although 157 have been authorized for recruitment, there are only 38 CAVHCS jobs posted on the VA's career website, including 14 in Montgomery, 20 in Tuskegee, one in Fort Rucker and three in Columbus, Georgia.

About 15 of those openings are for doctors, including primary care physicians, a nursing home physician, a neurologist, a urologist, a cardiologist, an ophthalmologist and a psychiatrist. The site also lists eight positions for registered nurses and several for pharmacy staff. The rest are mostly medical, mental health and substance abuse support staff.

Several employees, who wish to remain anonymous for fear of reprisal, say one of the biggest problems is a shortage of primary care providers.

Each facility has several teams of staff that provides primary care for veterans. Each team, which when fully staffed can take on 1,100 to 1,200 patients, is supposed to have doctor or nurse practitioner, a registered nurse, a licensed practical nurse and a medical support assistant.

But according to a staff list of primary care provider teams, which doesn't include shortages in staff who provide geriatric primary care, the primary care teams at CAVHCS' five locations are short 10 doctors, seven registered nurses, five licensed practical nurses and 13 medical support assistants.

When fully staffed, the 36 teams are supposed to be able to serve about 43,600 patients. According to a 2013-14 patient trend report, there are about 42,511 CAVHCS patients.

The only facility with fully staffed primary care teams is Monroeville, which has two. Of the 12 teams in Montgomery, seven are fully staffed and there are four physicians, one registered nurse, one licensed practical nurse and three medical support assistant vacancies.

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According to one of the employees who provided staffing data, the situation in Tuskegee is the worst. Fewer than half the teams are fully staffed.

Tuskegee is 4.5 doctors, three registered nurses, two licensed practical nurses and five medical support assistants short.

Several employees said there are thousands of Tuskegee patients seeking primary care appointments — who were previously on paper waiting lists — that have recently been put into the recall reminder, an electronic holding place for patients waiting for appointments.

Although the recall reminder is the appropriate list for those patients, the primary care teams are so short staffed that those patients aren't getting appointments and they aren't getting reassigned to other doctors, an employee said. As openings become available, they're given to new patients and established patients who call for a new appointment.

"Patients don't know they're just sitting there waiting for a provider," the employee said.

CAVHCS Director James Talton has not responded to two recent requests for interviews. But in an interview earlier this month, he said they've been having trouble recruiting and retaining doctors.

"If you don't have the physicians, you don't have the capacity to see new patients," he said. "That's the primary reason that the waiting list is so long. There's a national shortage of providers."

Talton said they're using a recruiter to find physicians, and have been "aggressively" recruiting since he started working at CAVHCS in 2011. He said they hire all the time, but there are physicians who are always retiring, transferring and going on to better opportunities.

"Birmingham can hire at the drop of the hat," he said. "Not so much for places like us here in Montgomery. Other reasons for that could be physicians often look for research and academic affiliations."

Talton said the budget isn't hindering his ability to hire, but finding doctors to come to Montgomery is a challenge partially because there are salary ceilings.

The salary range for the CSVHCS general surgeon job posting is $98,967 to $295,000 per year. The national average for a general surgeon is $216,810, according to the U.S. Department of Labor's Bureau of Labor Statistics.

The listed salary for a CAVHCS primary care physician is $98,967 to $195,000, and the national average is $147,890. For a registered nurse case manager, the salary is $63,547 to $99,721, and the national average is $70,590, according to the Bureau of Labor Statistics.

Talton said he didn't know CAVHCS' turnover rate, but he said part of the problem is not having adequate space for the physicians, especially in Montgomery.

CAVHCS is building a new 112,000-square-foot facility on Chantilly Parkway to address space needs, but have "minimum" new hires, Talton said.

HELP WANTED

Central Alabama Veterans Health Care Staffing levels as of June 27:

1,529

Total filled positions

157

Positions approved to be filled

282

Unapproved vacancies

2

Pending recruitments

38

Advertised positions

441

Total vacancies

Source: June 27 CAVHCS human resources staffing report