Understaffing and Underperformance: A Cautionary Tale from the Veterans Health Administration’s Troubled Past

Jael Basaraba and Mary Kirkpatrick

In March 2025, the US Department of Veterans Affairs (VA) announced its goal to lay off over fifteen percent of its workforce by the end of September.^[1] This news came shortly after the VA terminated over two thousand probationary workers, including those in the Veterans Health Administration (VHA). The VA Secretary reassured the public that they are carefully orchestrating these cuts to avoid disrupting veteran care and “make [veteran] life better.”^[2]

However, various news reports suggest that the department has not been as methodical concerning these dismissals as it promised. News 5 Cleveland reported that the Cleveland VA let go of at least two psychometrists in February, despite the department’s claims that it would not fire frontline employees. Furthermore, the manner in which the department has terminated non-frontline workers is concerning for VA employees. Administrative Officer Andrew Lennox and Emergency Management Specialist Adam Mulvey – among many other employees – were fired without their supervisors’ knowledge for supposedly poor performance, despite having no negative reviews. VA Nurses in Atlanta, San Diego, and Hines, Illinois, contend that the department’s cuts to support staff will force nurses to spend more time performing ancillary duties and less time with patients. The VHA’s history of personnel shortages shows how negligent staffing decisions hurt both veterans and the VHA itself, and serves as a cautionary tale about what could happen if the current VA does not execute its workforce reduction with proper care.

In 1946, the Veterans Administration (known today as the Department of Veterans Affairs) created the Department of Medicine and Surgery. In 1988, the federal government renamed it the Veterans Health Services and Research Administration and shortened it to the Veterans Health Administration in 1991. The Department initially created this subsection of the VA to help improve the medical services and research capabilities in veterans’ hospitals. Despite the organization’s initial positive advancements in areas such as medical research, nursing, and prosthetics, it has had its share of troubles.^[3] Adam Turner’s essay “A History of Neglect” claims that “personnel shortages and inadequate facilities” marred VA healthcare in the years following World War II, resulting in thousands of empty hospital beds because the VA did not have the medical staff to attend to them.^[4] The agency seemed to avoid major public scrutiny throughout the 50s and 60s, though it did receive complaints about the quality of care veterans received in its facilities after 1946.^[5] However, the staffing problems in VA hospitals came to a head during and after the Vietnam War. These problems largely contributed to the VA’s longest period of public scandal, lasting from the early 1970s until the mid-1990s. During this time, incidents of neglect caused by understaffing deepened the sense of distrust among veterans towards the VA’s healthcare system.^[6]

Throughout these years, the VA faced an influx of Vietnam War servicemen entering their hospitals. However, as reports of poor quality care began to surface, it quickly became clear that the system was not prepared to handle a rise in veterans. LIFE Magazine released an exposé on the conditions of VA hospitals in May of 1970 entitled “From Vietnam to a VA hospital: Assignment to Neglect.” This article pointed out the crucial role staffing played in the deteriorating care quality of VA facilities. The magazine observed that “there are 1,100 fewer staff in VA medical programs today than in 1966” and that many “wards remain closed for want of personnel and the rest are strained due to overcrowding.” While the exact reason for this extreme depletion in staff remains unclear, LIFE highlights that in general a lack of funding left hospitals without a sufficient number of medical personnel. The decrease in staff between 1966 and 1970 came at a difficult time. The continued escalation of the Vietnam War in the late 1960s meant even more veterans needed care post-1966 compared to prior years.

Understaffing continued to be a major issue throughout the 1980s. A 1988 article from The New York Times argued that the VA was in a financial crisis that further contributed to insufficient staffing. The Times attributed the crisis to poor communication between the VA and Congress, with the VA withholding important information on the needs of the agency.^[7] Specifically, the House Veterans Affairs Committee blamed General Thomas K. Turnage, the administrator for the VA at the time, for not requesting enough money and ignoring the obvious deficits within the VA.^[8] For example, while General Turnage acknowledged that some medical centers were facing a “grievous shortage of nurses,” he was not concerned because other centers had enough nurses. Such attitudes highlight the VA’s continual ignorance towards poor conditions in their facilities.^[9]

Understaffing profoundly affected veterans, and VA facilities wholly ignored many of them. Ron Kovic, a Vietnam serviceman, wrote about his VA experience in his autobiography Born on the Fourth of July. He stated, “the wards are filthy… there are never enough aides to go around on the wards… the most severely injured are totally dependent on the aides to turn them. They suffer the most and break down with sores.”^[10] Veterans also struggled to access any type of treatment in VA facilities. A 1973 article from The Washington Post revealed that VA facilities rejected many veterans because of a lack of staff to treat them.^[11] Further, the newspaper investigated a VA mental health treatment center in rural Ohio where “it was quite possible for a veteran to be admitted, treated and released without ever seeing a professional psychiatrist.”^[12]

The poor treatment veterans received in understaffed VA facilities negatively impacted their perceptions of the VA and the United States military itself. Marke Dumpert reflected on how his experiences in the Bronx VA hospital shifted his view of the military, revealing,“now I have nothing but disgust for my country. … If I had known what I know now, I would have never enlisted. I don’t mean just my injury, but the insensitivity and lack of care.” Veterans’ disgust with the treatment they received also inspired protests against the VA.^[13] These protests included hunger strikes and a campout in a senator’s office in March 1974, during which protestors refused to evacuate until they met with the head of the VA.^[14] Such protests exposed the broader public to the poor quality of care in VA hospitals and helped inspire Hollywood films such as Born on the Fourth of July, a film adaptation of Kovic’s book.^[15]

The understaffing in VA facilities also harmed the VA’s ability to retain and recruit quality staff. The experience of mental health nurse Frances Hodgkins, who left the Togus, Maine VA nursing home in the mid-1990s, illustrates how improper patient ratios drove nurses out of the system. As she explained in her interview:

“It was 50 beds, and it was horrible. I was the only nurse on the night shift. I had an LVN and two nursing assistants, and we were supposed to take care of 50 patients. … After three months of working in what I would characterize as probably the most unsafe conditions I’ve ever been in in my life, I said, ‘I’m not doing that anymore,’ and I quit the VA.”

The VA healthcare system not only had trouble keeping people like Hodgkins. Media coverage also hindered its recruitment capabilities. A Washington Post article from May 1970 asserted, “The Veterans Administration says that bad press reviews are hurting its efforts to recruit qualified doctors, nurses, and staff people.”^[16] It also claimed these press reviews “blamed most of the [VA’s] problem on the lack of staff, or lack of dedication by VA people.”^[17] The VA’s poor reputation, inflated by media reports, indeed kept well-qualified practitioners out of veterans’ hospitals. It was not until the Physicians’ Pay Bill of 1991, which came into full effect in 1993 and raised salaries for VA physicians, that the organization attracted high-quality doctors.^[18] The VA’s struggle to attract health care providers shows that when the system was understaffed, it harmed veterans by failing to equip itself with the professionals it needed to provide adequate services.

What does this history mean for the modern VHA? Is the problem really so dire? While the staffing situation in VA facilities today is not as precarious as it was in the 70s and 80s, a 2024 Inspector General report found that 137 of 139 surveyed VA facilities were understaffed in some capacity. Though it is unclear which regions suffer most from understaffing, a 2023 congressional assessment of VHA staffing reported significant variations in staff numbers between VISNs (regional networks of VA hospitals), meaning some regions have perhaps more staff at their disposal than others. Furthermore, the GAO found that healthcare provider shortages – not necessarily in VA facilities, but in rural communities in general – are a potential barrier to care for rural veterans. Personnel cuts thus have the potential to disproportionately affect rural veterans, who already face other care access issues in the VHA.

Since the VA initially announced its personnel cuts, veterans and veterans’ groups from across the nation have protested, and the department has altered its goal. It now aims to phase out approximately 30,000 workers by the end of the 2025 fiscal year. Although the VA has decreased its anticipated cuts, it must still exercise caution in executing these downsizing efforts to avoid risking veteran care. Furthermore, the reputational impact of this workforce reduction, if handled improperly, could hamper the VA’s ability to attract dedicated healthcare professionals. The U.S. is already facing healthcare provider shortages, which researchers expect to last for at least the next twelve years. As a result, any damage to the VHA’s recruitment efforts could make it especially hard for the organization to supply its hospitals with sufficient staff. In this way, the VHA’s history shows that understaffing can have grave consequences for veterans’ well-being. Above all, the federal government must ensure it has the people it needs to give veterans the care they deserve.

Featured image courtesy Pixabay.

Jael Basaraba

Jael Basaraba is a graduate student at the University of Saskatchewan pursuing her Master of Arts in history. Her research focuses on the intersection of gender and sexuality with major political events in 20th century America.

This author does not have any more posts.

Mary Kirkpatrick

Mary Kirkpatrick is an undergraduate student at the University of Saskatchewan pursuing a Bachelor of Arts Honours degree in history. She is particularly interested in Cold War history.

This author does not have any more posts.