Testifying before a congressional committee in April, APA's Randy Phelps, PhD, drew a dismal picture: More than 200,000 veterans are sleeping on America's streets today, some of them since shortly after the Vietnam War, and many of the more than 1 million service members deployed in Iraq and Afghanistan face the same risk if they experience post-traumatic stress disorder and traumatic brain injuries.

To stem that tide, the U.S. Department of Veterans Affairs (VA) will need to attract many more psychologists and other health-care professionals to its clinics and hospitals, said Sen. Daniel K. Akaka (D-Hawaii), chair of the Senate Committee on Veteran's Affairs, which held a hearing on April 9.

"The VA competes with other health-care systems for employees, and too often comes up short," Akaka said.

The hearing, "Making VA the Workplace of Choice for Health Care Professionals," was part of an effort by the committee to give the VA resources to attract and retain more top-notch health-care professionals.

In addition to Phelps, deputy executive director of APA's Practice Directorate, who spoke on behalf of the APA, speakers included VA officials, representatives from the Government Accountability Office and the Association of American Medical Colleges. Also speaking was APA member Jennifer L. Strauss, PhD, of Duke University and the Center for Health Services Research in Primary Care at the Durham VA Medical Center, who represented the Friends of VA Medical Care and Health Research.

A critical shortage

The VA is already the largest single employer of psychologists in the United States, with about 2,400 working throughout the system. But with more veterans returning from Iraq and Afghanistan, the need for psychological care in the VA system is escalating, military experts say.

The VA's shortfall mirrors the dwindling supply of health-care professionals nationwide, testified Marisa Palkuti, director of the VA's Health Care Retention and Recruitment Office. To attract more professionals, the VA established a work group to streamline the hiring process and posted jobs on commercial Web sites. The department continues to offer financial incentives such as the Employee Incentive Scholarship Program for employees who seek additional health-care related degrees and the Education Debt Reduction Program, a tax-free reimbursement of education loans, she added.

In his testimony, Phelps lauded the VA for its recent aggressive efforts to recruit new psychologists to help meet ever-increasing needs for services to veterans. According to Phelps, the VA has hired more than 800 new psychologists since 2005. Yet the vast majority of new hires are younger, less-experienced psychologists who enter the system at the GS-13 level or below. At the end of 2007, the number of VA psychologists nationally in the top pay range, GS-15, was considerably lower than the number of GS-15 psychologists in 1995.

"Without clear advancement systems in place, VA faces critical long-term recruitment and retention problems," Phelps testified. "As psychologists come to believe that there is little possibility for advancement, regardless of the level or complexity of responsibilities, fewer VA psychologists will be willing to accept positions of greater responsibility. In addition, potential trainees whom the VA would like to recruit will increasingly see VA as a 'dead end' for their careers and will be attracted to other career options that offer more potential for advancement."

Phelps noted several other VA policies and procedures that have an adverse effect on both psychologist recruitment and retention. One is the lack of uniform psychology leadership positions. Another obstacle relates to inequitable access to key leadership positions. Yet a third difficulty stems from the problematic implementation of personnel and pay considerations that apply to psychologists. (For more details, read Phelps' testimony at APA Practice Central.)

Unique opportunities

Despite these career shortcomings, VA psychologists work in an environment where they can blend their clinical and research interests, noted Strauss.

"The VA offers exceptional research and training opportunities for clinicians like me, who are interested in research careers," she said.

Among these, she said, is the Research Career Development Program, a competitive mentoring award that typically provides three to five years of structured research training. Clinicians who receive these awards are relieved of 75 percent of their clinical duties so they can focus on developing research programs.

However, once the research career development grant expires, many psychologists find themselves without dedicated research time, said Strauss. Unlike clinicians at most academic medical centers, VA clinicians may not fund a portion of their salaries through research grant support. The result is that VA clinicians must frequently donate their time, performing research duties early in the morning or late at night, in addition to a full day's work of seeing patients.

"I do not think that this is in the best interest of the VA or the veterans we serve," said Strauss. "I strongly recommend that the VA adopt a model that is more in line with what is available to clinician researchers working in academic medical settings."