The  growth in the demand for CRNAs is expected to continue. Overall, 54 percent of the chief anesthesiologists responding to our  survey reported temporarily closing some operating rooms and 72 percent  reported delaying some elective surgeries because of VA CRNA vacancies  in fiscal year 2006. On the basis of our survey results, in addition to their  current recruiting challenges, VA medical facilities will likely face a  challenge retaining VA CRNAs in the next 5 years due to the number of VA  CRNAs projected to either retire from or leave VA. VA medical facility  officials reported in our survey that the recruitment and retention  challenges are caused primarily by the low level of VA CRNA salaries  when compared with CRNA salaries in local market areas. Of all VA medical facility chief anesthesiologists that  responded to our survey, 74 percent reported that they had difficulty  recruiting CRNAs in fiscal years 2005 and 2006. According to VA Officials and VA CRNAs, Difficulty Recruiting and Retaining VA CRNAs is Due to Noncompetitive VA CRNA Salaries

Our surveys of VA medical facility chief anesthesiologists and HR officers  indicate that medical facilities have trouble recruiting and will have  trouble retaining VA CRNAs because salaries for VA CRNAs are low  compared to CRNA salaries in local market areas. Although the majority—about 79 percent—of VA medical facility chief  anesthesiologists reported that VA CRNA salaries are not competitive with  local market CRNA salaries, less than half of VA medical facility HR  officers who responded to our survey concurred. VA Can Offer Bonuses, Pay Education Costs, and Adjust Salaries to Recruit and Retain VA CRNAs

VA has three key mechanisms its medical facilities can use to recruit and  retain VA CRNAs. One program provides funding to registered nurses for training to become  a CRNA, and the other provides funding to offset educational debt  incurred by VA CRNAs. Finally, medical facilities can use VA’s LPS to  determine whether to adjust VA CRNA salaries to help the facilities remain  competitive with CRNA salaries in local market areas. Some Medical Facilities Use the Key Recruitment and Retention Mechanisms, Though in Some Cases LPS Was Used Incorrectly

Each of the three key recruitment and retention mechanisms—bonuses,  education payment programs, and VA’s LPS—are used by some VA  medical facilities. We found in fiscal years 2005 or 2006, of those VA  medical facilities that hired VA CRNAs, just over one-third gave  recruitment bonuses. In addition, less than one-third of all VA medical  facilities that employ VA CRNAs gave retention bonuses, and a few gave  relocation bonuses. However,  five of the eight VA medical facilities we visited did not fully follow VA’s  LPS policy in either 2005 or 2006, and officials at these facilities did not  appear to understand certain aspects of the policy. These problems  indicate VA has not provided adequate training on the LPS process since  the policy was changed in 2001. A Majority of Medical Facilities Use VA’s LPS to Determine Whether to Adjust VA CRNA Salaries, but Instances of Incorrect Use Indicate Inadequate Training on LPS Policy

According to VA’s 2005 data, 86 VA medical facilities that employ VA  CRNAs used VA’s LPS to determine whether to adjust salaries of VA  CRNAs at their facilities. As a result, VA medical facility officials have not received LPS  training that reflects VA’s current LPS policy, and accordingly, cannot  ensure that VA CRNA salaries have been adjusted as needed to be  competitive. VA is in the process of developing a Web-based training course for the LPS  that VA medical facility officials can complete on-line. Because VA has not made  the training a priority, it has not established a time frame for finalizing the  development and implementation of this training course. VA expressed concern about our projected VA CRNA attrition rate. Specifically, we (1) identified workforce challenges that VA  medical facilities may experience related to VA CRNAs, (2) identified the  key mechanisms that VA medical facility officials can use to recruit and  retain VA CRNAs, and (3) determined the extent to which VA medical  facilities use the key mechanisms to recruit and retain VA CRNAs.
Why GAO Did This Study

Certified registered nurse anesthetists (CRNA), registered nurses who have completed a master's degree program in nurse anesthesia, provide the majority of anesthesia care veterans receive in VA medical facilities. While the demand for CRNAs is anticipated to increase, many CRNAs employed by VA--VA CRNAs--are nearing retirement eligibility age. Concerns have been raised about the challenges VA may face in maintaining its VA CRNA workforce. GAO (1) identified VA CRNA workforce challenges that VA medical facilities may experience related to VA CRNAs, (2) identified the key mechanisms that VA medical facilities can use to recruit and retain VA CRNAs, and (3) determined the extent to which facilities use the key mechanisms. To identify VA CRNA workforce challenges, GAO analyzed Web-based surveys it sent to VA chief anesthesiologists, VA human resources officers, and VA CRNAs, with survey response rates of 92, 85, and 76 percent, respectively. GAO also identified the key mechanisms VA medical facilities can use to recruit and retain VA CRNAs and the extent that these mechanisms are used.

What GAO Found

Department of Veterans Affairs (VA) medical facilities have challenges in recruiting and retaining VA CRNAs for their workforce. About three-fourths of all VA medical facility chief anesthesiologists responding to GAO's survey reported that they had difficulty recruiting VA CRNAs. The challenge recruiting VA CRNAs has made it difficult to fill existing VA CRNA vacancies at VA medical facilities. Overall, 54 percent of VA medical facility chief anesthesiologists reported temporarily closing some operating rooms and 72 percent reported delaying some elective surgeries. VA's retention challenge comes from a projected substantial attrition rate. Based on the results of its survey, GAO projects that 26 percent of VA's CRNAs will either retire from or leave VA in the next 5 years. VA medical facility officials reported in GAO's survey that the recruitment and retention challenges are caused primarily by the low level of VA CRNA salaries when compared with CRNA salaries in local market areas. VA has three key mechanisms its medical facilities can use to recruit and retain VA CRNAs. VA medical facilities can give bonuses to VA CRNAs--recruitment, relocation, and retention bonuses. In addition, VA has education payment programs that provide funding to cover CRNA education costs. Finally, medical facilities can also use VA's locality pay system (LPS) to determine whether to adjust VA CRNA salaries to help the facilities remain competitive with CRNA salaries in local market areas. Each of the three key recruitment and retention mechanisms--bonuses, education payment programs, and VA's LPS--are used by some VA medical facilities. GAO found that in fiscal years 2005 or 2006, just over one-third of VA medical facilities that hired VA CRNAs gave recruitment bonuses. For VA medical facilities that have VA CRNAs, less than one-third gave retention bonuses in fiscal years 2005 or 2006. In addition, all VA CRNAs that applied for funds to attend a CRNA school or to offset their educational debt and were eligible received these funds in fiscal years 2005 and 2006. GAO also found that more than half of VA medical facilities used VA's LPS to determine whether to adjust VA CRNA salaries in 2005 and in 2006. However, in the eight VA medical facilities visited, GAO found that although the facilities used VA's LPS, the majority of them did not fully follow VA's LPS policy correctly in either 2005 or 2006. Officials at these facilities did not always know or were not aware of certain aspects of the LPS policy, and VA has not provided training on the LPS to VA medical facility officials since the policy was changed in 2001. As a result, VA medical facility officials have not received LPS training that reflects VA's current LPS policy, and accordingly, cannot ensure that VA CRNA salaries have been adjusted as needed to be competitive. Although VA is in the process of developing a Web-based training course for the LPS, the department has not established a time frame for finalizing the development and implementation of this training course.