Pago Pago, AMERICAN SAMOA — A recent report by the investigative-arm of the U.S. Congress describes the Veterans Health Administration’s (VHA) “vacancy trends” in the three U.S Pacific territories and the “use of human capital flexibilities to hire, recruit, and retain staff” in the territories of American Samoa, Guam, and the Commonwealth of the Northern Mariana Islands (CNMI).

In it’s report, the U.S Government Accountability Office (GAO) notes that VHA provided outpatient primary and mental health care services at VA outpatient clinics in the three territories to approximately 7,700 veterans in fiscal year 2021, according to the data.

The audit report publicly released by GAO late last week is required under a provision of a federal law that requires GAO to review VA hiring activities in the three U.S Pacific territories.

According to the VHA Workforce and Succession Strategic Plan for Fiscal Year 2020-2021, the agency faces difficulties ensuring it has the appropriate workforce to meet the current and future needs of veterans due to factors such as national shortages and increased competition with other health care systems for clinicians in hard-to-fill occupations, such as nurses.

In recent years, GAO and the VA Office of the Inspector General have raised questions about whether VHA has the appropriate workforce to meet the needs of veterans in these U.S. Pacific territories due, in part, to the geographic remoteness of these territories, the GAO audit report states in part.

Some of the highlights in the report state that in the U.S. Pacific territories, VHA generally experienced a decrease in total vacancies from fiscal year 2019 through 2021 — from 32 to 18 vacancies; followed by an increase to 34 vacancies in fiscal year 2022, based on GAO analysis of VHA data.

Guam accounted for the majority of the vacancies across the three territories, with 70 percent of vacancies during the four fiscal years. American Samoa and CNMI accounted for 25 percent and 6 percent of the vacancies, respectively, the audit report states.

“In American Samoa, a majority of vacancies were in the nurse, social work, health aid and technician, practical nurse, and transportation clerk and assistant occupations,” the report said.

According to VHA data, the total number of staff in American Samoa and Guam community-based outpatient clinics (clinics) increased from fiscal years 2016 through 2022.

For example, American Samoa clinic staff grew from 23 to 30 employees and Guam clinic staff grew from 47 to 55 employees. The largest occupation to increase was the medical support assistance occupation, which grew by a combined 10 employees between American Samoa and Guam.

VHA staff in the CNMI increased from one employee in fiscal year 2016 to three in fiscal year 2022. The increase in staff came from the addition of a social worker and a nurse.

The report further states that the medical officer (i.e. physician) occupation decreased in American Samoa and Guam. Both clinics shrank by a combined six medical officer employees from fiscal year 2016 through fiscal year 2022.

And the largest decrease in the medical officer occupation occurred in fiscal year 2022 in Guam where the clinic medical officer staff shrank from seven to four employees.

Data is also provided in the report describing staffing at each of the clinics in the three territories.

According to the report, VHA hiring officials told GAO that they generally rely on recommendations from staff in the U.S. Pacific territories to identify positions that need to be filled in the territories’ various clinics.

Hiring managers from the VA Pacific Islands Healthcare System at Honolulu then use these recommendations to seek and obtain budgetary approval for filling the positions from VA finance officials. Once approved, the officials forward the request to human resources staff to create the posting to fill the vacant position.

The report, dated Feb. 16 was addressed to Subcommittees on Military Construction, Veterans Affairs, and Related Agencies Committee on Appropriations - in both the U.S House and U.S Senate. (Details of the report online at www.gao.gov)