Veterans' Insurance and Health Care Improvements Act of 2009

VETERANS' INSURANCE AND HEALTH CARE IMPROVEMENTS ACT OF 2009 -- (House of Representatives - July 27, 2009)

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Mr. HARE. Mr. Speaker, I rise in strong support of H.R. 3219, the Veterans' Insurance and Health Care Improvements Act of 2009.

Earlier in this session, I introduced H.R. 1302, a bill to create a full-time Director of Physician Assistant (PA) Services in the Department of Veterans Affairs (VA) Central Office. I would like to thank my colleague, Representative JERRY MORAN, for his leadership with me on this bill, as well as Chairmen FILNER and MICHAUD, Ranking Members BUYER and BROWN and many other VA Committee colleagues for joining us as cosponsors''.

Today, I am very pleased to speak in support of H.R. 3219, which incorporates the provisions of my bill and eight other bills that were favorably considered by the House Committee on Veterans' Affairs.

PAs have long been a key component in the Veterans Health Administration (VHA). Almost two thousand PAs are currently employed by the VA, roughly 30 percent of whom are veterans. While the PA Advisor position, established by Congress in 2000, has been valuable, many problems exist.

For example, as the American Academy of Physician Assistants (AAPA) explained in written testimony on October 18, 2007, ``In one case, a local facility decided that a PA could not write outpatient prescriptions despite licensure in the state allowing prescriptive authority. In other facilities, PAs were told that the VA facility can not use PAs and will not hire PAs.'' These inconsistencies and restrictions not only hinder PAs currently employed by the VA, but also discourage PAs from even entering the VA system, ultimately impacting the medical care of our nation's veterans.

PAs are the fourth fastest growing profession in the country, yet the VA is simply not competitive with the private sector for new PA graduates. The lack of a Director of PA Services at the VA prevents necessary recruitment and retention of the PA workforce in the VA at a time when we need more health care professionals to provide necessary care to our Veterans.

Considering the fact that nearly 40 percent of all VA PAs are projected to retire in the next five years, the VA is in danger of losing its PA workforce unless serious focus is directed toward recruitment and retention of this critical group.

One of the biggest challenges facing current and future PAs in the VA system is their exclusion from recruitment and retention benefits. The VA designates physicians and Nurse Practitioners (NPs) as critical occupations. As such, these individuals receive priority in scholarships and loan repayment programs. Unfortunately, the VA has not designated the PA profession as a critical occupation despite the fact that the VA has determined PAs and NPs functionally interchangeable.

Additionally, VA medical facilities, at times, post vacant positions for NPs only, excluding PAs. There is also a hiring trend in the VA of NPs outpacing PAs nearly three to one, again despite the interchangeability between the two specialties.

Finally, PAs are not included in any of the VA special locality pay bands, so PA salaries are not regularly tracked and reported by the VA. There is evidence that this has resulted in lower pay for PAs employed by the VA compared to other health care professionals. This only serves as yet another deterrent for PAs to enter the VA system.

A permanent Director at the VA Central Office (VACO) would serve as an advocate on behalf of PAs and work to ensure their fair treatment. It is time for the VA to devote serious attention to PA recruitment and retention. Enactment of H.R. 1302 is a start.

As a Congressman who represents a district with rural communities, I know that PAs play a key role in providing medical care in rural and other medically underserved areas. I want to ensure that they are equally well utilized by the VA. I know that medical institutions like the Cleveland Clinic, the Mayo Clinic, the MD Anderson Cancer Clinic at the University of Texas, and others have a Director of PA Services to make sure that the PAs they employ are integrated into their health systems. Additionally, each branch of the Armed Services has a Chief PA to help the military best utilize its PA workforce. It is time for the VA to do the same.

I strongly urge my colleagues to show their support of strengthening Veterans' healthcare by voting ``yes'' on H.R. 3219.

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