Leaders at the Department of Veterans Affairs are planning the largest reorganization of the agency's health care system in three decades, saying the changes will cut bureaucracy and improve care for veterans.
VA Secretary Doug Collins outlined the plan during a hearing before the Senate Veterans Affairs Committee. He said the overhaul is intended to address long-standing concerns raised by auditors, lawmakers from both parties, and veterans groups.
"We were trapped internally into our own policies and procedures," Collins said, arguing that an increasingly dense bureaucracy in many ways had done more to sustain the department than serve veterans.
He said the goals of the reorganization include improving health care quality, empowering local hospital directors, eliminating duplicative layers of administration, and ensuring policies are applied consistently across VA medical facilities.
"I believe this is generational change," Collins said. "I believe this is something that both sides can agree on and find ways to move forward."
Administrative workers may not see their jobs change, Collins said, and staffing levels for them won't change much. He said the reorganization will not lead to another round of job cuts at VA hospitals and clinics, though the agency does plan to eliminate 25,000 vacant positions.
But VA workers and some lawmakers remain skeptical, pointing to ongoing staffing shortages across the system that were a problem even before the VA got rid of tens of thousands of workers last year.
A report released ahead of the hearing by Sen. Richard Blumenthal of Connecticut, the committee's top Democrat, said the VA lost about 40,000 workers over the past year, many through the so-called DOGE cuts. The report said nearly 90 percent of those departures were health care staff.
About 10,000 positions have since been refilled, though Blumenthal said during the hearing it's unclear what kinds of jobs have been filled.
In his report, Blumenthal wrote that the VA staff were exhausted and demoralized.
"The costs of these policies are mounting," the report said. "VA is hemorrhaging doctors, mental health professionals, nurses, and other frontline providers. Experienced staff are leaving in droves, while recruitment falters amid toxic working conditions and indiscriminate firings. The resulting harm to the quality and timeliness of care will be felt for years."
The department lost about 1000 physicians, 1500 schedulers, and 3000 registered nurses in fiscal year 2025, the report said, noting that those positions were already hard to recruit before the second Trump Administration.
Front-line workers say staffing remains the most urgent problem.
"We need more people that are boots on the ground," said Sharda Fornnarino, a VA registered nurse in Colorado. While she agrees the agency has administrative inefficiencies, she doubts restructuring offices will solve the shortages affecting hospitals and clinics.
The VA's Office of Inspector General reported last summer that VA facilities saw a 50 percent increase in staffing shortages, including doctors and nurses. The agency disputed the findings, saying staffing levels compare favorably with those at private sector health care systems.
Fornnarino said shortages extend beyond medical staff to essential support roles such as cleaning rooms, sterilizing equipment, and delivering meals. Some in those roles lost their jobs last year and weren't replaced because of a hiring freeze. Nurses say that's required front-line workers to take on those duties as well as their own, making it harder to care for patients properly.
"We're doing multiple people's jobs, which leads to burnout, which leads to moral distress and not being able to take time for ourselves," Fornnarino said. "And then, you know, we're always worried about the patients."
The federal government's cancellation last year of a host of union contracts, including for nurses, has left them even more vulnerable when they advocate for themselves and their patients, she said.
A major component of the reorganization would eliminate most of the VA's regional administrative centers, known as Veterans Integrated Service Networks, or VISNs. The agency would reduce the number of VISNs from 18 to five, each covering a much larger territory. Under the remaining networks, new offices called Health Service Areas would work more directly with local medical center leadership.
VA officials said that will help hospitals get solutions to problems quickly, rather than navigate multiple layers of bureaucracy.
To some employees, the plan looks like a reshuffling of management rather than a solution, given that VA leaders say administrators won't significantly change staffing levels.
"Leadership jobs haven't been cut," Fornnarino said. "They're just going to be renamed."
The VA says the 25,000 vacant positions it plans to eliminate are mostly pandemic-era jobs that have been unfilled for more than a year.
"What we saw the beginning of Covid is a massive ramp up in resources because we didn't know what the demand was going to be," said Greg Goins, the acting Chief Operating Officer of the VA health care system, during the hearing.
Officials argue removing the open jobs will not affect veteran care. But Matt Pearsall, an organizational behavior professor at UNC-Chapel Hill's Kenan-Flagler Business School, said front-line workers may interpret the change as a sign that additional help is not coming.
"You've adjusted to the new normal," Pearsall said. "You either don't do certain things as well, or you just don't do them because there's no way to do the job of 10 people with seven people forever."
VA leaders said during the hearing they are still able to fill open jobs for front-line healthcare workers, and they say they have been hiring when vacancies arise.
Republican Sen. Jerry Moran of Kansas, the committee's chairman, voiced support for VA officials, but cautioned that similar reform promises have been made repeatedly over the years.
He noted that he has served through 11 VA secretaries.
"They all made promises to improve the bureaucracy, backlogs, implementation of VA care, and while they have made good faith efforts to do so, we continue to look for long-lasting, successful changes and improvements at the Department of Veterans Affairs," he said.
The VA expects the reorganization to take about two years to complete.
This story was produced by the American Homefront Project, a public media collaboration that reports on American military life and veterans.
