Tommy Washbush
The William S. Middleton Memorial Veterans Hospital.
The Veterans Health Administration operates 1,380 health care facilities, including the William S. Middleton Memorial Veterans Hospital, above, in Madison.
I arrived at 8:15 a.m. for the first day of my third-year rotation in surgery at William S. Middleton Memorial Veterans Hospital. “You should be in surgery,” a nurse told me. “You have to hold the heart.” My knees gave out a little as I went to the operating room to scrub in. The next day, the 69-year-old veteran, whose heart I had held during the operation, squeezed my hand and wiggled his toes. I was instantly hooked on clinical medicine and caring for veterans.
After completing several more years of medical training, I worked for 27 years as an internal medicine physician and geriatrician at the Madison VA hospital; I also taught at the hospital and University of Wisconsin School of Medicine. I retired in 2012 and have no current affiliation with the VA hospital. But I am watching from the sidelines, alarmed at what is happening to veterans’ healthcare under the current federal administration. My former colleagues at the hospital are afraid to discuss the crisis, fearful for their jobs. One quarter of agency employees are veterans. The Guardian reported that VA hospitals have removed politics and marital status from guidelines protecting patients from discrimination, though the VA says a 2013 policy directive continues to protect patients from discrimination.
The Veterans Health Administration, the largest integrated health care system in the country, is in crisis. Elon Musk’s DOGE staff are embedded as senior advisors at the agency while VA leaders were required to sign nondisclosure agreements. Over 2,500 employees were fired, though some were reinstated following a court order; 14,000 have applied for retirement. This includes 1,700 RNs, 900 advanced medical support staff and 200 doctors. Doug Collins, secretary of Veterans Affairs, forecast a total of 83,000 employee job cuts despite a 2024 audit by the Office of Inspector General that found the VA was understaffed by 66,000 employees. Collins said these cuts are “to save money.” A hiring freeze is now in place.
The VA operates 1,380 health care facilities, including 170 medical centers and 1,193 outpatient sites. There are 18 million living veterans, 6.1% of the U.S.population. Nine million received healthcare through the VA in 2023. Veterans are family, our friends and neighbors. They served us during their prime, perhaps lost a limb or suffered permanent disability.
According to a June 10 report in Federal News Network, the VA has contracted with the Office of Personnel Management to “manage a massive reduction in force (RIF), with the goal of cutting more than 80,000 positions."
Why the cuts? Bottom line: The Republican administration wants to privatize healthcare for veterans. This is a long-standing goal of Republicans. As reported in Military Times, “expanding community care options — opportunities for veterans to seek private-sector care at taxpayers expense — was a major campaign promise for Trump.”
According to sources with knowledge of current conditions at the Madison hospital, contracted custodial services have been discontinued for the outpatient clinics and reduced for the medical center. Secretaries and cardiovascular surgeons now clean their own offices and clinical staff are also cleaning bathrooms. Hospital admission is delayed while RNs clean hospital rooms; surgeries are held up as nurses clean operating rooms. Veterans tell me the phone is not always answered at the hospital when they call, and they are now waiting an extra three to four months for clinical appointments. The service network for the hospital no longer has a telephone operator 24 hours a day; nurses take night calls.
Across the system, geriatrics-trained nurses no longer help with hospital discharge planning for older adults with complex medical issues. Geriatrics-trained social workers were reassigned to other areas of the hospital. Vietnam War veterans, the majority of current veterans, are now in the geriatric age group.
Elsewhere, the Danville VA medical center in Illinois closed its inpatient unit to new patients because so many RNs had resigned and in Orlando, Florida, there is a backlog of at least 1,700 VA patient X-rays unread because radiologists have quit.
The VA is also losing research funds for the study of substance abuse, mental health, cancer, cardiovascular disease, and spinal cord and traumatic brain injuries. One veteran who volunteered for the Million Veteran Program, a national study looking at how genes, lifestyle, military experiences and other factors affect wellness in veterans, recently asked me what will become of her personal data, service history, and the blood she donated for genetic testing. What will happen to this important research program?
To encourage VA employees to resign, Collins has made working conditions more difficult. Employees are asked to list their accomplishments for the week. As support staff are let go, like the custodians in Madison, the clinical staff must take on more non-patient care work. Providers cannot keep up.
Is this designed to make the VA look bad, to make veterans unhappy with their care and open the door wider to privatization of veterans’ healthcare?
During my time at the VA, I helped veterans and their families with medical problems, including traumatic brain injuries and amputations, homelessness, addiction and post traumatic distress syndrome. I could do this because of the dedicated team of professionals committed to our mission: the care of the veteran. The VA healthcare team tackles these problems with the dignity of the veteran foremost in mind. The VA healthcare team honors the commitment to our veterans. Our government should do the same.
Michael Siebers received his M.D. from the University of Wisconsin School of Medicine in 1980. He lives in the Madison area.
[Editor's note: This column and its subhead were amended on July 5. An earlier version said significant cuts were impacting care at VA facilities. A VA spokesman denies this, saying that the employees dismissed in February were almost all brought back due to a court order. Also, the column now clarifies that 14,000 employees applied for retirement, rather than took retirement. A reference to earmarked funding for private healthcare services was also removed.]
