Hampton Partnership with USPHS Fills Critical Staffing Positions

A few years ago, the Hampton VA Health Care System, one of the oldest and fastest-growing VA health care systems in the nation, hit some hard staffing challenges.  Recruiting quality, experienced clinical staff had always been difficult, but the period following the 2020 COVID-19 Pandemic helped to create a perfect storm for the Southeast Virginia health care facility.  Health care professional availability across the country declined; as many left the field, having experienced the risks and turmoil of the deadly pandemic.  The staffing outlook appeared bleak. 

Leaders had some hard discussions and made difficult decisions. Compounded by competing demands for clinical services across a military-rich community (The Portsmouth-Norfolk-Hampton Roads region boasts the most densely populated and highest volume military region in the nation), with federal resources offering modest compensation, the situation presented a dire picture for area hospitals.  It was a grave concern because need was rising.  Soon, the staffing challenges would affect patient care. The shortages were most pronounced in hard-to-recruit locations such as the Elizabeth City Community Based Outpatient Clinic (CBOC) – in a very rural part of northern North Carolina – as well as in high-demand specialties including mental health, medical-surgical/telemetry, and the emergency department. Administrators scratched their heads because they were doing all they could to avoid compromising care and the results still left a gap.

Then, in 2021, a new idea emerged.  Discussions began concerning the possibility of using a recently established program VA initiated with the Department of Health and Human Services (HHS), United States Public Health Service (USPHS), to bring some of their officers to Hampton, in the most critical areas. The idea hadn’t been on the table before, but it seemed to offer the possibility of some relief. Hampton leadership approved the effort to recruit USPHS Officers. 

This was a novel idea that only became possible after an early 2017 Memorandum of Agreement (MOA) between VA and HHS was signed, initiating a relationship between the two organizations.  Partnering with USPHS offered Hampton leaders a way to secure experienced clinicians who could integrate quickly into operations without lengthy onboarding timetables often necessary when hiring from the community. The USPHS wasn’t new, it’s one of the United States’ eight uniformed services, that has been around since 1798 (although the service has experienced some reorganization, originally constituted as the Marine Hospital Service, it’s mission has focused on the nation’s health) and it has enjoyed similar agreements with other federal agencies over time, it can boast a legacy of health related service around the globe. So, it made sense as a resource.

The USPHS Commissioned Corps is a Title 42 Organization comprised of just over 5300 dedicated active duty public health professionals, including physicians, dentists, nurses, pharmacists, clinical and rehabilitation therapists, dieticians, engineers, environmental health and health service officers, scientists, and veterinarians, who pursue diverse assignments,support public health emergencies, national emergencies, disaster relief, service to underserved and vulnerable populations and other missions as directed by the Secretary of the Department of Health and Human Services. Many of them come to the USPHS from other uniformed services.

Captain Robert Marietta is a 14-year USPHS Officer with 8 years prior Navy Service and a psychiatrist, who was heavily drawn by the USPHS mission of public health and disaster response. About his service, Marietta says, “I love the Public Health Service. For me it has been the perfect blend of my passion, profession, uniformed service and service [to others]”.

Although these individuals may be assigned to any one of more than 20 Federal agencies in 800 locations, for anywhere from two to an unspecified number of years, they continue to belong to the USPHS Commissioned Corps. They are still susceptible to an emergency rotation which could temporarily deploy or detail them to another location. Hampton is Marietta’s fourth assignment in the USPHS. He has also deployed to Africa for Ebola response, to Connecticut for mental health intervention after the school shooting, to Puerto Rico for earthquake relief and to Texas for the Afghanistan refugee mission.

Because the relationship was new in Hampton, it took some time to establish processes. But the program was already well-structured and very straightforward to implement. By spring 2022, Hampton VA was receiving USPHS Officers. They were everything the beleaguered staff could have hoped for. They were time-tested clinicians with experience in needed fields who could hit the ground running where required, even in hard to fill rural locations. According to Hampton Nurse Recruiter James Hudson, “our facility gained immediate support in areas of greatest need; on the other, the new officers were able to enhance their skillsets and broaden their experience within the VA system.”  It didn’t take long to work the kinks out of meeting the staffing requests, and so they have hired a few more USPHS Officers.

Originally created to protect the health of sailors and immigrants carrying disease from far-off places and evolving into a superior public health organization devoted to protecting public health from scourge (in the 1800’s it was Smallpox and Yellow Fever, in the late 1900’s it was AIDS and lung ailments related to smoking), the USPHS conducts research and responds to disasters and public health crises. While most of its commissioned officers are committed to full-time assignments, which are hard-to-fill and/or in remote or isolated areas (there is no enlisted force in the USPHS), they are also charged with placement on a rotating deployment timetable. When they come to work for VA, they are committed to assignments of at least two years, with an indefinite window. But, the expectation is that their tenure will average about three to five years. Nine Officers currently assigned to Hampton, from a high mark of 11. Leadership aniticpates the number may rise again.

The beauty of the set-up is that the clinicians coming to the facility are doing what they love, in a place they want to be. Lieutenant. Kristen Caluag, currently on an extended active-duty assignment from the USPHS Ready Reserve, hopes to convert the assignment to regular duty, “because this service truly has my heart.” She has also deployed, as a USPHS Officer, with the US Coast Guard to the waters between Key West, FL and Cuba and, most recently, to Guantanamo Bay, Cuba.

USPHS Officers are masters of their domain, so-to-speak, as they have the opportunity to choose their assignments. The service puts out a call for a need and they have the opportunity to answer that call. They have to interview for the slots once they apply, but they are the ones who choose to accept an assignment. For Caluag, who happens to be an Air Force Veteran, “I am someone who is passionate about practicing at the top of my scope and leaving nothing on the table, so I am excited that there will likely be more ways to challenge myself and contribute to national and international health, safety, and well-being.”

The way the USPHS Officers feel about working in VA was summed up well by Lt. Christopher Johnson, offering that “Working at the VA has been an incredibly gratifying experience,” adding, “it has been a breath of fresh air to work in a setting where - by and large - the individuals I'm working with both want and need the services I provide, and they're motivated to work towards achieving the goals we set together.”

Even if VA built more space, the organization would still need to staff it. Hampton leadership is not daunted, because they got just what they’ve needed through USPHS.  This solution addressed part of their problem, but certainly not all of it. Hudson says, it is a “monumental success.”  Staffing in clinical service lines is still at critical levels in so many specialties, nationwide. So, they will continue to go back to the well.

What began as a local solution for Hampton has grown nationally, improving staffing support across VA. Although use of the VA-USPHS MOA has grown since its 2017 inception and when Hampton began leveraging it , only one other VA health care system employs more of the 107 officers currently assigned to VA. The agreement offers relief where needed, if available, and word about the resource is spreading.

The USPHS offers another potential avenue for VA to locate resources that are hard to come by. It is a relationship with control over the process, demonstrating cost-effectiveness by reducing the need for expensive private-sector incentives while delivering experienced, dedicated professionals. Hampton leadership now views the program as “indispensable.” According to Hampton VA Associate Director for Patient Care, Marie Robinson-McLaughlin, “The Officers are dependable, enthusiastic, and mission focused to support the Hampton VA Healthcare System.”

The USPHS VA Liaison Office is organizationally aligned within VHA’s Human Capital Management/Workforce Management and Consulting for the VA-HHS/USPHS memorandum of agreement. VA sites of care interested in filling a position with a USPHS Officer can contact the Liaison Office (USPHSLiaisonOfficers@va.gov).