The VA Maine Healthcare System at Togus has the go-ahead to hire nearly 40 new full-time employees. Now comes the hard part – finding the right people to fill the positions.

Getting in the way is the chronic shortage of health care workers in the VA system, particularly those who provide treatment for mental illness. It is a problem that predates the VA’s waiting-list scandal, and that has previously resisted solutions similar to the ones offered in the latest series of reforms.

Togus, which serves veterans over a wide, rural area, is in many ways emblematic of the challenges facing the broader veterans health care system. Success here, then, could very well be indicative of whether the recently enacted reforms, already showing signs of sluggishness, will ever really work.

NEW HIRES

The hiring push is part of the Veterans Access, Choice and Accountability Act signed into law last August. It included $5 billion for additional doctors, nurses, social workers and other health care providers.

The need for new hires is clear. Outpatient visits to the VA system rose from 46.5 million in 2002 to 83.6 million a decade later. The number of veterans receiving mental health treatment grew from less than 900,000 in 2006 to more than 1.2 million in 2012. Staffing levels have not kept pace.

In response, Togus is now authorized to hire 38.8 full-time equivalent new employees, including 17 in mental health services.

But listing the jobs may not be enough.

HARD TO FILL

To deal with a 30 percent rise in requests for appointments between 2011 and 2014, Togus officials previously tried to hire mental health workers, yet positions went unfilled.

Maine is not alone in that dilemma. An acute mental health unit in Montana that opened in 2011 was underused until its recent closing, which was blamed on “chronic workforce shortages.” The same shortages have been reported throughout the system, particularly in smaller, rural facilities.

Some blame low pay and the long federal hiring process, while others point to the overall lack of some types of providers in the health care system as a whole. All are factors.

However, the impact of the shortage could be at least somewhat alleviated if the VA moved more quickly to implement Veterans Choice, a program that allows veterans who live far from a VA facility to receive care outside the VA system.

A Veterans of Foreign Wars report found that although Veterans Choice is working for those who are enrolled, only one-fifth of the veterans eligible have been offered the program, and the program’s eligibility criteria are so stringent that some veterans who could benefit will be left out.

SETTING AN EXAMPLE

It is in this challenging and volatile environment that officials at Togus must find a way to make improvements.

Maine’s VA health care center was not mentioned in the initial scathing reports that broke the VA scandal, but allegations have since surfaced that it manipulated patient files and used scheduling ploys similar to those employed at other VA facilities.

And regardless whether those specific allegations are borne out, understaffing is clearly a problem at Togus.

That Togus serves only about 40,000 patients – as opposed to 68,000 in Boston or about 80,000 in Phoenix, the epicenter of the VA scandal – and that its patient satisfaction has been so high in the past, means the Maine system arguably has a more manageable task in front of it.

That provides hope Togus can fix its shortcomings quickly, and in a way that may work elsewhere, too.

Turning around the second-largest government agency following a damning scandal is daunting. But improving access to care in one small system should be achievable.