The Department of Veterans Affairs has lost thousands of healthcare professionals deemed “core” to the system’s ability to function and “without which mission-critical work cannot be completed”, agency records show.
The number of medical staff on hand to treat veterans has fallen every month since Donald Trump took office. The VA has experienced a net loss of 2,000 registered nurses since the start of this fiscal year, the data show, along with approximately 1,300 medical assistants, 1,100 nursing assistants and licensed practical nurses, 800 doctors, 500 social workers and 150 psychologists.
The numbers are at odds with claims by the VA secretary, Doug Collins, that veterans’ healthcare would not be impacted by an agency-wide reduction of 30,000 workers to be completed this year through a combination of attrition, a hiring freeze and deferred resignation program.
The reduction in medical staff is also feeding fears that the Trump administration is seeking to transform the VA, which currently operates the largest integrated healthcare system in the United States, into a private voucher program.
“It’s a betrayal,” said Manuel Santamaria, 42, a disabled veteran who served as a US army medic and paratrooper in Iraq and Afghanistan. “It takes away the government’s accountability to veterans who have sacrificed for them.”
The VA said in a statement to the Guardian that the fear of privatization “is a far-left canard” and that “anyone who says VA is cutting health care and benefits is not being honest”.
The decline in the number of health workers, documented by the VA’s monthly workforce dashboard, comes as the agency has experienced an influx of nearly 500,000 patients with complex medical issues linked to war-time toxic exposure. Bipartisan legislation passed by Congress in 2022 dramatically expanded veterans’ eligibility for care for toxic exposure.
Patricia Fieldings, a registered nurse who works in the spinal cord injury unit at the VA hospital in Augusta, Georgia, said the departures are creating “very unsafe” conditions for her patients, many of whom lost the use of their neck or became paraplegic due to war wounds.
Because of staffing shortages, nurses are being pulled from other parts of the hospital, who lack adequate training to “safely care for a spinal cord patient”, she said.
Veterans and employee unions note that even before these departures the VA was already understaffed. Last August, the VA’s inspector general reported that 86% of the agency’s 170 medical centers and more than 1,000 clinics reported a “severe” shortage of doctors, while 82% of facilities reported severe shortages of nurses.
The staff reductions reported by VA this year represent an additional 2% decrease in the number of nurses and 3% decline in the number of doctors, exacerbating the existing shortages.
In response to a detailed list of questions, the VA press secretary, Peter Kasperowicz, did not dispute that the VA employed fewer doctors and nurses under President Trump, but said “a nationwide shortage of healthcare workers” had made “hiring and retention difficult for the last 15 years across the entire healthcare sector, including at some VA locations”.
However, agency data shows that under Biden, the VA was able to attract doctors and nurses. The VA added approximately 10,000 “mission-critical” healthcare professionals, between May 2023 and January 2025, agency dashboards show.
Kasperowicz said the VA “has several strategies to navigate shortages while ensuring veterans continue to receive timely, high-quality health care”, which include referrals to private healthcare providers and telehealth. He dismissed the “severe shortages” of doctors and nurses reported by the VA inspector general saying the watchdog’s congressionally-mandated report was “completely subjective, not standardized and unreliable”.
Collins has made cutting employee headcount a priority, arguing the agency is bloated and can improve healthcare quality while shedding 30,000 jobs. Collins said his goal is “reducing bureaucracy” by consolidating “costly administrative functions”.
Documents reviewed by the Guardian, however, show the agency is also losing healthcare providers.
So far this year, VA nurses represented by the labor union National Nurses United have filed 116 notices, known as “assignment despite objection”, the union said, to protest situations they believe put patient health and safety at risk.
One written by a shift supervisor in the intensive care unit in the Bronx in June, reported three nurses had been tasked with treating three patients each, contrary to established safety standards that stipulate critical care nurses should not care for more than two patients at a time. Six nurses cared for 15 patients at the ICU in the Bronx during the nurse’s shift, they wrote: 10 had been placed in isolation, all were listed as “high risk” of falls. The nurse also reported that equipment was broken and that nurses had to work through breaks and meal times.
At the VA in Augusta, Georgia, Fieldings filed five reports alleging conditions that “posed a serious threat to health and safety of patients” in the spinal cord unit between April and July. On 6 June, she wrote that two registered nurses had been tasked with caring for 10 patients, seven of whom were on ventilators and all of whom were at high risk of falls. On 24 July, she reported three nurses were charged with taking care of nine veteran patients, all of whom had been placed in isolation. “Staff were not properly trained,” she indicated, and the unit was staffed with “unqualified” or “inappropriate personnel”.
“These are some of our most vulnerable patients,” Fieldings said in an interview. “They have difficulty eating. Many have broken their necks.”
She said departures had also led to regular forced overtime for nurses, leaving them exhausted. “Nurses stay until their moral distress is so great that they can’t take it anymore and then they leave,” she said.
In its statement, the VA said reports of unsafe conditions in Augusta’s spinal cord unit were “false”and that “the unit is fully staffed”. The VA did not respond to reports alleging unsafe conditions at the agency’s hospital in the Bronx. It said the Guardian was “cherry picking issues that are mostly routine, limited to a handful of sites and in many cases were worse under the Biden administration”.
On Wednesday, the agency said it was terminating labor agreements with unions that represent most of its health workers, citing a March executive order from President Trump that sought to eliminate collective bargaining rights on “national security” grounds.
The termination of union agreements eliminates the VA’s obligation to respond to these reports of unsafe working conditions. Contract language requiring nurses be provided professional training has also been voided, along with rules that require management to “float”, or temporarily reassign nurses to cover parts of the hospital experiencing staffing shortages, “based on qualifications and competencies of the RN”.
In statements, the AFL-CIO, National Nurses United and the American Federation of Government Employees, which represents 320,000 VA workers, said the VA is retaliating against workers for speaking up for patients. The agency says the end of collective bargaining means “staff will spend more time with Veterans” and allow the agency to “manage its staff according to Veterans’ needs, not union demands”.
The unions, who say their right to bargain collectively cannot be voided on “national security” grounds, said they would press their case in the courts.
At the VA Northport Medical Center on Long Island, a virtual town hall on 30 July with hospital director Antonio Sanchez devolved; the chat function in Microsoft Teams burst with complaints. “We are desperate. We are getting burnt out,” a clinician in the facility’s inpatient medical unit wrote. “We are not able to keep pace with our cut in staff.”
Others raised concerns about short staffing and patient care across other critical care units at Northport, the Teams chat shows, including the intensive care unit, post-anesthesia care unit and community living centers, the VA’s version of nursing home care.
Near the end of the meeting, Sanchez responded that he was “working hard” to bring staff on board as soon as possible.
Veterans advocates and employee unions allege the Trump administration is consciously seeking to starve the veterans healthcare system so it can be turned into a private voucher program. The administration’s budget proposal for 2026 includes a major re-alignment of priorities – a 50% increase in taxpayer funding for private healthcare for veterans, $11bn, paid for by a corresponding cut to the existing public system.
During his Senate confirmation hearing to be the VA’s undersecretary for health on 23 July, John Bartrum, a retired air force major general, said it was time to “revisit the balance” between private and government veterans healthcare. In a statement to the Guardian, the VA rejected the idea that it was seeking to privatize the agency and said it had opened 13 healthcare clinics since January. Advocates said those facilities had been in the works for years.
The same day as Bartrum’s hearing, the Access Act, a bill that would make it dramatically easier for veterans to seek private healthcare with taxpayer support, cleared a key House committee on a 12-11 party-line vote.
A blue-ribbon commission established by the agency last year found veterans received significantly better care at lower cost from the public system. Private providers operated with little oversight, they wrote, and “are not required to demonstrate competency in diagnosing and treating the complex care needs of veterans nor in understanding military culture, which is often critical to providing quality care for veterans”.
Independent studies from the Congressional Budget Office and Rand Corporation have similarly found that veterans in the private system face longer wait times and poorly coordinated healthcare at higher costs to the taxpayers.
In Las Vegas, Santamaria bristled at the suggestion the VA was bloated. He said difficulties scheduling appointments have “gotten much worse” under Trump – and that he now often spends more than two hours on hold.
In addition to post traumatic stress disorder, Santamaria suffers from psoriasis, a skin disease that causes a rash with itchy scaly patches that disrupt his sleep and make it hard to concentrate. In February, when his medication ran out, Santamaria sought to switch to a different drug, but was unable to schedule an appointment with the VA until May. By then his entire body was covered by cracked, bleeding welts.
Psoriasis is among the conditions presumed to be connected to war-time toxic exposure under the Pact Act, the 2022 law that extended healthcare and benefits eligibility. According to the VA, the wait time for new dermatology patients at the VA hospital in southern Nevada was 137 days as of August 7.
In its statement, the VA blamed the delays Santamaria faced on a lack of communication from the private dermatologist he saw through the agency’s “community care” voucher program. Once that doctor filled out the proper paperwork, “new medication was mailed out just five days later”, the agency said.
The agency said the average wait time on phone calls placed to the VA in southern Nevada was one minute and 47 seconds. Santamaria said VA workers typically answer the phone relatively quickly, before putting him on hold for two hours or more.
The Guardian asked the VA for data in order to compare patient wait times during the Trump and Biden administrations at each VA facility. The VA did not provide it, but shared a chart that indicated wait times for some health services had marginally improved this fiscal year, while others had worsened. The fiscal year covers the final three and-a-half months of the Biden administration and first six months of Trump’s second term.
The VA’s workforce dashboards show the decline in staffing was accelerating. In February, the VA reported a net loss of 223 registered nurses and 94 doctors; in June the VA lost an additional 409 registered nurses and 147 doctors.
The VA declined to answer questions on the acceleration in the reduction of “mission-critical” medical workers employed in agency hospitals and clinics.
Those staffing losses do not include 10,000 VA workers who accepted deferred resignation offers early in Trump’s second term, whose last day on the books will be 30 September.
In response to a Freedom of Information Act request filed by The War Horse, a non-profit news outlet focused on veterans issues, the VA provided a list of occupations held by these workers. In addition to thousands of human resources professionals, management analysts and other government bureaucrats, 214 nurses will also leave the agency, along with dozens of doctors, social workers and psychologists.
