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Veterans hospitals are struggling to replace hundreds of doctors and nurses who have left the health care system this year as the Trump administration pursues its pledge to simultaneously slash Department of Veterans Affairs staff and improve care.
Many job applicants are turning down offers, worried that the positions are not stable and uneasy with the overall direction of the agency, according to internal documents examined by ProPublica. The records show nearly 4 in 10 of the roughly 2,000 doctors offered jobs from January through March of this year turned them down. That is quadruple the rate of doctors rejecting offers during the same time period last year.
The VA in March said it intended to cut its workforce by at least 70,000 people. The news sparked alarm that the cuts would hurt patient care, prompting public reassurances from VA Secretary Doug Collins that front-line health care staff would be immune from the proposed layoffs.
Last month, department officials updated their plans and said they would reduce the workforce by 30,000 by the end of the fiscal year, which is Sept. 30. So many staffers had left voluntarily, the agency said in a press release, that mass layoffs would not be necessary.
“VA is headed in the right direction,” Collins said in a statement.
But a review of hundreds of internal staffing records, along with interviews with veterans and employees, reveal a far less rosy picture of how staffing is affecting veterans’ care.
After six years of adding medical staff, the VA this year is down more than 600 doctors and about 1,900 nurses. The number of doctors on staff has declined each month since President Donald Trump took office. The agency also lost twice as many nurses as it hired between January and June, records viewed by ProPublica show.
In response to questions, a VA spokesperson did not dispute numbers about staff losses at centers across the country but accused ProPublica of bias and of “cherry-picking issues that are mostly routine.”
Agency spokesperson Peter Kasperowicz said that the department is “working to address” the number of doctors declining job offers by speeding up the hiring process and that the agency “has several strategies to navigate shortages,” including referring veterans to private providers and telehealth appointments. A nationwide shortage of health care workers has made hiring and retention difficult, he said.
Kasperowicz said that the recent changes at the agency have not compromised care and that wait times are getting better after worsening under President Joe Biden.
While wait times for primary, mental health and specialty care for existing patients did increase during Biden’s presidency, the VA’s statistics show only slight reductions since Trump took office in January.
However, appointment wait times for new patients seeking primary and specialty care have slightly increased, according to a report obtained by ProPublica.
As of early July, the average wait time nationally to schedule outpatient surgery appointments for new patients was 41 days, which is 13 days higher than the goal set by the VA and nearly two days longer than a year ago.
In some locations, the waits for appointments are even longer.
At the Togus VA Medical Center in Augusta, Maine, internal records show that there is a two-month wait for primary care appointments, which is triple the VA’s goal and 38 days longer than it was at this time last year. The wife of a disabled Marine veteran who receives care at the facility told ProPublica that it has become harder in recent months to schedule appointments and to get timely care.
Her husband, she said, served in Somalia and is completely disabled. He has not had a primary care doctor assigned to him for months after his previous doctor left over the winter, she said.
“He has no person who is in charge of his health care,” said the woman, who did not want to be named because of fears her comments might affect benefits for her husband. “It was never like this before. There’s a lack of staff, empty rooms, locked doors. It feels like something that’s not healthy.”
Kasperowicz said the VA is taking “aggressive action” to recruit primary care doctors in Maine and anticipates hiring two new doctors by the end of the year.
Nationwide, records reviewed by ProPublica show, the vacancy rate for doctors at the VA was 13.7% in May, up from 12% in May of 2024. Kasperowicz said those rates are in line with historical averages for the agency. But while the vacancy rate decreased over the first five months of 2024, it has risen in 2025.
Sen. Richard Blumenthal, D-Conn., who has been critical of Collins’ stewardship, has argued that the VA is heading in a dangerous new direction. He said that ProPublica’s findings reinforce his concerns about “damaging and dangerous impacts” from cuts and staffing reductions.
“Dedicated professionals are fleeing — and recruitment is flagging — because of toxic work conditions and draconian funding cuts and firings,” he told ProPublica. “We’ve warned repeatedly about these results — shocking, but not surprising.”
In the VA’s Texas region, which covers most of the state, officials reported in an internal presentation in June that approximately 90 people had turned down job offers “due to the uncertainty of reorganization” and noted that low morale was causing existing employees to not recommend working at the medical centers.
Anthony Martinez, a retired Army captain who did tours of duty in Iraq and Afghanistan, said he has witnessed a downgrade in care at the Temple, Texas, VA facility. He said that the hospital has lost records of his recent allergy shots, which he now has to repeat, and he has to wait longer for appointments.
“Problems have always existed but not to this degree,” Martinez said.
Martinez, who runs a local nonprofit for veterans, said he’s heard similar frustrations from many of them. “It’s not just me. Many vets are having bad experiences,” he said.
Kasperowicz said the agency couldn’t discuss Martinez’s case without a patient privacy waiver, which Martinez declined to sign. He said wait times for primary care appointments for existing patients at Temple are unchanged over the past fiscal year. But internal records show an increase in wait times for new patients in specialties such as cardiology, gastroenterology and oncology.
Administrators there have expressed concern about the impact of staff losses, warning in their June internal presentation about “institutional knowledge leaving the Agency due to the increase of supervisors departing.”
It is not just the loss of doctors and nurses impacting care. Shortages in support staff, who have not been protected from cuts, are also adding to delays.
In Dayton, Ohio, vacant positions for purchasing agents resulted in delays in acquiring hundreds of prosthetics, according to an internal VA report from May. Kasperowicz said the hospital has recently cut processing time for such orders by more than half.
Some facilities are experiencing trouble hiring and keeping mental health staff.
In February, a human resources official in the VA region covering much of Florida reported in an internal warning system that the area was having trouble hiring mental health professionals to treat patients in rural areas. The jobs had previously been entirely remote but now require providers to be on site at a clinic.
When the region offered jobs to three mental health providers, all of them declined. The expected impact, according to the warning document, was longer delays for appointments. Kasperowicz said the VA is working to address the shortages.
Yet even as the agency faces these challenges, the Trump administration has dramatically scaled back the use of a key tool designed to help the VA attract applicants and plug gaps in critical front-line care.
The VA in recent years has used incentive payments to help recruit and keep doctors and other health care workers. In fiscal 2024, the agency paid nearly 20,000 staffers retention bonuses and over 6,000 new hires got signing bonuses. In the first nine months of this fiscal year, which started Oct. 1, only about 8,000 VA employees got retention bonuses and just over 1,000 received recruitment incentives. The VA has told lawmakers it has been able to fill jobs without using the incentive programs.
Rep. Delia Ramirez, D-Ill., said during a congressional oversight hearing in July that the Trump administration is withholding the bonuses because it “wants them to leave” as part of a plan to privatize services.
“It’s not that VA employees are less meritorious than they were under Biden,” she said. “They want every employee to be pushed out so they can decimate the VA’s workforce.”
Do you have information about the VA that we should know about? Contact reporters David Armstrong on Signal, DavidArmstrong.55, or via email, david.armstrong@propublica.org; Eric Umansky on Signal, Ericumansky.04, or via email, eric.umansky@propublica.org; and Vernal Coleman on Signal, vcoleman91.99, or via email, vernal.coleman@propublica.org.
Joel Jacobs contributed reporting.
ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.
Seven years ago, when President Donald Trump signed the Preventing Maternal Deaths Act into law, it was hailed as a crucial step toward addressing the nation’s maternal mortality crisis.
The law pumped tens of millions of dollars a year into a program to help fund state committees that review maternal deaths and identify their causes. The committees’ findings have led to new protocols to prevent hemorrhage, sepsis and suicide. Federal money has allowed some states to establish panels for the first time.
The committees’ work only became more urgent after the Supreme Court overturned the constitutional right to abortion. Last year, Georgia’s committee determined the state’s abortion ban contributed to the preventable death of 41-year-old Candi Miller.
But now the program that enabled this progress — known as Enhancing Reviews and Surveillance to Eliminate Maternal Mortality, or ERASE MM — is in danger, maternal health advocates say.
The program’s funding expires on Sept. 30, and efforts to renew it have thus far not succeeded. Congress included money to extend ERASE MM in a broader stopgap funding measure that almost passed in December 2024 before being scuttled by Republican opposition. The program isn’t paid for in the Trump administration’s budget proposal for 2026. Late last week, the Senate Appropriations Committee introduced a bill to fund the Department of Health and Human Services for the next fiscal year that includes money for ERASE MM, but the measure hasn’t moved forward yet.
Adrienne Griffen, executive director of the Maternal Mental Health Leadership Alliance, said she fears how little attention the program’s fraught future has drawn amid waves of layoffs at federal health agencies and ferocious debate over impending Medicaid cuts.
“We were concerned when the president’s budget did not include these programs,” Griffen said. “While we are happy with the progress, there is still a lot that needs to happen.”
The Centers for Disease Control and Prevention, which is responsible for awarding ERASE MM grants and guiding the work of state maternal mortality committees, didn’t answer specific questions from ProPublica about the future of the program. Andrew Nixon, communications director for HHS, the CDC’s parent agency, said in a statement that HHS “is committed to improving maternal and infant health outcomes.”
“We are currently reviewing the maternal and infant health portfolio to identify the most effective ways to collect and analyze data and improve the health and safety of mothers and infants,” the statement said.
HHS Secretary Robert F. Kennedy Jr. didn’t respond to requests for comment on whether advocates’ concerns are warranted.
The Trump administration’s budget proposal jettisons not only ERASE MM but a slate of programs known as the Safe Motherhood initiative, which aims to reduce risks such as premature births and infections that affect mothers and infants. All previously had bipartisan support. That’s left some members of Congress mystified about why their funding is in jeopardy.
At a June budget hearing, Rep. Greg Landsman, D-Ohio, pressed Kennedy on why the administration had proposed eliminating the programs, including ERASE MM.
“I genuinely believed this was zeroed out either accidentally or by some sort of oversight,” Landsman said, asking Kennedy to work with members of the House Committee on Energy and Commerce to restore funding.
After their exchange at the hearing, Landsman told ProPublica that Kennedy had agreed to meet to discuss restoring the funding.
“We want to save this investment,” he said. “It’s critical for expecting moms.”
ERASE MM came about in 2019 after reporting by ProPublica and others showed that hundreds of American women were dying each year from preventable causes related to pregnancy. U.S. maternal mortality rates had risen sharply over two decades as rates in other affluent nations had dropped.
Other countries, particularly the United Kingdom, had reliable national data on maternal mortality, as well as robust case-review systems designed to turn information into improvements in care. In the U.S., by contrast, only two-thirds of states had review processes at all and even those sometimes went years between reports or operated inconsistently.
ERASE MM was designed to plug these holes, ensuring that lessons from maternal deaths didn’t go unlearned.
Over the last five years, the CDC has distributed nearly $90 million to fund the work of state review committees. At least by federal standards, the program is relatively inexpensive; it divvied up a total of about $40 million last year between 46 states, an average of $870,000 apiece.
The members of maternal mortality review committees — usually a mix of physicians, nurses, mental health professionals and advocates — volunteer their time. ERASE MM grants typically pay to hire the staffers who gather records from hospitals, medical examiners, police and other agencies and abstractors who redact private information from case summaries.
Committees are advisory in nature, but their findings have made a difference, advocates say. In recent years, many states have developed mental health initiatives for pregnant people and new mothers based on maternal mortality reviews. Recommendations by New Hampshire’s committee, for example, led to a program in which OB-GYNs collaborate with psychiatrists on treatments for post-partum depression or substance use disorder.
In Indiana, which used ERASE MM funds to establish a maternal mortality review committee in 2018, the panel’s work spurred state officials to expand an initiative to have nurses make post-partum home visits to new mothers.
Indiana is one of at least five states that rely entirely on federal dollars to pay for their maternal mortality reviews (the others are South Carolina, Iowa, Missouri and Utah). Committee members in several states expressed alarm that this money may evaporate.
Before ERASE MM, Utah had a joint committee that reviewed both infant and maternal deaths, said Dr. Marcela Smid, a maternal-fetal health specialist. Utah set up a maternal mortality review committee for the first time in 2019 using funds from ERASE MM, which Smid chairs. It found increasing numbers of maternal deaths by suicide, leading to programs for better mental heath and substance use disorder screening and treatment. Since 2021, the committee has received about $1.7 million from the CDC.
“If we get defunded, I suspect it would be devastating,” Smid said.
As part of reviews, committee members consider the legal and socioeconomic context in which a woman dies. Those steps were critical in Georgia when the committee reviewed deaths that had occurred after Roe v. Wade was overturned in 2022 and the state prohibited abortion. The CDC hasn’t directed committees to ask explicitly about such laws, but committee members say the process has provided a window that could be lost if ERASE MM ends.
Case reviews are typically confidential, but ProPublica reported last year that Georgia’s committee had concluded the abortion-related deaths of Miller and Amber Thurman, 28, had been preventable.
Reviewers found both women had taken abortion pills and suffered a rare complication when they failed to expel all the fetal tissue from their bodies. Miller decided not to go to the doctor when she began having symptoms of sepsis because she feared repercussions related to the state’s abortion ban, the review committee found. Thurman went to the hospital but died after doctors waited 20 hours to perform a dilation and curettage to clear her uterus; the procedure, also used to perform abortions, had become entangled in restrictions subjecting doctors to criminal penalties if they violated the law.
Even before the threat to ERASE MM’s funding emerged, four states, including Florida and Texas, had opted out of accepting money from the program. The Florida Department of Health didn’t respond to questions from ProPublica about why it had done this. The Texas Department of Health said the state Legislature had instructed it not to take the funds and instead allocated funding to create its own system. Texas, which accounts for about 10% of U.S. maternal deaths, also stopped sharing data collected by its maternal mortality review committee with the CDC shortly after restricting abortion access.
Officials at the Texas Department of Health also have chosen not to have the state’s maternal mortality review committee examine cases from 2022 and 2023, a period that includes two preventable deaths ProPublica reported on last year. The panel was nearly four years behind on case reviews, and state officials said skipping two years would help it catch up. The state also forbids its panel from investigating deaths related to abortion.
Dr. Thomas Westover, a maternal-fetal medicine specialist who also sits on the maternal mortality review committee in New Jersey, said he worries that if ERASE MM goes away, there will be no consistency from state to state in how maternal deaths are reviewed or what data is collected on them.
“You’ll have states that pick and choose what to review,” Westover said. He noted that some states likely would ignore accidental deaths to manage their caseloads, while others, like Texas, choose to exclude deaths related to abortions, making data less comparable nationally. “That’s a bad decision.”
As part of ERASE MM, the CDC gives state review committees detailed guidance on what contributing factors to consider when assessing maternal deaths, including obesity, mental health issues, substance abuse and homicide.
This information fuels analysis that goes well beyond what’s in death certificates, said Amy Raines-Milenkov, an associate professor at the University of North Texas Health Science Center and longtime maternal health scholar-practitioner. Based on this information, Texas expanded nurse home visits to post-partum mothers that’s similar to Indiana’s initiative.
“What we choose to measure is what we value in society,” Raines-Milenkov said.
Maternal health advocates say they’re working together to bring national attention to the potential funding threat to ERASE MM. Griffen, the executive director of the Maternal Mental Health Leadership Alliance, said she’s hopeful with more meetings on Capitol Hill that a solution can secure the program.
Women’s lives depend on it, she said.
Kavitha Surana contributed reporting. Mariam Elba contributed research.
For the first time in almost four decades, The Muny presents La Cage aux Folles, Harvey Fierstein and Jerry Herman’s hilarious romp about complicated family dynamics. After 20 years together, […]
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