2026-10-01T09:00:29.940Z / 美国有线电视新闻网（CNN）
弗吉尼亚州弗雷德里克斯堡——
去年，退伍军人事务部（VA）在弗吉尼亚州弗雷德里克斯堡——迈克尔·邓拉普的家乡——举行剪彩仪式，开设了一家全新的先进诊所，邓拉普对此欣喜不已，因为就医距离近了很多。
现年63岁的邓拉普曾在美国海军陆战队服役23年，军衔为枪炮军士长，近年来他因背部椎间盘破裂、皮肤癌、肩颈问题以及呼吸道疾病接受治疗。但在这座位于华盛顿特区以南约1小时车程的弗雷德里克斯堡退伍军人医疗中心，他在约一年半的时间里已经换了四位主治医生。
“你会收到一封格式信件，上面就写着，‘感谢你为国家服务，我不会再在这里任职了’，”邓拉普说，“你和医生建立了信任关系，现在你多少会有点不安，因为下次又得把所有情况从头解释一遍。”
这座被VA标榜为“全美规模最大的退伍军人医疗诊所”的设施占地47万平方英尺，耗资3亿美元。据当地退伍军人、医疗服务提供者以及国会代表透露，开业18个多月后，该诊所仍难以配齐足够的医护人员。该地区是美国退伍军人集中度最高的区域之一。
他们描述称，诊所拥有宽敞的停车场和崭新的走廊，但大部分空间都空荡荡的，即便在紧急护理场景下，退伍军人也很难预约到号或是见到医护人员。
这种情况正在全美范围内上演。在拜登总统任期内通过的立法扩大了福利范围后，VA新建或翻新了约40家医疗设施，退伍军人的医保登记人数也大幅增加。
但这项努力却遭遇了全国性的医疗危机，尤其是在美国农村地区。这场危机由医护人员严重短缺和资金压力引发，导致大量医院关门。VA也面临着类似的人员配置难题，而且在与私营部门竞争岗位时处于劣势。
上个月，该部门的监察长发现，97%的VA医疗机构报告称医生岗位候选人严重短缺，86%的机构报告称护理岗位候选人严重短缺，这表明它们在招人方面普遍遇到了困难。报告指出，这些机构并非都存在职位空缺，而是认为这些岗位很难招到人。
尽管弗雷德里克斯堡诊所采取了分阶段逐步开放的模式，但据CNN获取的VA数据显示，其人员空缺率仍接近40%，意味着超过350个岗位尚未填补。数据显示，截至7月，约一半的新设施职位空缺率达到两位数。
“这意味着退伍军人无法获得他们需要的服务，”众议员尤金·温德曼告诉CNN。这位弗吉尼亚州民主党议员代表的选区正是弗雷德里克斯堡诊所所在地。
温德曼曾是陆军伞兵和军法署军官，其选区约有7.2万名退伍军人。他表示，自己的团队一直在接到愤怒的退伍军人来电，抱怨该诊所的服务。该诊所毗邻海军陆战队匡蒂科基地和美国陆军A.P.希尔堡驻军。
“问题在于他们留不住员工，招不到员工，看病等待时间变得过长，”温德曼说，“这让退伍军人根本没办法就诊。这是亟需解决的问题。”
VA坚定地为弗雷德里克斯堡诊所的运营和为退伍军人提供的护理辩护。VA新闻秘书奎因·斯莱文在给CNN的一份声明中表示，随着分阶段开放的推进，诊所目前已经“达成了招聘目标”，但未具体说明目标是什么。
“开业不到两年，该诊所已经完成了超过24.5万次诊疗，新患者登记进度也超出预期，”斯莱文说。
斯莱文表示，所有符合条件的退伍军人都可以选择在弗雷德里克斯堡诊所就诊，或是前往附近的其他VA医疗机构。他还说，退伍军人也可以选择在私营医疗机构接受护理，费用由VA承担。
斯莱文还强调，在第二届特朗普政府任期内，美国退伍军人整体获得的服务有了“显著改善”。例如，他表示退伍军人等待VA福利审批的积压情况已大幅减少。
一位不愿具名的弗雷德里克斯堡医疗中心医护人员（因担心遭到报复）以及其他熟悉该诊所的人士则给出了截然不同的说法。
他们表示，人员短缺导致医护人员过劳离职，还需要从弗吉尼亚州里士满一家规模更大的VA医疗中心调派员工过来，两地车程约1小时。
“工作负荷过大。他们都筋疲力尽，纷纷离职，”这位医护人员谈到医生和其他护理人员时说，他形容员工们连午餐休息时间都没有，工作氛围就像“汽车生产线”。
52岁的陆军退伍军人凯瑟琳·坎宁安-卡洛特住在弗雷德里克斯堡，她说自己预约神经科、耳鼻喉科、精神科和物理治疗的服务时遇到了困难。
她表示，最近她因耳部感染前往弗雷德里克斯堡诊所寻求紧急护理，却被告知没有医护人员可以接诊。
“候诊室里一个人都没有，空荡荡的。我说，‘能不能找个人来看看我？’”她回忆起和接待员的对话。她说对方回答说不行。当她询问能否见到护士时，得到的答复依然是不行。
坎宁安-卡洛特说停车场同样空荡荡的。“我当时还想，这里倒是适合青少年练习开车，”她打趣道。
阿什利·卡罗斯甚至连诊所大门都没进去过。这位40岁的空军退伍军人住在弗吉尼亚州伍德布里奇，长期以来一直饱受95号州际公路的拥堵困扰，不得不驱车前往华盛顿特区的退伍军人医疗中心就诊。她原本以为去弗雷德里克斯堡诊所会方便很多。
“于是我打了电话，电话里的人告诉我，‘考虑到人员短缺，你最好还是继续在华盛顿特区的诊所看病吧’，”她告诉CNN。
医疗行业多年来一直在发出警报。隶属于卫生与公众服务部的健康资源和服务管理局去年12月预测，到2038年，美国整体医生缺口将超过14.1万人。
“放射科医生短缺，初级保健医生短缺，精神卫生从业者短缺，”进步派智库退伍军人医疗政策研究所的高级政策分析师苏珊·戈登说。
“我们看到全国范围内的医疗人员短缺情况正在恶化，”戴维·舒尔金博士说。他曾在首届特朗普政府时期担任VA部长，在奥巴马政府时期担任负责卫生事务的副部长。
“过劳问题并非VA独有，”他补充道，“这整个医疗行业都面临着这个大问题。我们看到护士和医生，尤其是他们，因为工作环境的压力提前离职。”
但舒尔金补充道，VA受到了一些非自身因素的限制——包括向医护人员支付薪酬的限制以及臃肿的官僚机构。他表示，VA招聘和认证一名医生所需的时间比私营部门多几周。
“这相当于让VA双手被绑在背后开展工作，”舒尔金说，“根据VA获得的职权，包括薪资和支付市场利率的灵活性在内，它们在吸引合格医护专业人员方面的能力受到了限制。”
根据现行薪资上限，VA医生的年薪不得超过美国总统的薪资，即每年40万美元。根据拜登政府期间通过的立法，VA可以为300个医生岗位使用豁免权，支付高于该上限的薪资。
但舒尔金表示，对于拥有170家医疗中心和近1200个门诊点的VA医疗系统来说，300个豁免名额远远不够。此外，据了解内情的国会消息人士透露，现任VA当局尚未使用全部豁免名额。
VA新闻秘书斯莱文告诉CNN，“VA正在分配全部300个薪资上限豁免名额”，并指出仅有约1%的VA医生获得了豁免。
“在分配豁免名额时，我们需要花费大量时间和精力，确保不会对该部门绝大多数无法获得豁免的医生的士气和留任率造成负面影响，”斯莱文说。
斯莱文补充道：“VA在招聘和留住医护人员方面受到了医生法定薪资上限的阻碍，在许多情况下，私营部门的医生每年可以多赚数十万美元。”
戈登表示，在特朗普政府VA部长道格·柯林斯领导下的VA也不能为人员短缺问题免责。
戈登指出了柯林斯任内的裁员情况。VA在今年和去年已裁减了约3万名员工，并取消了数万个空缺职位。
“现在坊间流传的是……‘别去VA工作’，”戈登说，“这里的工作环境不稳定，充满敌意。”
VA built dozens of new veteran health centers but can’t find enough doctors and staff
2026-10-01T09:00:29.940Z / CNN
Fredericksburg, Virginia—
When the Department of Veterans Affairs opened a new, state-of-the-art clinic with ribbon-cutting fanfare last year in his hometown of Fredericksburg, Virgina, Michael Dunlap was thrilled to have care so close.
Dunlap, 63, has been treated in recent years for a ruptured disk in his back, skin cancer, shoulder and neck issues, and respiratory problems. But at the Fredericksburg VA Health Care Center about an hour south of Washington, DC, he’s already gone through four primary care doctors in about a year-and-a-half.
“You get a form letter that just says, you know, ‘Appreciate serving you. I won’t be there anymore,’” said Dunlap, who spent 23 years in the Marines as a master gunnery sergeant. “You build up a rapport with a doctor, and now you lose a little bit of confidence because now you’ve got to explain everything all over again.”
Touted by the VA as “the nation’s largest VA health care clinic,” the 470,000-square-foot, $300 million facility is still struggling to adequately staff up more than 18 months after opening, according to veterans; health care providers; and members of Congress who represent the area, which has one of the highest concentrations of veterans in the United States.
They describe a vast parking lot and gleaming hallways – much of the space empty – and difficulties getting appointments or being seen by a medical professional, even in urgent care situations.
It’s a scene playing out across the country where the VA has built or updated about 40 health care facilities after legislation enacted under President Joe Biden expanded benefits, and there was a surge of veterans enrolling for care.
That effort has run headlong into a national health care crisis, especially in rural America, driven by critical workforce shortages and funding pressures that led to widespread hospital closures. The VA is facing similar staffing problems – and having trouble competing with the private sector to fill jobs.
Last month, the department’s inspector general found that 97% of VA facilities reported severe shortages of candidates for doctor occupations, and 86% had severe shortages of candidates for nursing positions, a sign of the widespread trouble they have filling jobs. The report says these facilities do not necessarily all have vacancies, but rather that the facilities have identified those jobs as ones that are difficult to fill.
While the Fredericksburg clinic has undergone a phased, rolling opening, it still has a staffing vacancy rate of nearly 40%, which means more than 350 positions haven’t been filled, according to VA data obtained by CNN. Roughly half of the new facilities had double-digit vacancy rates as of July, the data shows.
“That means that veterans are not getting the services they require,” Rep. Eugene Vindman told CNN. The Virginia Democrat represents the district where the Fredericksburg clinic is located.
Vindman, a former Army paratrooper and JAG officer whose district includes about 72,000 veterans, said his staff has been fielding calls from frustrated veterans complaining about services at the facility, which is near Marine Corps Base Quantico and US Army Garrison Fort A.P. Hill.
“It is the fact that they can’t keep staff, that they can’t hire staff, that it’s taking too long. That’s making wait times too long,” Vindman said. “That’s making it impossible for veterans to actually get in the door. And that’s what needs to get fixed.”
The VA staunchly defends its operations at the Fredericksburg clinic and the care offered to veterans. VA press secretary Quinn Slaven, in a statement to CNN, said that the clinic has “met its hiring goals” so far as the phased opening continues, but did not elaborate on what the goals were.
“In less than two years since opening, the clinic has already completed more than 245,000 appointments and is ahead of schedule for enrolling new patients,” Slaven said.
Slaven said all eligible veterans have the choice to get care at the Fredericksburg clinic or at other nearby VA locations. Or veterans can opt to get care at community providers in the private sector at the VA’s expense, he said.
Slaven also stressed what he called “dramatic improvements” in how well America’s veterans have been served overall during the second Trump administration. For instance, he said there’s been a drastic reduction in the backlog of veterans waiting for VA benefits.
One health care provider at the Fredericksburg health care center, who asked to remain anonymous for fear of retribution, as well as other sources familiar with the facility, painted a different picture.
They said a staffing crunch there has led to burnout, departures and the need to shuttle employees from a larger VA medical center in Richmond, Virginia, about an hour to the south.
“It’s overload. They’re exhausted. They’re leaving,” the provider said about doctors and other caregivers, describing employees not taking lunch breaks and a work atmosphere akin to a “car production line.”
Katharine Cunningham-Carlot, a 52-year-old Army veteran who lives in Fredericksburg, said she had trouble getting appointments for neurology, ENT, psychiatry and physical therapy.
She said she recently sought urgent care for an ear infection at the Fredericksburg facility, only to be told there was no provider to see her.
“There was nobody in the waiting room. It was completely empty. I said, ‘Could I see anybody?’” she said, relaying her conversation with reception. She said she was told no. When she asked if she could see a nurse, she said, again, she was told no.
Cunningham-Carlot said the parking lot was just as empty. “I actually thought this would be a good place to practice teenage driving,” she joked.
Ashley Carothers didn’t even get in the door. The 40-year-old Air Force veteran, who lives in Woodbridge, Virginia, had long battled traffic on the I-95 corridor to get care at the VA Medical Center in Washington, DC. She thought it would be far easier to go to the Fredericksburg facility.
“And so, I made a phone call. I was told on the phone, ‘Actually, you’re better off, because of staffing shortages, just to keep your care at DC,’” she told CNN.
The health care sector has been sounding the alarm for years. The Health Resources and Services Administration, part of the Department of Health and Human Services, projected in December that the US would experience an overall shortage of more than 141,000 physicians by 2038.
“There’s a shortage of radiologists. There’s a shortage of primary care practitioners. There’s a shortage of mental health practitioners”, said Suzanne Gordon, senior policy analyst for the progressive-leaning Veterans Healthcare Policy Institute.
“We are seeing a worsening of the health care shortages across the country,” said Dr. David Shulkin, who served as VA secretary in the first Trump administration and was an undersecretary for health during the Obama administration.
“Burnout is not isolated to the VA,” he added. “This is a big problem in health care in general. We’re seeing nurses and doctors, in particular, leaving the workforce at earlier ages because of the stress of the environment.”
But Shulkin added that the VA is constrained by factors that are not of its own making – including restrictions on what it can pay health care providers and an unwieldy bureaucracy. He said it can take weeks longer to hire and credential a doctor at the VA than it would take in the private sector.
“This is asking the VA to do something with several hands tied behind their back,” Shulkin said. “They are limited in their ability to be able to attract qualified health care professionals with the authorities that they’re given, in terms of salary and the flexibility to be able to pay market rates.”
Under a current salary cap, doctors at the VA cannot earn more than the salary of the president of the United States, or $400,000 per year. Under legislation passed during the Biden administration, the VA can use waivers for 300 doctor positions to pay above that amount.
But Shulkin says 300 waivers are inadequate for the VA health care system that includes 170 medical centers and nearly 1,200 outpatient sites. Moreover, the current VA administration has not used all of those waivers, according to congressional sources familiar with the matter.
Slaven, the VA press secretary, told CNN that the “VA is in the process of assigning all 300 of the salary cap waivers,” and noted that only about 1% of VA’s doctors get the exemption.
“It takes considerable time and effort to allocate them in a way that doesn’t negatively impact morale and retention among the department’s broader physician workforce — most of whom will not receive waivers,” Slaven said.
Slaven added: “VA’s ability to recruit and retain health care personnel is hindered by statutory pay caps for physicians, who in many instances can make several hundred thousand dollars more per year in the private sector.”
Gordon says the VA under the leadership of Doug Collins, Trump’s VA secretary, is not blameless for the staffing problems.
Gordon points to cutbacks under Collins. The VA workforce has been reduced by about 30,000 employees this year and last, and the agency has eliminated tens of thousands of vacant positions.
“The word on the street now … is that, you know, ‘Don’t work at the VA,’” Gordon said. “It’s an unstable work environment. It’s a hostile work environment.”