A Learjet 31 took off before daybreak from Helena Regional Airport in Montana, carrying six Veterans Affairs medical providers and 250 doses of historic cargo cradled in a plug-in cooler designed to minimize breakage.
The group’s destination was Havre, Montana, 30 miles from the Canadian border. About 500 military veterans live in and around this small town of roughly 9,800, and millions more reside in similarly rural, hard-to-reach areas across the United States.
About 2.7 million veterans who use the VA health system are classified as “rural” or “highly rural” patients, residing in communities or on land with fewer services and less access to health care than those in densely populated towns and cities. An additional 2 million veterans live in remote areas who do not receive their health care from VA, according to the department. To ensure these rural vets have access to the covid vaccines, the VA is relying on a mix of tools, like charter and commercial aircraft and partnerships with civilian health organizations.
The challenges of vaccinating veterans in rural areas — which the VA considers anything outside an urban population center — and “highly rural” areas — defined as having fewer than 10% of the workforce commuting to an urban hub and with a population no greater than 2,500 — extend beyond geography, as more than 55% of them are 65 or older and at risk for serious cases of covid and just 65% are reachable via the internet.
For the Havre event, VA clinic workers called each patient served by the Merril Lundman VA Outpatient Clinic in a vast region made up of small farming and ranching communities and two Native American reservations. And for those hesitant to get the vaccine, a nurse called them back to answer questions.
“At least 10 additional veterans elected to be vaccinated once we answered their questions,” said Judy Hayman, executive director of the Montana VA Health Care System, serving all 147,000 square miles of the state.
The Havre mission was a test flight for similar efforts in other rural locations. Thirteen days later, another aircraft took off for Kalispell, Montana, carrying vaccines for 400 veterans.
In Alaska, another rural state, Anchorage Veterans Affairs Medical Center administrators finalized plans for providers to hop a commercial Alaska Airlines flight on Thursday to Kodiak Island. There, VA workers expected to administer 100 to 150 doses at a vaccine clinic conducted in partnership with the Kodiak Area Native Association.
“Our goal is to vaccinate all veterans who have not been vaccinated in and around the Kodiak community,” said Tom Steinbrunner, acting director of the Alaska VA Healthcare System.
VA began its outreach to rural veterans for the vaccine program late last year, as the Food and Drug Administration approached the dates for issuing emergency use authorizations for the Pfizer-BioNTech and Moderna vaccines, according to Dr. Richard Stone, the Veterans Health Administration’s acting undersecretary. It made sense to look to aircraft to deliver vaccines. “It just seemed logical that we would reach into rural areas that, [like] up in Montana, we had a contract with, a company that had small propeller-driven aircraft and short runway capability,” said Stone, a retired Army Reserve major general.
Veterans have responded, Stone added, with more than 50% of veterans in rural areas making appointments.
As of Wednesday, the VA had tallied 220,992 confirmed cases of covid among veterans and VA employees and 10,065 known deaths, including 128 employees. VA had administered 1,344,210 doses of either the Pfizer or Moderna vaccine, including 329,685 second vaccines, to veterans as of Wednesday. According to the VA, roughly 25% of those veterans live in rural areas, 2.81% live in highly rural areas and 1.13% live on remote islands.
For rural areas, the VA has primarily relied on the Moderna vaccine, which requires cold storage between minus 25 degrees Centigrade (minus 13 degrees Fahrenheit) and minus 15 degrees C (5 degrees F) but not the deep freeze needed to store the Pfizer vaccine (minus 70 degrees C, or minus 94 degrees F). That, according to the VA, makes it more “transportable to rural locations.”
The VA anticipates that the one-dose Johnson & Johnson vaccine, if it receives an emergency use authorization from the FDA, will make it even easier to reach remote veterans. The vaccines from Moderna and Pfizer-BioNTech both require two shots, spaced a few weeks apart. “One dose will make it easier for veterans in rural locations, who often have to travel long distances, to get their full vaccination coverage,” said VA spokesperson Gina Jackson. The FDA’s vaccine advisory committee is set to meet on Feb. 26 to review J&J’s application for authorization.
Meanwhile, in places like Alaska, where hundreds of veterans live off the grid, VA officials have had to be creative. Flying out to serve individual veterans would be too costly, so the Anchorage VA Medical Center has partnered with tribal health care organizations to ensure veterans have access to a vaccine. Under these agreements, all veterans, including non-Native veterans, can be seen at tribal facilities.
“That is our primary outreach in much of Alaska because the tribal health system is the only health system in these communities,” Steinbrunner said.
In some rural areas, however, the process has proved frustrating. Army veteran John Hoefen, 73, served in Vietnam and has a 100% disability rating from the VA for Parkinson’s disease related to Agent Orange exposure. He gets his medical care from a VA location in Canandaigua, New York, 20 miles from his home, but the facility hasn’t made clear what phase of the vaccine rollout it’s in, Hoefen said.
The hospital’s website simply says a staff member will contact veterans when they become eligible — a “don’t call us, we’ll call you,” situation, he said. “I know a lot of veterans like me, 100% disabled and no word,” Hoefen said. “I went there for audiology a few weeks ago and my tech hadn’t even gotten her vaccine yet.”
VA Canandaigua referred questions about the facility’s current phase back to its website: “If you’re eligible to get a vaccine, your VA health care team will contact you by phone, text message or Secure Message (through MyHealtheVet) to schedule an appointment,” it states. A call to the special covid-19 phone number established for the Canandaigua VA, which falls under the department’s Finger Lakes Healthcare System, puts the caller into the main menu for hospital services, with no information specifically on vaccine distribution.
For the most part, the VA is using Centers for Disease Control and Prevention guidelines to determine priority groups for vaccines. Having vaccinated the bulk of its health care workers and first responders, as well as residents of VA nursing homes, it has been vaccinating those 75 and older, as well as those with chronic conditions that place them at risk for severe cases of covid. In some locations, like Anchorage and across Montana, clinics are vaccinating those 65 and older and walk-ins when extra doses are available.
According to Lori FitzGerald, chief of pharmacy at the VA hospital in Fort Harrison, Montana, providers have ended up with extra doses that went to hospitalized patients or veterans being seen at the facility. Only one dose has gone to waste in Montana, she said.
To determine eligibility for the vaccine, facilities are using the Veterans Health Administration Support Service Center databases and algorithms to help with the decision-making process. Facilities then notify veterans by mail, email or phone or through VA portals of their eligibility and when they can expect to get a shot, according to the department.
Air Force veteran Theresa Petersen, 83, was thrilled that she and her husband, an 89-year-old U.S. Navy veteran, were able to get vaccinated at the Kalispell event. She said they were notified by their primary care provider of the opportunity and jumped at the chance.
“I would do anything to give as many kudos as I can to the Veterans Affairs medical system,” Petersen said. “I’m so enamored with the concept that ‘Yes, there are people who live in rural America and they have health issues too.’”
The VA is allowed to provide vaccines only to veterans currently enrolled in VA health care. About 9 million U.S. veterans are not enrolled at the VA, including 2 million rural veterans.
After veterans were turned away from a VA clinic in West Palm Beach, Florida, in January, Rep. Debbie Wasserman Schultz (D-Fla.) wrote to Acting VA Secretary Dat Tran, urging him to include these veterans in their covid vaccination program.
Stone said the agency does not have the authorization to provide services to these veterans. “We have been talking to Capitol Hill about how to reconcile that,” he said. “Some of these are very elderly veterans and we don’t want to turn anybody away.”
KHN (Kaiser Health News) is a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.
Looking to meet with a VA recruiter? Forget the crowded conferences – VA is making it easier to connect with one by taking the traditional job fair online with a virtual open house.
Starting this month, we’re launching a new series of virtual open houses aimed at connecting doctors, nurses, and job seekers in other critically needed occupations with a VA recruiter. (And in May, there will be a special open house just for nurses!). The series will be hosted every fourth Wednesday of the month from 2-3 p.m. ET.
In addition to doctors and nurses, each month will offer a specialty booth focused on a specific field:
March: Physicians, social work.
April: Medical support assistants, medical technologists.
May: Nurses, practical nurses.
June: Medical records technicians.
September: Medical instrument technicians.
These occupations are being highlighted as part of VHA’s 75th anniversary celebration, recognizing decades of providing high quality health care to millions of the nation’s Veterans.
What to expect
Like a traditional job fair, these virtual open houses bring together employers and job seekers for a set period of time on a particular date. But instead of face-to-face meetings, you’ll connect via chat.
You’ll be able to upload your resume when you register and then participate in a brief, web-based chat with a recruiter, who will answer basic questions about working at VA and how to apply for open positions.
“This is a great chance for interested candidates to chat with recruiters who understand the process behind getting hired at VA,” said Mike Owens, recruitment marketing program specialist at VA.
To make the most of your time with a recruiter, make sure you prepare your questions ahead of time.
You should use a smartphone, tablet or computer with a reliable internet or wireless connection to connect. Our virtual career fairs are compatible with all internet browsers but work best with Chrome.
If you’re considering a career caring for America’s heroes, now is a great time to get connected with one of our hiring experts.
Innovation is essential to delivering modern, high-quality health care. Embracing new technologies and exploring groundbreaking techniques is not only encouraged at VA — it’s celebrated.
Take a look at 3D printing, a relatively new technology with a myriad of applications to health care.
Back in 2017, we were an early adopter of 3D printing, establishing an integrated virtual printing network for creating hand and foot orthotics, replicating organs and planning surgeries. The network has now grown to 40 hospitals across the country.
“This 3D printing technology is all about empowering our frontline staff and patients to advocate for what they need and then to build it,” said Beth Ripley, MD, Ph.D., director of VHA’s 3D Printing Network and chair of the 3D Printing Advisory Committee.
VA pushed even further in 2020. The department can now print medical devices onsite, allowing us to deliver more efficient, personalized care to Veterans.
We were also able to rise to several challenges presented by the COVID-19 pandemic, helping to develop a 3D-printed nasopharyngeal swab and creating face mask design challenges to address problems encountered by health care workers and first responders.
How was this quick action possible? Because, according to Ripley, VA culture is “non-siloed, integrated and collaborative.”
We don’t innovate from the top down. We encourage our employees, at all levels of the organization, to be part of the process.
Through Innovation Ecosystem programs, over 25,000 of our employees have received training, engaged in innovation competitions or led implementation of promising new practices. We’ve positively impacted the lives of more than one million Veterans and saved $40 million since 2015.
Changes don’t have to be solely made on a large scale. Small, local changes can have an equally big impact on the quality of care we’re able to deliver to more than 9 million Veterans across the nation.
Some innovations inspired by our employees in 2020 include:
A device that dispenses only one eye drop at a time, helping Veterans who struggle with reduced vision and manual dexterity.
A 10-week health education group to address health care disparity for LGBTQ+ Veterans.
A software system that helps reduce six- to 12-month wait times for prosthetics.
Virtual reality therapy to help Veterans coping with post-traumatic stress disorder.
Wearable sensors to help improve COVID-19 patient outcomes as well as readmissions for heart failure.
Augmented reality microscopes that leverage artificial intelligence, big data and machine learning models to detect and classify cancers.
“The status quo is not enough — if we continue to do what we have always done, we will get the results we have always gotten,” reads the VHA State of Innovation Report.
Work at VA
We are always looking for clinical and non-clinical professionals who want to be part of this culture of change and improvement. Discover if a career at VA is right for you.
VA is working to streamline and demystify the job application process for potential candidates, and one champion of this effort is Tracey Therit, VA’s chief human capital officer.
Therit joined host Mike Owens for “Talk About It Tuesday,” a weekly live broadcast on LinkedIn, to discuss her work chairing the VA Employee Experience Council. The council has collaborated with the Veterans’ Experience Office to map the journey of a VA employee.
“We’ve identified moments that matter in that employee journey, and we are working across the department to increase trust in the employee experience by making things easy and effective,” Therit said. “One of the stages in the journey looks at the applicant experience.”
Moments that matter
After talking with current and former employees about their experience at VA, the team identified five stages of a VA applicant’s experience along with additional important steps within those stages.
“We’re really looking at all that rich data, listening to that feedback that we got from individuals who’ve applied for positions with VA and either got in or didn’t get in, and how we can use that information to improve the application experience,” Therit said.
The stages of the “getting in” phase include searching for jobs, applying for jobs, interviewing, receiving an offer and accepting the offer. Therit went on to provide tips to applicants to help them successfully navigate each of these stages.
Keep in mind that, as a federal agency, VA must follow more hiring rules and regulations than the private sector. Therit said your odds for successfully landing that VA job will increase if you:
Ensure you meet the qualifications for the job.
Tailor your resume for each position.
Narrow your job search criteria to those that are a best match to your skills and experience.
Provide all necessary documentation, especially if you are a Veteran, military spouse or have a disability.
While VA is continuing to hire at a rapid pace during the COVID-19 pandemic, there can still be stiff competition for job openings.
“We have so many people who are knocking on VA’s doors and trying to get in to serve our nation’s Veterans,” Therit said.
Making a difference for Veterans
The granddaughter of a World War 2 Veteran and daughter of a Korean War Veteran, Therit identifies closely with VA’s mission on a personal level.
Working alongside other dedicated staff to help Veterans receive health care, overcome homelessness and connect with educational benefits is her favorite part of working at VA.
“It is humbling to serve Veterans knowing that my family has fought for the freedoms that we enjoy today,” Therit said.
Work at VA
If you’re looking for a meaningful career serving our nation’s heroes, consider VA. We are seeking health care providers, administrative staff and support personnel at facilities throughout the nation.
If you like innovation, you’ll love working at VA. We have adopted and continually promote a culture of innovation among our team. One of the ways we do this is by encouraging employee-developed and implemented innovations and promising practices that lead to better care and services for our nation’s Veterans.
The iEX conference showcased solutions and practices created by employees and honored top innovators with an Innovator of the Year Award and VHA Innovators Network (iNET) Awards.
Eighteen employee innovators from the iNET Spark-Seed-Spread Innovation Investment Program participated in iEX demonstrations. These frontline employees designed innovative products or programs over the past year, while being trained in innovation-related competencies. The event also featured 15 Diffusion of Excellence Shark Tank competition finalists who pitched their promising, evidence-based practices to tough health care challenges. These solutions were presented to VA leaders, or “sharks,” interested in replicating these practices at their facilities.
From the Army to VA nurse and employee innovator
Terri Ohlinger, a Cincinnati VA Medical Center (VAMC) nurse, has been creating health solutions for her patients throughout her 30-year nursing career. She developed a sense of resourcefulness while serving in the Army, caring for her fellow soldiers. That ingenuity followed Ohlinger to VA – it’s how she approaches caring for her fellow Veterans. Luckily, the Cincinnati VAMC is part of iNET. Her latest quest is called “Drop Ease.”
Ohlinger developed the Drop Ease device to measure eye drops efficiently while making it easy enough for all Veterans to use.
“Too many patients were not performing their eye drop treatment regimens because the bottle was too hard to squeeze, potentially leading to poor outcomes,” said Ohlinger. “They were also using too many drops with each dose and needed to reorder drops more frequently, resulting in increased costs.”
Since iNET connects and partners with academia, nonprofit companies and the private sector, Ohlinger was able to get in touch with Quality Life Plus (QL+), a nonprofit focused on fostering and generating innovations that aid and improve the quality of life for those who have served. The company teamed engineering students from the University of Cincinnati with Ohlinger to work on prototyping Drop Ease as part of their senior project.
Empowering employees and Veterans
iNET allows VA employees to innovate and succeed. Its success isn’t based solely on the final innovative solution design or its implementation. Rather, it is measured by the sense of empowerment the employee innovator gets from participating in iNET.
What does it mean to be part of iNET? “That I am being heard,” Ohlinger said. “More importantly, [that] the Veterans are being heard. I asked what the problem was and then strived to find the answer – and then took it back to the Vets so they could tell me how to make it better.”
It is because of the passion and drive of innovators like Ohlinger that VA delivers the best care anywhere.
Work at VA
VA is always looking for talented innovators who want to make a difference in the lives of Veterans. See if a VA career is right for you:
Are you ready to launch a career with your advanced degree? Are you interested in public leadership and helping Veterans? If you answered yes to these questions, take a look at VA’s prestigious Presidential Management Fellows (PMF) program.
We use the PMF program to attract talented candidates and turn them into talented leaders. After two years, fellows may be able to convert their fellowship opportunity into a full-time position at VA, which helps us grow the pool of exceptional talent serving our nation’s Veterans. The program is a win-win.
Throughout the program, we provide fellows with the training and development opportunities they need to become effective change leaders, including a senior-level mentor. Fellows may create an individual development plan for their program, network with other fellows and contribute to VA’s larger mission.
“While working on my master’s in social work, I knew I wanted to be in an environment where my job would be meaningful and the mission would align with social work’s values,” said PMF fellow Sarah Leder. “My position in the Office of Community Care within the Veterans Health Administration allows me to do that by working on implementing policies to connect Veterans and their families with the health-related help they need.”
Pathways for students
To be eligible for a fellowship, you must be completing, or have completed, a qualifying advanced degree — a master’s, law or doctoral program — within the past two years. You also must complete a rigorous selection process that assesses writing, interpersonal, analytic and leadership skills.
We are always seeking highly qualified candidates to join our workforce and offer many different internship, trainee, fellowship and residency programs for prospective employees to explore. The PMF program is one of three programs in VA Pathways, which aims to recruit talented students and graduates for potential VA careers.
“I encourage anyone passionate about policy and motivated by public service to apply to the PMF program,” said Vanessa Studer, a second-year fellow. “The PMF program provides an accelerated pathway to immerse oneself in the inner workings of the federal government and be an agent of change.”
In addition to the opportunity to serve our nation’s heroes, VA employees enjoy many other benefits, including generous time off, a robust federal retirement plan and a wide selection of comprehensive health insurance plans. Other perks that come with choosing a VA career include:
Flexible work schedules and shifts.
Diversity and inclusion policies and programs.
Continuing leadership and other professional development opportunities and mentoring programs.