As an Agency, the VA has determined to change this fact and we commend the recognition that veterans need quick appointments.  The manner in which it has decided to demonstrate less cancellations, less time to reschedule  and a more efficient use of a VA providers time however is what NFFE takes issue with.  Rather than thinking through the problem, VA as is typical for many National decisions, by fiat,  has ordered it's primary care providers to see patients (veterans) where it is actually not possible.  Providers have had their vacations cancelled, Leave dramatically restricted, important continuing education training scrubbed, etc.,  as the VA simply dumped the clinic cancellation problem on front line providers.  VA may have made it's Medical Center Director's Performance Standards and Chief of Staff standards reflect the need for better handling of clinic cancellations, but seems to offer no additional resources to accomplish the task.  As with far too many management decisions, some bureaucrat simply stated "no more" and Providers are now over burdened and swamped with an impossible task at many VA stations.

The NFFE Labor Management Agreement of 1997 allows a provider to apply for unscheduled leave and approval of unscheduled leave is to accomplished normally within 24 hours.  With the stroke of a pen, VA has done away with this binding contract provision and has, at many facilities,  ordered providers to see every patient on a their panel.  If the veteran shows up at a VA, regardless the planning she or he must be seen.  Imagine that, if in one one day 25 veterans arrive at a VA Medical facility and they are all on Provider X's Panel, they must be seen on Provider X!   Provider X has a full day of patients yet she or he is now responsible for seeing the extra 25 on top?  Is it then any wonder Primary Care providers are leaving VA for the Private Sector.  In the words of one PC Provider, "I came to the VA to slow down a bit, and to serve veterans.  I didn't come for the money.  I wanted more to spend more time with my patients.  Now, I am expected to give up my lunch break, my morning and afternoon breaks, which I don't mind,  but giving up my leave and being required to see veterans until late into the evening is something else...", -- I am sincerely considering a return to the private sector where at least I could earn twice the money and I will feel appreciated."

At one Midwestern VAMC, the number of examination rooms have been deliberately over reported by the VA Management in order to give the VISN the impression that this VA is performing Advanced Clinic Access.  The fact of the matter is, less than one examination room per provider exists and this ratio is entirely inadequate for ACA or for any realistic patient schedules to provide for veterans care.

NFFE at the VA Council level is examining what appears to be the VA's unilateral implementation of a Clinic Cancellation Policy without proper notice to the Union and in violation of the 1997 Collective Bargaining Agreement.  While Primary Care Providers become frustrated and quit many of our VA facilities, the VA seems to hold to the management model that if you stick it in the Center Director's Performance Standard, she or he will stick it in the employees performance standard and it will get done, or at least they can make it look like they are getting it done.  What VA isn't counting on, is the incredible burn out of Physicians and Mid Level providers who are opting to seek and accept work elsewhere in order to escape the draconian management tactics.   This hurts veterans, disrupts continuity of care  and most certainly isn't consistent wit the Transformational Initiatives of Secretary Shinseki.