The VA's Own Hospitals Are Short-Staffed. Its Outside-Care Bill Isn't.
Summary
VA hospitals reported 4,434 severe staffing shortages in 2025 — up 50% in a year, with 94% of facilities missing physicians. Over the same stretch, VA's obligations for care bought from private providers are set to climb from $40.7 billion to a requested $57 billion by 2027, growing two and a half times faster than the budget for VA's own hospitals.
Follow the dollar
's medical budget runs through four accounts. Two do the actual work of care — Medical Services pays for treatment delivered by 's own staff in 's own facilities, and Medical Community Care pays private providers for treatment couldn't deliver itself. The other two — facilities upkeep and administrative support — are overhead.
View data as table
| Medical Services (VA's own hospitals) | $88.5B | 58.7% of total |
|---|---|---|
| Medical Community Care (private providers) | $40.7B | 27.0% of total |
| Medical Support & Compliance | $11.6B | 7.7% of total |
| Medical Facilities | $9.9B | 6.6% of total |
Of $150.7 billion in total FY2025 Medical Care obligations, per 's own FY 2027 Budget in Brief, 58.7 cents went to Medical Services — 's in-house hospitals and clinics — and 27.0 cents, $40.7 billion, went to Medical Community Care: veterans treated by a private doctor, at 's expense, because itself couldn't see them in time or didn't offer the specialty nearby.
Two accounts, two growth rates
That 27-cent slice isn't holding steady. Compare 's own request for how both accounts grow between the FY2025 enacted level and the FY2027 budget it submitted to Congress in April 2026.
View data as table
| Direct care, FY2025 enacted | $88.5B | |
|---|---|---|
| Direct care, FY2027 request | $102.1B | +15.4% |
| Community care, FY2025 enacted | $40.7B | |
| Community care, FY2027 request | $57.0B | +40.0% |
Direct care — the account that pays 's own doctors and nurses — grows from $88.5 billion to a requested $102.1 billion: +15.4% over two years. Money sent to private providers grows from $40.7 billion to a requested $57.0 billion: +40.0% over the same two years, per the same FY 2027 Budget in Brief. Community care isn't just growing — it's growing 2.6 times faster than the budget for the hospitals actually staffs.
The same year, counted in staff
The budget doesn't explain itself in a vacuum. In the same fiscal year requested more money to send veterans elsewhere, its own watchdog found the worst shortage of in-house clinicians it has ever recorded.
View data as table
| FY2024 | 2,959 | VA OIG occupational staffing questionnaire |
|---|---|---|
| FY2025 | 4,434 | +50%; 94% of facilities short on physicians |
Every one of VHA's 139 medical facilities reported at least one severe occupational staffing shortage in FY2025, according to the VA Inspector General's annual determination — 4,434 shortages VHA-wide, up 50% from 2,959 the year before, the sharpest jump the has measured. Ninety-four percent of facilities (131 of 139) reported a severe shortage of Medical Officers — 's term for physicians — and 79% (110 of 139) reported one for Nurses. Both occupations have made the 's severe-shortage list every year since 2014.
The takeaway
- The safety valve is carrying more pressure every year. Community care obligations are requested to grow 2.6 times faster than the budget for 's own hospitals between FY2025 and FY2027 — $40.7 billion rising toward $57.0 billion.
- The staffing hole is the worst on record. 4,434 severe occupational shortages VHA-wide in FY2025, up 50% in a single year, with 94% of facilities missing physicians and 79% missing nurses.
- These aren't two separate stories. A veteran can't staff to see in-house is a veteran pays someone else to see — the same dollar, routed around the shortage instead of fixing it.
Figures cover Medical Care accounts only (Medical Services, Medical Community Care, Medical Support & Compliance, Medical Facilities) and exclude 's separate benefits, research, and construction accounts. FY2026 and FY2027 figures are enacted and requested levels as of 's April 2026 budget submission, not final appropriations.
Sources
- Dept. of Veterans Affairs — 2027 Congressional Budget Submission, Budget in Brief (April 2026), the source for all Medical Care obligations by account category, FY2025 enacted through FY2027 requested. department.va.gov
- Office of Inspector General — Determination of Veterans Health Administration's Severe Occupational Staffing Shortages, Fiscal Year 2025 (Report No. 25-01135-196, Aug. 12, 2025), the source for FY2024/FY2025 shortage counts and physician/nurse shortage rates by facility. vaoig.gov
Comments
Always open. Logged-in readers can annotate paragraphs in place.
The Department of Veterans Affairs runs its own hospitals and pays outside ones, out of the same budget. When can't staff an appointment in-house, it buys the visit from a private provider instead — a safety valve, by design, under the 2018 MISSION Act. In 2025 that valve carried more money than ever, in the same year 's own hospitals reported the worst staffing shortages on record.