Psychiatrists registered with the Department of Veterans Affairs to provide care in the community often encounter payment delays and scheduling problems, causing them to leave the VA system, according to a former VA clinician now in private practice. (Stars and Stripes)
WASHINGTON — Chronic medical staffing shortages at the Department of Veterans Affairs make it difficult for the most ill patients with mental health conditions to see psychiatrists in a timely manner, according to a former VA clinician now in private practice.
In addition, psychiatrists registered with the VA to provide care in the community often encounter payment delays and scheduling problems, causing them to leave the VA system, said Shankar Yalamanchili, a former VA psychiatrist who now directs River Region Psychiatry Associates, a privately run multistate practice.
Yalamanchili delivered the message to lawmakers Tuesday at a House Veterans’ Affairs Committee subpanel on health hearing. He said VA hospitals need the ability to contract directly with private physician groups to fill vacancies so veterans are not underserved or forced to wait months for care.
The Veterans Health Administration is facing medical staffing shortages, according to a VA Office of Inspector General report that found severe personnel shortages in fiscal 2024 impacting clinical and non-clinical jobs. Shortages span nurses, primary care doctors and psychiatrists, among other roles.
Missy Jarrott — mother of Navy veteran Landon Holcomb — told lawmakers that the VA repeatedly canceled and delayed her son’s appointments to see a psychiatrist for mood-stabilizing drugs to treat his depression.
“The system completely failed him,” she said.
Holcomb, 39, died from a drug overdose in 2024, after his requests for psychiatric care were denied and then delayed, Jarrott said.
“All Landon asked for was a mental health appointment for medicine management. He raised his hand over and over,” she said.
Rep. Mariannette Miller-Meeks, R-Iowa, the subpanel chairwoman, said she does not believe spending more to provide care at the Veterans Health Administration is the answer. In fiscal 2024, Congress provided $121 billion in funding for health services for veterans.
But a severe shortage of doctors was reported by 86% of VA hospitals and clinics in 2024. Though the VA hired more than 300 psychiatrists since 2023, the agency has faced chronic shortages for psychiatrists for several years, reflecting a national shortage. Fewer medical students choose psychiatry as their specialty, according to the American Association of Medical Colleges.
Approximately 40% of veterans require mental health services every year, said Yalamanchili, who urged lawmakers to be more “proactive” in addressing the VA’s shortages of medical staff by considering alternative solutions that include hiring doctor groups to fill gaps in care.
Yalamanchili offered insights about shortages and delays in the delivery of care to veterans with psychiatric illnesses. He said private clinicians who register with the VA to accept veterans as patients get frustrated by frequent problems in receiving timely reimbursements for the care that they provide. The VA schedules appointments that veterans have with private clinicians in the community.
Yalamanchili described a “lack of coordination” by the VA that results in appointment cancellations and delays for follow-up visits.
“Private doctors are frustrated and leave the network,” he said.
But Rep. Julia Brownley, D-Calif., said “here is a serious lack of oversight” of private doctors in the community, compared with clinicians at the VA.
“We must find a balance between community and VA care,” she said.
Michael Urban, an Army veteran and clinical social worker, said he began taking prescribed painkillers after he was injured in an accident during a jump as a paratrooper in the 82nd Airborne Division.
Urban was medically discharged and had to undergo multiple surgeries for his injury. He was placed on a regimen of opioids to dull the pain — “a path all too familiar to many veterans,” he said.
In 2004, he began receiving medical care at the Philadelphia VA Medical Center. But Urban said there were long delays for addiction treatment and mental health care.
“I’ve experienced the challenges of accessing care in the system,” he said.
Though there are shorter waits for health care since passage of the Mission Act, which enabled veterans to see community-based clinicians, he said there are sometimes bureaucratic delays in accessing community care.
But Maria Llorente, acting VA undersecretary for the health office of integrated veterans care, said the availability of residential addiction treatment for veterans has grown, as the VA now sends veterans to care in the community when beds at a VA hospital are not available.
Brownley said residential treatment is more costly at private programs, running to $6,000 per day.
Jarrott said her son was booked at Charleston VA Health Care in South Carolina in May 2024 to see a psychiatrist six months after he originally sought mental health care and medication management for his depression.
But Holcomb died from fentanyl poisoning before his scheduled visit, she said. Her son’s drug abuse was an attempt to “numb the pain” from mental health problems connected to military service, Jarrott said.
“He was experiencing anxiety, insomnia, restlessness and mood swings. Landon knew that he needed a mood stabilizer,” she said. “Help did not come soon enough.”
