On August 5th, the Department of Veterans Affairs, Office of the Inspector General (VA OIG) released a report entitled “Review of Radiology Staffing and Services at the VA Washington D.C. Healthcare System.” The blandly titled report was an indictment of the second Trump administration’s misguided return-to-office (RTO) policy. The OIG documented that the RTO caused a “mass exodus” of radiologists from the medical center and delays in patient care (although no documented patient harm). Additionally, the report found that facility leaders didn’t follow appropriate protocols in notifying quality management of known problems and failed to track incomplete radiologic studies.
The OIG report appeared just five days after The American Prospect reported on multiple problems at the DC VA Medical Center, one of them being the loss of its radiologists. The OIG, which has formal investigative powers to question witnesses and collect critical data, confirmed not only what we reported in our July 31st article, but added far more detail to the picture.
Read: A VA Medical Center Meltdown
The OIG observed what has become common knowledge in medicine today: There is a “critical” shortage of American radiologists, who can thus get jobs almost anywhere, and partly as a result, remote work has become “standard practice in radiology.” So it was no surprise that since Secretary Doug Collins issued his VA-wide return to the office order in February, OIG had “substantiated that most of the facility’s radiologists resigned between July and December 2025, which contributed to delays in completion of radiologic studies.”
The report adds key details to the return-to-office timeline. The VA issued its order in February last year, in keeping with administration policy. When employees who had been specifically hired to work remotely, like mental health professionals, complained about their inability to maintain patient privacy, the then-VA press spokesman, Peter Kasperowicz, dismissed their concerns. The VA, he said, “is no longer a place where the status quo for employees is to simply phone it in from home.”
In May, the VA softened the mandate with a memorandum exempting radiologists providing telehealth or virtual care, including the National Teleradiology program. In October, the VA, possibly worried about staff losses, exempted all radiologists. This exemption, however, required annual renewal and review.
Not surprisingly, as the report confirms, this did not prevent a “mass exodus” of radiologists from the VA DC Medical Center. As the former DC chief of radiology told the OIG, “It was unclear if the exemption would extend beyond one year, creating uncertainty that drove radiologists to seek non-VA, telework-permitted positions, and hindered VHA’s ability to recruit and hire radiologists.” The former chief also said that his workload increased to a “productivity level more than double the expected amount.”
The VA tried to compensate for the loss of radiologists by utilizing its National Teleradiology Program (NTP). The NTP employs radiologists to fill gaps in coverage—for example, reading images at night or on the weekend, or for smaller VA facilities that do not have radiologists on site. However, the services the NTP could provide were “limited” because of the NTP’s own staffing shortages, which were documented in an OIG report released in December 2025, which it argued was a product of the increasingly dire national radiologist shortage.
In December 2025, the VA OIG recommended that VA leaders analyze staffing shortages and create a plan of action to get more radiologists for NTP and throughout the VA system. But in the August 2026 report, the OIG stated that as of February 2026, its recommendations “remained open.” That is, nothing had apparently been done to implement them.
The predictable result: outsourcing. VA radiology referrals are now routinely going to what are euphemistically known as “fee basis” or “community” providers—i.e., private-sector providers who contract with the VA and whose services are far more expensive than those provided by in-house staff. As one DC VA Medical Center physician told the Prospect, “We are spending a lot of money on fee-basis providers who we are paying by the hour. We also have contracts with private-sector radiology groups. This indicates that you do not have a functioning radiology infrastructure. If you did, you wouldn’t have to put together the piecemeal system like we do now.” Among those private providers, ironically, is the former radiology chief mentioned above—now being paid even more to “phone it in,” as Kasperowicz put it. This is how the radiology backlog was ostensibly addressed, per the OIG report.
The DC VA Medical Center physician said that there is also a problem recruiting and retaining diagnostic radiology technologists who support radiologists with CT scans, X-rays, or MRIs, and are credentialed on each machine. In a competitive marketplace like DC, with many hospitals competing for staff, rigid government pay scales reduce the VA’s appeal.
While the VA OIG report focused on only one VHA facility, as the Prospect has reported, staffing shortages across many fields are a system-wide problem. On August 11, for example, the VA OIG issued a report on its inspection of the VA Syracuse Healthcare System in New York. “Executive leaders,” the OIG wrote, “identified staff departures due to the deferred resignation program, and multiple staff positions that remained unfilled during a federal hiring freeze (in effect from January 20, 2025, to October 15, 2025) as system shocks. Executive leaders told the OIG that staff losses and difficulties filling vacancies had negatively affected facility operations … leaders explained they were actively recruiting to fill the positions but had received few applications.”
Other VA doctors and nurses from around the country described problems with accessing in-house radiology services to the Prospect. A physician from a hospital in the Pacific Northwest wrote that, “We are struggling with adequate radiology support, and all general X-rays are sent to the community unless they are needed urgently.” Another said that VHA has lost an estimated 37 percent of its radiologists nationwide.
A nurse practitioner in a large VA center in the West said that one of their radiologists had left due to VA funding issues, causing a backlog in reading images. Now if a patient needs an MRI, that means they may have to stay in the hospital longer.
When contacted, the VA declined to comment.
PATIENTS ARE ALSO EXPRESSING their frustrations with delays in getting needed services. James Jones, an Army veteran who served in the Gulf War and lives in rural North Carolina, said he has been treated at the Asheville VA Medical Center for sinus and breathing issues following his service in the Gulf War, where he was “exposed to all kinds of airborne contaminants.”
When he visited his primary care physician in February, he was told he needed a CT scan of his sinuses. The physician referred him to the ear, nose, and throat clinic in Asheville. He was then informed that because of severe understaffing, he couldn’t get an appointment till August. The alternative was community care, where he finally got the CT study he needed. Unfortunately, Jones added, it was performed in a hospital that is slated for closure because of the Trump administration cuts to Medicaid.
“Secretary Collins says we are getting more choice of services,” Jones said. “But if there are long waits at the VA hospital and you have to go to the private sector, that’s not really a choice, is it?”
Read: Trump Funding Cuts Endangering City and Rural Hospitals Alike
All this was easily foreseeable. As one VA expert explained, “VA leaders should have been aware that there is a national shortage of radiologists. This is hardly a secret. They should also have been aware of the ongoing investigation by the VA OIG about radiology staffing shortages, and the problems at the National Teleradiology Program.” But the current crop of VA leaders has, this expert opined, little health care experience and seemingly “very low health care intelligence.”
While one particular radiology shortage has been resolved at the DC VA Medical Center at considerable cost, there remains a serious problem elsewhere in the VA health system. No modern health care system can remain viable without radiologists. Seeking private-sector radiologist backup is not a viable long-term solution to this problem. It is expensive and potentially unreliable, as the shortage affects all parts of the health care system.
Indeed, it may worsen the shortage. Lack of VA staff at the VA will harm its ability to teach future generations of physicians in the field. After the Centers for Medicare and Medicaid Services, the VA is the second-largest funder of postgraduate medical education in the U.S., so it is in a perfect position to help ease shortages in critical specialties like radiology, psychiatry, and primary care. It is also well-placed to attract more needed medical staff in VA, since residents who train there are more likely to want to stay with the agency. But without currently working staff, that is obviously impossible. As one VA expert explained, “To do this you need radiologists who can both interpret imaging studies and meet the rigorous teaching requirements of academic affiliates who oversee residency programs. Being able to effectively teach physician trainees is not a skill every doctor has.”
This situation can, of course, be remedied—but only if VHA leaders revoke policies that have, as the Prospect has reported, damaged VHA’s prior reputation as an employer of choice. As one VA specialist physician commented, “While it’s true that the VA doesn’t pay market-rate salaries, many physicians care about more than money. At the VA I’ve been able to get closer to the ideal way medicine should be practiced. Because my patients are so complex, I have smaller patient loads so I can spend more time with them. I can get patients the resources they need, like mental health care, supplies like home blood pressure monitors, and support for housing. Patients who would have died in the private sector are alive for decades because of the VA. All that is now in jeopardy.”
