How Trump Put Veteran Care in Crisis
Eight days after his second inauguration, President Donald Trump reactivated and expanded a bureaucratic purge he had launched eight years earlier. In a mass email, Trump’s Office of Personnel Management offered a stark choice to two million federal employees: immediately resign from your position and receive pay until an official exit date in the fall, or stay and face what the incoming administration promised would be an onslaught of cuts and chaos.
On its face, the choice may have looked easy. But countless federal employees see their positions as not simply a job, but a calling. This feels especially true at the Department of Veterans Affairs, the second-largest federal agency, where a full one-third of staff are veterans, and many more hail from military families.
Amy Smith is one such example: a deeply dedicated VA nurse who, by the time the OPM email landed in her in-box, had devoted 33 years to working with veterans. She wanted to invest at least ten more. Smith’s grandfather fought in World War II, her father was a Marine in Vietnam, and her husband served in the Air Force. “The mission for veterans runs deep in my blood,” she told the Prospect.
Smith secured a job at the Jackson, Mississippi, VA hospital fresh out of nursing school and never looked back. Along the way, she repeatedly distinguished herself and earned a series of promotions. As the Jackson VA’s chief nurse during Hurricane Katrina, Smith helped orchestrate a massive shift of patients and resources out of New Orleans and into neighboring VA clinics and hospitals on higher ground. For this, she was awarded the VA secretary’s “Hero Award.” She also coordinated COVID-19 care in 2020, and ran a similar emergency response for Hurricane Laura, while serving as the hospital’s deputy chief medical officer.
“In times like that, everybody pulls together. They quickly move staff and resources wherever they’re needed across the system,” Smith said proudly. “That’s one of the great advantages of having an integrated health care system.” In 2022, she was named the hospital’s director of clinical operations.
The particulars of Trump’s 2025 retirement offer meant little to Smith. Her decision to leave ultimately hinged on her worry that, should she stay, she would witness the erosion of care at her beloved hospital. “I didn’t want be part of dismantling something that the veterans have earned,” she said. “I really intended to do it for much longer. But I did a lot of soul-searching, and I made my decision—though I’ve grieved leaving the veterans.”
Smith is one of thousands who have left the VA in the first year of Trump’s second term. Their backgrounds and specialties cover a wide spectrum, from janitors and nurses to doctors and claims assistants, therapists, pharmacists, innovative neurosurgeons, and psychologists, plus a slate of high-ranking administrators like Smith who developed invaluable institutional knowledge over decades of service.
VA Secretary Doug Collins has pitched this exodus, and his broader plans to eliminate 56,000 positions in the VA workforce, as a straightforward exercise in government efficiency, to pare down inessential workers while sparing core clinical staff. And yet many of the people who have departed in recent months specialize in clinical areas that Trump and Collins have pledged to prioritize, including suicide prevention.
Among the departed is Dr. Matthew Miller, formerly the executive director for VA Suicide Prevention. Miller is himself a veteran whose work was deeply driven by his personal background. Miller lost his best friend to a firearm suicide during his last year in the Air Force, a tragedy that inspired him to carefully and credibly address what was long a third rail in the veteran suicide crisis: firearm access. On Miller’s watch, the VA formed pathbreaking partnerships with the firearms industry, and launched effective safe storage initiatives.
Also gone is Dr. Marsden McGuire, the director of the Continuum of Care and General Mental Health in the VA’s Office of Mental Health and Suicide Prevention. Then there are hundreds of frontline mental health staff who have left, including clinicians like Dr. Melissa London, a psychologist in the San Francisco Bay Area who was celebrated as the 2024 hospital employee of the quarter.
“I thought this would be my career forever,” she told the Prospect dejectedly. “Nobody wanted to leave.”
A half dozen VA sources said many of the newly vacant positions within the department are not being backfilled or have been eliminated from the organizational chart entirely. “People are scrambling to cover responsibilities,” one source said. “Some are doing multiple jobs at once.”
Some are cautiously optimistic that the VA system will prove resilient, after weathering a similar campaign during Trump’s first term. “I think we’ve laid systems and processes in place that produce good results,” said Dr. Steve Holt, who recently stepped down from his job running the VA’s North Texas network, the second-largest VA system in the country.
Holt was known internally as a remarkable fixer for struggling VA systems, improving Houston’s metrics and smoothing out tricky dynamics at the Captain James A. Lovell Federal Health Care Center in Chicago, the only fully integrated VA DOD facility in the country. At the Dallas VA system, Holt also expertly negotiated the acquisition of a shuttering 180-bed hospital for free. “It’s going to take time to fully break this system,” Holt concluded.
Yet the question, after a devasting first year of Trump attacks on the VA, is whether it can survive three more.
AN ANTI-WORKER CAMPAIGN OF THIS ZEAL and scope is perhaps not entirely surprising from a president whose signature tagline is “You’re fired.” In truth, Trump has been fixated on the VA workforce since his 2016 presidential campaign, repeatedly deriding them on the trail and making a personnel purge a cornerstone campaign promise. The germ for his attacks emerged in 2014, during a wait-time scandal at a VA hospital in Phoenix, Arizona. While largely overhyped in scope, the scandal nonetheless exacted deep political damage. VA Secretary Eric Shinseki resigned. Then, in November 2014, Republicans retook the House with the largest majority since 1928, partly due to a crop of candidates smearing commander in chief Barack Obama as anti-veteran.
The Phoenix scandal precipitated calls on the right for VA “accountability.” In response, Trump delivered the 2017 VA Accountability and Whistleblower Protection Act. Speaking at the signing ceremony, Trump crudely claimed that dysfunctional VA staff had been festering within the department for decades: “They could be sadists. They could be late. They could be bad. They could have lots of problems. They could talk back to you. You couldn’t do a thing. For 40 years, they’ve been trying to get it passed, and we got it passed. It’s called VA Accountability. And as I’ve said before, we now look at the person that violates our great veterans, and we say, ‘Jim, get the hell out of here.’”
Trump’s law created an “accountability” office that was quickly wielded to enact a first-term firing blitz. In the eight months after the law was signed, the administration fired 1,269 VA staff, many of them frontline clinical employees. Thousands more were demoted or punished, creating intense stress and burnout that fueled more voluntary departures. In 2018, Kevin Patterson, a feisty Marine veteran and VA housekeeper, warned me about the vicious cycle these personnel attacks would perpetuate. “We got employees here doing double the amount of work, in some cases triple the amount of work that they were doing if we would have been fully staffed,” he said. “And what do we get back as feedback? They’re going to cut our jobs, they’re going to cut our pay, they’re getting rid of us and not replacing us.”
As Trump attacked and dismissed frontline staff, dozens of senior staffers also left. They included Dr. Amy Fahrenkopf, a well-respected physician serving as the VA’s acting deputy undersecretary for health, and Christopher Vojta, a physician serving as the health secretary. Scott Blackburn, the VA’s chief information officer, departed, as did John Fuller, a retired Army major who voted for Trump but nonetheless left after the administration revoked financial support for a program he’d led for eight years to improve race relations throughout the agency. “It really is an anomaly,” Fuller said, “to see so many people who have such great records leave.”
TO HIS CREDIT, PRESIDENT JOE BIDEN went on a record-setting hiring spree at the VA. This work would ultimately serve as fodder for conservatives pushing the slash-and-burn DOGE agenda of Trump’s second term, but the reasons undergirding this hiring made perfect sense.
The administration was compensating for Trump’s woeful first-term staffing record, in which the VA became wracked by roughly 30,000 vacancies. Secondly, there was the COVID-19 pandemic, which spiked clinical needs at the VA and across the country. Finally, there was the 2022 passage of the PACT Act, which greatly expanded care and benefits eligibility for ailments related to toxic exposures dating back to Vietnam. In the year after PACT’s passage, the VA saw a 39 percent jump in benefits claims, and undertook three million more appointments than the year before. Thanks largely to the department’s new hires, the system avoided the sort of wait-time crunch that had damaged its reputation in Phoenix. What emerged was good news: The VA managed to grow its numbers of mental health appointments by 6.5 percent, and field significantly more calls to the Veterans Crisis Line.
Much of this progress, however, was wiped away in the first few months of Trump’s second term. Shortly after his confirmation, Secretary Collins floated plans to slash the workforce by 15 percent, or roughly 80,000 positions. Under bipartisan pushback, Collins instead pledged to reduce the VA’s rolls by 30,000 employees. He promised this new policy was “centered on reducing bureaucracy and improving services to veterans.”
In truth, however, core clinical initiatives have been hobbled. This includes suicide prevention efforts, as well as housing initiatives, which both Trump and Collins have repeatedly paid lip service to.
In recent months, the VA has lost John Kuhn and Keith Harris, two of the most respected housing experts in America. In 1992, Kuhn developed in the Bronx one of the first veteran-specific housing projects in the nation, while Harris, a trained clinical psychologist, served as the national director of clinical operations for housing programs during a highly productive period that saw veteran homelessness functionally eliminated in many American cities. Kuhn and Harris had partnered up to tackle the problems in Los Angeles, launching a series of programs now in doubt, including a tool to better assess the characteristics and housing needs of veterans in the region, as well as the available housing stock. Two sources told me that Dr. Carma Heitzmann, the national director of the VA’s Homeless Veterans Community Employment Services program, has also left.
The VA’s work to address the needs of its aging patient population has also been jeopardized. One of the departed is Dr. Marianne Shaughnessy, who directed the VA’s Geriatric Research Education and Clinical Center. “Half of the VA population is over 65,” Shaughnessy told the Prospect. “We were a major player in prepping our workforce to treat this population through training and research. We created new models of care.” Now, Shaughnessy said, “there are risks to this program as a whole.” Dr. Michele Karel, who directed geriatric mental health programs at the VA, is also gone.
Last September, after 35 years of federal service, Dr. Glenn Graham left his role as the executive director of the VA’s neurology clinical programs. Before that, Graham headed up the stroke unit at the Albuquerque, New Mexico, VA and, in 2017, founded the department’s TeleStroke Program. The program has grown to include 45 neurologists who beam into VA clinics across the country 24 hours a day, seven days a week, and help quickly diagnose and treat strokes, where time is of the essence. (During a stroke, 1.9 million brain cells die every minute.) As part of Graham’s program, the VA developed and then released for free an iPad app that helps care teams rapidly document, diagnose, and treat stroke victims.
“What appealed to me about the VA was being in public service, and the opportunity to work on a national scale,” Graham told the Prospect. “I liked the broad scope—the 20 million veterans, the 1,000-plus points of care, the 170 hospitals—it was possible to develop systems that, compared to any other single health care system in the U.S., had a big impact.”
The Trump administration has also targeted care for minority populations, even as they increasingly represent the military population. Dr. Michael Kauth, once the director of the VA’s LGBTQ+ health programs, has left. “I have never seen an administration with such callous disrespect and disregard for veterans, for health care, for those in need, and for federal workers,” he wrote shortly after his departure. “I have never seen health care withdrawn and denied to a population before. This is disturbing.” Also departed is Dr. Jillian Shipherd, who served as Kauth’s deputy director, but also as a psychologist specializing in women’s care at the VA’s National Center for PTSD.
The most recent VA vacancy data, which covers the last quarter of 2025, shows that Trump has opened a staffing chasm even wider than in his first term. The numbers specifically show the VA health system struggling with 52,652 vacancies in positions of all sorts, including more than 900 openings for psychologists, 500 for veterans claim staff, 1,800 for custodians, 2,600 for social workers, and more than 11,000 for nurses.
Rather than fill these positions, the White House is moving to entirely scrap many of them from the VA’s organizational chart, recently telling the Prospect that about 26,000 of these open jobs are “COVID-era roles that are no longer necessary.” Ironically enough, this purge is set to eliminate 358 openings at the Phoenix VA—once a fevered focal point for how insufficient staffing resources can create vexing wait-time problems.
These severe staffing reductions, which will increase the workloads of those who remain, will surely be met with second-order departures from clinicians facing stress and burnout. They have already threatened to permanently damage the VA’s reputation as a good place to work, with job applications to the agency falling 57 percent over the last year. “We’ve hemorrhaged people from national leadership positions, and that’s a worry,” Graham said, noting that the work environment has become so hostile that, going forward, the VA may be forced to hire less-qualified people, or pay a premium to recruit top-level talent.
It was the agency’s growing hostility to staff that ultimately pushed Dr. London, the Bay Area psychologist, to leave. In recent years, she became frustrated by increased outsourcing, which compromised the VA’s much-vaunted care coordination. She bluntly described the current situation as a “shitshow.” Trump’s tenure, she said, has been marked by more privatization and a flurry of conflicting, ever-changing treatment plans and bureaucratic procedures that took increasing time away from care delivery. “There was so little validation, communication, concern, and consideration for how much we were doing, for how much we were holding. I felt like a robot,” she said. “The burnout was so real, and the environment was so demoralizing.”
All this belies the fact that veterans, by and large, want to preserve and strengthen the VA for the future. And yet as part of its workforce reductions, the administration has become increasingly detached from these voices. Yet another departed VA staffer is Jennifer Hunt, who, for years, served as a liaison between senior department leaders and lawmakers, the press, and veterans advocates. She helped create a healthy channel of dialogue during a period of unprecedented policy changes, in which advocates were often able to sway policy in important ways.
“I worry that that any goodwill to work together is going to slow down or end without me there,” Hunt told the Prospect. “I really worry, too, about the state of VA transparency. Stakeholders need to get information about the VA to their members, and also to use that information to advocate for veterans writ large.”
Added another VA service chief: “It’s devastating to see so many talented, experienced individuals leave the VA. It’s been a gut punch to have them go. So many people I know who are talented individuals, who have given entire careers to make the system better, have decided the VA is not hospitable. The loss of talent, expertise, and experience is something you’d be hard-pressed to regain anytime soon.”
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