Dear Secretary Doug Collins and Members of Congress,

In 1946, General Omar Bradley—the “G.I. General” whose logistical and strategic acumen helped win WWII—set in motion the two most remarkable years in the Department of Veterans Affairs’ history.

General Bradley approached the position of VA Administrator as he had the role of Army general. He set clear objectives, ensured support and resources, and then expected his people to get the job done. He trusted his medical director, Dr. Paul Hawley, to take the lead in any decision that might affect a Veteran’s health, stepping in only when needed to smooth the way. Under his leadership, the VA adopted three mutually-reinforcing missions—patient care, education, and research—and by the time he left, the VA had been turned from a national disgrace into one of the finest health systems in the world.

Another general, Carl Gray, took over as Administrator on Bradley’s departure. Reversing General Bradley’s course, General Gray centralized power. He cut clinical staff out of decision-making and made unilateral decisions on personnel, construction, and numerous other issues. The extraordinary gains of the preceding years began to slip away.

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We, the undersigned VA medical staff, are proud of this institution and its mission, and we fear that General Bradley’s clear vision of excellence in caring for Veterans is dimming once again. In raising our concerns publicly, we echo our colleagues at the NIH who recently published the Bethesda Declaration, a thoughtful and honest accounting of recent events at that storied institution. We are similarly compelled by duty—to current and future Veterans—to speak frankly about potential threats to our mission. We hope that VA and Congressional leaders are listening.

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Community Care: A Misguided Shift

Contrary to conventional rhetoric, the VA provides higher quality care and greater patient satisfaction, while offering better value, than non-VA care. Thirty years of systematically focusing on patient outcomes, team-based care, quality improvement and service coordination have steadily led to this level of excellence. We’re not better clinicians; we simply work in a better, less chaotic, more integrated system. Regular reviews of published studies find that, in addition to meeting or beating the care received by the general public, Veterans receive better care and are more satisfied at the VA than with VA-funded Community Care.

Despite this, we believe Community Care has an important role to play. The VA fails some Veterans. We may not have resources close enough or the service they need. We may have broken trust in some way. Veterans deserve streamlined care, especially when the VA can’t meet their needs, and we share the Secretary’s and Congress’s concerns in this regard. While improved from years past, the Community Care process remains difficult for everyone involved, with Veterans suffering the cost.

Unfortunately, we believe the current proposed solutions are more likely to worsen the situation, focusing on policy instead of operations. Rather than taking a balanced, stepwise approach to quality improvement, the budget proposal by Secretary Collins shifts significant resources from the VA (medical expenditures down 17 percent) to non-VA health care entities (Community Care expenditures up 50 percent). Just as concerning is the plan to diminish local VA oversight of these resources. Unchecked, Community Care utilization will skyrocket, regardless of the actual clinical need, subjecting Veterans to the real risks of unnecessary and inappropriate treatments, all billed to the taxpayer. It also risks putting local VA facilities into a quality death spiral, with under-resourced medical centers needing to use Community Care more often, in turn pulling away more resources.

Veterans should get quality care where and when they need it. We ask leadership to focus on first quickly and fully implementing the common-sense approaches recommended by the Government Accountability Office, in partnership with local facilities who understand the problems well. We can best improve the Veteran experience by focusing on the nuts and bolts of program execution and striking the right balance with Community Care spending.

Reductions in Force: Undermining the Team

The VA runs lean (23 percent administrative staff as compared to 29 percent in the private sector) and historically has had issues with understaffing affecting care. Yet Secretary Collins has proposed cutting 15 percent of VA staff, without a clear plan or rationale. This would mean returning to the staffing level of 2019, before the surge of newly enrolled Veterans brought in by the PACT Act. We have seen no evidence that such a reduction can occur without harming Veteran services.

Leadership has stated that frontline staff will be protected. But we comprise the majority of VA staff. Protecting us means disproportionately cutting the people who keep our clinics and hospitals running: the schedulers, technicians, contracting officers, and facility staff who ensure we have the space, tools, and time to do our jobs. Essential staff are already being lost—through direct dismissals, new hires walking away after conflicting guidance, and new red tape driving attrition. In one telling example of new bureaucracy, otherwise excellent probationary employees will now be terminated automatically if their manager errs in their retention paperwork; reinstatement requires the SecVA himself to petition OPM.

And while we might be the ones to sew wounds, find housing, and sit at bedsides, the truth is that good bureaucrats save lives. These professionals—program managers, policy analysts, IT experts, and others—are rarely in the spotlight, but they helped cure over 85 percent of Veterans with Hepatitis C, quickly mobilized emergency housing during COVID, and are expanding VISN Regional Clinical Resource Hubs to bring specialists via telehealth to rural Veterans.

With the loss of support staff locally, and administrative staff regionally and nationally, we clinicians will become less efficient and less effective at caring for our Veterans. Whether or not we carry a stethoscope, VA employees work as a team.

Clinician-Led Care, Education, and Research: A Mission in Jeopardy

The tripartite mission of the VHA, in which patient care, research and education are braided together for the benefit of Veterans, has been directly damaged in the preceding months.

Across the country, VA clinicians have seen their ability to guide patient care increasingly constrained. In one early example, essential local contracts were abruptly terminated by the central office—without warning or consultation with the field—directly affecting clinical services. Many were later reinstated following widespread concern, but the damage was done, and no safeguards were put in place to prevent future recurrence.

This pattern of decisions made centrally without clinical or field input has continued. In March, VA leadership unilaterally altered medical staff bylaws across all facilities, eliminating certain explicit protections against discrimination. This bylaws controversy has caused distraction and distress among Veterans and staff, and the message from VA leadership has led to further confusion. We are told these alterations were absolutely necessary and urgent, yet at the same time change nothing for either Veterans or staff. By longstanding VA, American Medical Association, and Joint Commission practice and requirement, any such changes should have been reviewed and voted on by medical staff. Our bylaws are intended to reflect our shared professional standards, and overriding this process risks jeopardizing our accreditation and compromising our ethical obligations.

Most concerning has been the interference in our exam rooms. Veterans and clinicians must be able to make health decisions based on evidence, not politics. While we accept clinical guardrails—such as formularies and utilization review—we do so with the understanding that they are guided by clinical reasoning and can be appealed in individual cases.

Yet in March, VA leadership bypassed this process entirely, issuing a blanket ban on initiating hormone therapy for gender dysphoria. There was no clinical exception process, no formal review, and no engagement with the medical community. Leadership cited cost concerns, but the move was widely perceived as politically motivated. This precedent threatens to politicize Veteran care—from birth control to addiction treatment to vaccines. We must reaffirm that Veterans’ health is not a political bargaining chip, but a matter of evidence-based, patient-centered care.

VA research has also suffered significantly. VA staff have been at the forefront of health research since General Bradley and Dr. Hawley’s time. We showed aspirin can prevent heart attacks, created the first implantable pacemaker, performed the first successful liver transplant, pioneered health systems research and predictive analytics, and created the first successful electronic health system. These days, VA researchers analyze the best approaches to primary care, work to prevent suicide and homelessness, print custom 3-D medical devices and are building cutting edge AI clinical tools. All of this has been damaged in just a few months. The sudden, unexpected dismissal of researchers across the country earlier this year has ground or delayed much of this research. We have lost productive researchers with decades of experience, and young talent must now think twice about joining a system that no longer appears to protect or value its scientific mission.

Clinical work informs the questions that research answers. Research drives better treatments and system improvements. Trainees sharpen our clinical work and sustain our pipeline of talent. This model is not theoretical; it is the backbone of a health system that consistently outperforms its peers. Veterans benefit from this integrated mission, and undermining any part weakens the whole. The erosion of respect for front-line expertise and the disruption of research paint a troubling picture: VA leadership appears disconnected from the very engine of its excellence—its people.

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In 1951, alarmed by the VA’s declining performance, a special subcommittee of the Senate Committee on Labor and Public Welfare investigated the organization and leadership of the VA. It found that the issues at the VA largely stemmed from General Bradley’s and General Gray’s contrasting management styles. The subcommittee pointedly recommended that General Gray adopt General Bradley’s more decentralized approach and give clinical staff the space and support they needed to succeed.

To his credit, General Gray did the most difficult thing possible when challenged—he changed his mind and changed course. As a result, the VA steadily improved for the rest of his tenure.

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Today’s challenge is that of 1951, when the Senate stepped in to avert backsliding. The modern VA has a culture of high quality and continuous improvement, which is now at risk as we lose funding, staff, and trust in clinical staff.

We need leadership to refocus their attention. Just as General Bradley stepped in to support Dr. Hawley, we still need help in many arenas: finding technology for a modern health system, revamping byzantine hiring, rebalancing and improving Community Care, and simplifying the navigability of VA programs for Veterans.

We need a steady hand at the helm, maintaining course, avoiding complacency and choosing the next challenge. Secretary Collins has already discussed his wish to focus on suicide and homelessness, to connect with those Veterans who have been most difficult to reach. None of us will settle for the status quo, and this is exactly the kind of challenge we want to take on under his leadership.

We should learn from General Gray’s experience, and we should follow General Bradley’s example. We ask that our leaders, with the help of Congress, give us the stability, the trust and the space to get the work done, and to do it well.

We look forward to working with Secretary Collins and Congress to ensure Veterans receive the best care possible.

- The undersigned VA medical staff