1 week Ago By Jasper Craven
Jonathon Solonar spent 19 years in the U.S. Navy as a medical corpsman, deploying across the world to help keep America’s fighting force healthy.
Among his various roles, Solonar served as the sole medical official on a nuclear submarine, providing primary care to more than 160 fellow sailors traversing the deep seas. Solonar’s service ended abruptly, in 2022, when he was medically retired, forcing him to scramble for a civilian career. Because he’d been discharged just shy of the 20 years needed to secure his military pension, Solonar hoped to find another federal job that would qualify him for benefits, ideally one with a mission and meaning.
He also wanted to move back home to rural Montana. Somewhat remarkably, he found a profession that perfectly fit his needs, as a physician assistant, or PA, at the Department of Veterans Affairs. In 2018, Solonar’s senator, Jon Tester (D-MT), had helped establish a modest scholarship pilot program to bolster the ranks of PAs.
Each year, 35 recipients were sent to PA school on the VA’s dime in exchange for at least two years of clinical service. Solonar applied for a scholarship spot, nabbed one, and in 2023 landed at the University of Washington’s PA program, in Tacoma. He recently concluded a four-month primary care rotation at the VA in Olympia, work that greatly reaffirmed his new career path.
“I was in the military for so long, and I woke up every day with purpose,” Solonar recently explained in an interview. His primary care stint in Olympia engendered similar feelings. “I wasn’t just a number, I wasn’t in a for-profit organization.
I was contributing to an integrated health facility taking care of the men and women who served our country.” When he graduates in August, Solonar hopes to return to Montana, and work in a rural, community-based VA outpatient clinic, providing primary and mental health care to fellow veterans. His eagerness to work in a rural setting should make Solonar a coveted candidate.
An outsize number of American veterans live in rural areas, and yet the VA has long struggled to recruit health care professionals to work and live in such environments. Montana’s major VA medical center, in Fort Harrison, is currently grappling with about 130 vacancies, with its more rural clinics facing similar shortages. And yet Solonar has spent many fruitless months going back and forth with VA recruiters, unable to land a job even though the department paid for his diploma.
VA administrators frequently fail to create job listings that are “dual eligible,” allowing both nurses and PAs to apply. Solonar said officials have told him they prefer hiring nurses to PAs, in part because they have what’s called “full practice authority”—a designation that empowers them to practice without physician oversight. (During the pandemic, VA leaders took steps toward , but failed to set new practice rules in stone, largely due to opposition from the , a doctors’ organization that also opposed giving nurses this authority.
) The department has also declined to classify PAs as a “core mental health profession,” which spurs increased recruitment efforts, even as psychiatry is a required part of PA education, and a significant component of the profession’s national certification exam. Solonar is but one example in the VA’s strained relationship with PAs. PAs are generally cost-effective and undergo comparable training to nurses.
Moreover, the profession itself was pioneered by the VA, and is largely composed of former service members. And yet they’ve struggled to increase their presence, despite their skills and enthusiasm. “There are so many like-minded vets like me looking to get back into the community and struggling to get that opportunity,” said a Marine Corps veteran who repeatedly applied for one of the scholarship program’s few spots.
After finally securing one and undergoing his education, the veteran faced months of uncertainty over whether the VA would hire him. He remained patient, and was ultimately given a position, but many others have fled for the private sector. “I can only wait so long for the VA to express an interest,” vented another former Navy corpsman.
These vexing conditions have only gotten worse since the 2024 election. Tester, a vocal champion of PAs, lost his re-election bid to Tim Sheehy, a former Navy SEAL supportive of . Meanwhile, President Donald Trump’s agenda of hiring freezes and staff firings have put clinical students like Solonar on edge.
Solonar told the that VA administrators recently informed his graduating class that “they may not have jobs for us once we graduate.” He concluded: “My scholarship’s about to end and I could now face months with no income. That’s super stressful, man.
” A knowledgeable source warned that this class of PA scholars may not only fail to get a job at the VA, but then could be forced to pay back the scholarship with painful penalties: the full price of the training times , plus interest. “It’s completely insane and diabolical,” he said. “I’m hoping by the time I graduate, in a year, things will be cleared up,” said a second, younger PA candidate at the University of Washington.
“Why would the VA pay for us to go to school and then not hire us?” Solonar sees more stability in the private sector, but still wants desperately to serve in the VA. “I would be so bummed to miss this chance,” he said. “Veterans like being taken care of by vets.
We know how to talk to them, and we know how to treat them.” VA press secretary Pete Kasperowicz declined to clear up questions around the scholarship program, or to answer other basic questions about PAs in the VA. Instead, he sent the following statement: “Jasper Craven’s liberal bias and false are on display for everyone to see on his X feed.
The fact that is OK with Craven publicly spreading disinformation underscores why nowadays most media outlets are better known for their bias than their reporting.” at the VA during the Vietnam War. In 1964, as America grappled with a severe shortage of primary care physicians, Duke University’s medical school chief, Dr.
Eugene Stead, then also a clinician at Durham’s VA Medical Center, envisioned a new clinical role that would have a clear lineage to doctors, but with an abbreviated education, forming reduced salary requirements and allowing faster deployment to needy American hospitals. In 1965, Dr. Stead launched the first PA training program with four former Navy medical corpsmen.
His curriculum was based on fast-tracked medical trainings developed in the military during World War II. In 1967, the VA become the first employer of PAs. A few years later, they also helped fund another early PA training program at St.
Louis University. The VA today remains the single largest employer of PAs in America, about a of whom are veterans—mostly former Navy corpsman and Army medics. One early graduate was Ken Harbert, a Navy man who entered PA school in upstate New York after coming home from Vietnam.
He served for five decades in various positions, and became a prominent advocate for veterans in the profession. “We are extremely well-trained in physical trauma, but also PTSD and mental health diseases,” Harbert said in an interview. “If you look at any PA program in the United States, they are required to provide mental health awareness and treatment education.
” Harbert himself served as one of the first PAs in a psychiatric setting, while also doing stints in emergency and family medicine. Due in large part to the profession’s relative newness, PAs occupy a befuddled middle space in medicine. They’ve also fomented a quiet competitiveness with nurses.
These dynamics were summed up well in a 1965 magazine feature on PAs entitled “ ” Practically speaking, nurses and PAs share more similarities than differences. In one , VA researchers examined nearly 6,000 nurses and PAs across 30 specialties. They found comparable productivity levels between the two professions, though PAs became slightly more productive when granted more autonomy.
A that PAs often produce equivalent outcomes to physicians, at lower costs. One , for instance, found no difference in quality or health outcomes between VA patients treated by PAs and physicians for diabetes and cardiovascular disease. PAs also hold proficiency in mental health care, which has long been the VA’s top clinical priority.
According to the , the VA is projecting a 32 percent increase in demand for outpatient mental health care over the next decade or so. Like advanced practice registered nurses and physicians, PAs are able to provide both primary and mental health care, including prescribing medications. One academic journal article noted that the inclusion of PAs in the provision of outpatient psychiatric care increased access and improved the quality of care.
It also decreased physician workload. In 2019, the Medicare Payment Advisory Commission to Congress that PAs were an underdiscussed resource in increasing access while decreasing costs. “PAs,” the commissioners wrote, “provide care that is substantially similar to physicians in terms of clinical quality outcomes and patient experience.
” spreads across America, some have argued that PAs are again primed to fill the void. The profession is one of the fastest-growing in the United States, with the Bureau of Labor Statistics projecting a 28 percent increase in the number of PAs from 2023 to 2033. In a , two PAs argued their profession was key to “building [the VA’s] primary care workforce.
” VA clinical leaders seemed to agree. Beginning in , medical facilities across the country reported to the Office of Inspector General that PAs were a critically needed resource, one of the top five occupations with the “largest staffing shortages.” They continued to report these issues until , when, somewhat mysteriously, PAs were no longer included on the VA’s list of core clinical professions.
The number of PAs on the VA’s rolls remains relatively small. The department employs around , as opposed to its roughly . While agency leaders have carved out about 200 residency slots for nurses, PAs have just about 30.
Tester’s scholarship pilot was meant to remediate some of these disparities, but sources say the program has been poorly advertised, and unevenly implemented. One of Solonar’s classmates said the VA dragged its feet for months in response to her scholarship application, forcing her to pay $25,000 out of pocket for the summer and fall quarters. “The VA will not retroactively cover that,” she said.
“Still, I’m happy with all the support they’re giving me.” Another knowledgeable source told me that hundreds of applicants poured in during the first few years, but that the VA effectively stopped promoting it in 2024, then quietly whittled down the program to just 25 slots, pointing to a supposed lack of demand. And yet the many PAs with military service are often intensely committed to working at the VA.
One Navy veteran in Nevada told me she spent years applying for jobs at three different medical centers before she landed in her current role. “It’s hard for PAs to get in the VA,” she explained. “Overall, they favor nurse practitioners.
” Jim Cavanaugh, an Air Force veteran and former president of the VA’s PA Association, said it took ten years of tough advocacy for the VA to appoint a full-time director of PA services. Another source said the position has been partially neglected, given insufficient autonomy and no support staff. “They’re giving us table scraps,” he said.
The reasons for this intransigence are somewhat opaque, though some longtime observers see the invisible hands of nurses in senior administrative roles. “Time and time again I saw directives that pertained to utilization of PAs go through central office for concurrence, and time and again they were shot down,” Cavanaugh claimed. All the PAs interviewed for this story spoke positively about their nurse colleagues.
One of them, Shephard Stone, is married to one. Still, Stone argued the “the resistance to our profession has always come from higher levels in the nursing hierarchy.” Another longtime PA agreed.
“Nurses have been around a long time, and have built a strong lobby,” he said. Indeed, nurse executives fill many senior administrative roles at VA medical centers around the country. Data from 2013, meanwhile, shows that less than 1 percent of PAs at the VA served in senior administrative roles.
Four PAs from different regions said they’ve heard from nursing executives explicitly that they don’t hire PAs. “When VA puts a nurse as the head of a department, it often shuts down PA hiring opportunities,” one of them explained. The already difficult hiring and pay environment for PAs seems set only to get worse in the coming years, as the Trump administration aims for massive budget and staff cuts at the VA, and across government.
At a national level, PAs are now under the auspices of the VA’s Office of Patient Care Services, which is overseen by nurses, as opposed to the Office of Clinical Services, run by the VA’s chief medical officer, a physician. Advocates have spent years aiming to move PAs under the medical officer, and also to mandate VA dual-posting all relevant jobs to expand PA opportunities. They also want to expand and solidify the scholarship program.
But Congress itself is riven by offices loyal to different clinical lobbies. “There’s different camps in Congress for different professions,” said a source. “It creates a lot of unnecessary infighting.
” In response to acute VA access issues during the Obama administration, Dr. David Shulkin, then the VA’s undersecretary of health, granted nurse practitioners full practice authority. Shulkin told the that PAs “serve a vital and essential role in delivering care to veterans,” and reasoned that they “should work at the top of their license, especially as the VA faces access issues.
” “Is there a role for PAs to independently practice? My guess is there probably is—it’s just how big is that scope of independence.” He reasoned that properly empowering PAs could also help improve their morale. “Part of the responsibility of a health system is to make sure that professionals feel valued,” he said.
A PA at the department said that those in his profession have struggled to get appointments with congressional offices, and seen the “cold shoulder” from officials within the VA’s central office, in Washington, D.C. “I’ve been in meetings where people in positions of power at VA would use openly hostile language—like ‘I don’t know why we are talking to these people.
’” He similarly chalked this up to a “turf war that shouldn’t occur.” One of the profession’s few recent victories was the 2017 Choice and Quality Employment Act, which, among other things, was meant to make PA pay more competitive. A 2015 report from the department found that PAs typically earned salaries 20 to 30 percent higher in the private sector than at the VA.
But it, too, has been inconsistently implemented. In early 2018, Tester wrote to the VA saying he was “concerned that the department is not yet taking advantage of this tool.” An independent market pay study I obtained for the West Palm Beach VA Medical Center, in Florida, “supports up to [a] 22 percent increase” for PA pay.
But a PA source there said the findings were kept from PAs, and that the pay increase hasn’t occurred. “We don’t get the same recognition that nurses get,” he vented. “Monetarily or otherwise.
”.
