Nearly 100 doctors who have practiced at the US Department of Veterans of Affairs (VA) issued a mass letter on Wednesday raising “urgent concerns” about Trump administration policies that they said will “negatively affect the lives of all veterans”.
The letter sent to congressional leaders, VA secretary Doug Collins and the agency’s inspector general marks the first time VA physicians have spoken collectively about staffing cuts and aggressive privatization moves at the nation’s largest integrated healthcare system.
Related: US veterans agency lost thousands of ‘core’ medical staff under Trump, records show
“We have witnessed these ongoing harms and can provide evidence and testimony of their impacts,” said the letter, which was signed by roughly 170 physicians, psychologists and other health workers in all.
If the trend continues, these current and former staffers said, VA “facilities may be forced to close, and veterans may be forced into costlier, often overburdened community health systems ill-equipped to meet their specialized needs”.
Attorneys say the letter is protected under federal whistleblower law.
The letter raises concerns that widespread staff cuts are being made without clear objectives or assessments of their impact on veterans’ access to healthcare. It also says rapid growth in the outsourcing of veterans healthcare to private doctors “threatens to divert resources” from the VA’s high-quality direct care.
Agency officials assert these changes are aimed at reducing bureaucracy and will not undermine medical services for veterans. Collins, the VA secretary, has said he’s simply “giving veterans more choices for quality, timely healthcare, whether at VA facilities or with doctors in the community”.
“Our focus: Veterans first, always,” Collins tweeted earlier this month.
The Guardian has asked the VA for a response to the doctors’ letter and will add it to this story when the agency provides a reply.
Sixty-nine active VA physicians signed the letter, organizers said, joined by about 100 others – including former VA physicians as well as current and former VA researchers, psychologists, physical and occupational therapists. Many chose to sign anonymously out of fear for retaliation.
The letter doesn’t mention Trump by name, but it delves into the major changes that have occurred at the agency during his second term in office. The doctors titled their missive the “Lincoln Declaration,” after Abraham Lincoln’s call in his second inaugural address to care for those who “have borne the battle” and their families, remarks which serve as the basis for the VA’s mission.
The VA treats 9 million military veterans at 170 medical centers and more than 1,000 outpatient clinics.
Tom Devine, legal director of the Government Accountability Project, which has represented thousands of whistleblowers over five decades, says the doctors’ missive is part of an unprecedented wave of formal complaints by hundreds of federal employees under Donald Trump, including workers at the Environmental Protection Agency (EPA), the Federal Emergency Management Agency (Fema) and the National Institutes of Health.
The Trump administration responded by immediately suspending more than 100 workers who signed the EPA letter. Dozens of Fema employees were also put on leave.
Several VA doctors who signed the letter, some of them veterans themselves, told the Guardian that’s a risk they’re willing to take.
“The VA is an excellent integrated system that provides state-of-the-art healthcare to veterans and is worth fighting for,” said Dr Dean Winslow, a retired air force colonel who served four deployments in Iraq and two in Afghanistan and, as a professor of medicine at Stanford University, holds admitting privileges at the VA in Palo Alto, California.
Dr Lucile Burgo-Black, an assistant clinical professor at Yale University who supervises medical residents at the VA in West Haven, Connecticut, said she signed the letter out of concern for veterans with complex health needs.
As a result of their military service, many veterans require ongoing treatment for overlapping medical conditions, including post-traumatic stress disorder, traumatic brain injury and cancers caused by toxic exposure. Burgo-Black worries some might opt for private care and later seek to return to the VA only to find it gone.
“This has reached a point where we will spiral down,” she said.
The VA’s proposed budget, which has already cleared both the US House and Senate, cuts $12bn from the public veterans’ healthcare system with a corresponding increase in funding for private medical services.
The Guardian has reported the agency lost thousands of “mission critical” health workers during the first six months of Trump’s second term – doctors, nurses, psychologists and social workers. Hospital units have closed, and appointments have been cancelled, internal documents showed, with medical tests facing backlogs.
In August, the VA’s inspector general found the agency faced “severe” staffing shortages at all its hospitals.
The VA has characterized the congressionally mandated watchdog report as “completely subjective, not standardized and unreliable”.
Kyleanne Hunter, chief executive of Iraq and Afghanistan Veterans of America, who served multiple deployments as an AH-1W Super Cobra attack helicopter pilot, said the protesting physicians have the support of her organization.
“The VA was designed as a public health institution placing the veteran at the center of care and decision-making,” she said. “That care is a promise America makes when someone raises their right hand. It’s a recruitment tool as much as it’s an earned right. We must do everything we can to maintain that promise.”
The veterans’ organization’s most recent survey of its members, in 2022, found only 31% of respondents felt private providers understood their needs. An even smaller proportion – 14% – felt confident in the ability of the VA and private providers to effectively coordinate care.
The VA doctors’ letter includes a five-page appendix linking to numerous academic studies and government audits, which show VA healthcare to provide superior healthcare for veterans at a lower cost to taxpayers than private care.
Those include studies that show lower suicide rates among veterans seen at VA facilities than at private providers, lower mortality rates for veterans on dialysis and an 80% cure rate for veterans with hepatitis C when those veterans were treated at VA facilitates.
