The Department of Veterans Affairs has set the stage for its largest health care workforce shift in decades. This restructuring aims to address recent hiring trends and streamline administration, ensuring the system is optimized for current Veteran needs.

Officially named the Restructure for Impact and Sustainability Effort (RISE), the initiative announced by VA Secretary Doug Collins in late 2025 focuses on streamlining administrative layers. However, the rollout has prompted thoughtful discussions among lawmakers and VA employees regarding how these staffing adjustments might affect frontline Veteran care.

The RISE Initiative: Streamlining Administration

A central component of the RISE initiative is the consolidation of the VA’s administrative networks. The plan will streamline the Veterans Integrated Service Networks (VISNs)—the regional offices overseeing local VA medical centers—reducing them from 18 to 5.

The VA is also updating its community care network contracts to improve operational efficiency. Officials explain that reducing these administrative layers will help direct a larger portion of the budget directly toward patient care.

Adjusting to Post-PACT Act Realities

During a January 28, 2026, Senate Veterans’ Affairs Committee hearing, VA leaders discussed the need to realign the system after a period of significant proactive hiring.

VHA acting Chief Operating Officer Greg Goins testified that the VA hired commensurately for an expected surge in patients stemming from the 2022 PACT Act.

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However, the data showed a 14% increase in personnel compared to a 6% increase in actual workload, prompting a need to right-size the workforce.

To address this imbalance, the VA is implementing new workforce measures. Following a reduction of approximately 30,000 employees through natural attrition in 2025, Secretary Collins indicated the department will close roughly 24,000 currently vacant positions, many of which are unfilled pandemic-era billets.

Additionally, localized staffing guidelines and caps have been introduced to manage facility growth moving forward.

Congressional and Oversight Perspectives

While the VA emphasizes that these adjustments target unfilled administrative roles rather than active clinical staff, members of Congress and oversight agencies are closely monitoring the potential impact on the ground.

During the January hearing, lawmakers expressed a shared desire to protect frontline care. Sen. Maggie Hassan (D-N.H.) voiced concerns about the localized staffing caps, emphasizing the essential role that doctors and nurses play in the system.

Additionally, Sen. Richard Blumenthal (D-Conn.) issued an oversight report expressing concern over the retention of frontline medical staff during the transition.

Outside the hearing, federal employee groups gathered to echo the Government Accountability Office’s long-standing concerns about geographic access disparities and staffing challenges in rural VA facilities.

Matching Care Capacity to Where Veterans Live Today

The VA intends to bring world-class healthcare closer to home for today’s veterans. For most patients, the restructuring remains unlikely to produce immediately visible results.

VA officials say they plan to roll out changes gradually, over 18-24 months, starting with improving access to appointments and matching actual local staffing to demand.

The initiative challenges the VA to adapt a legacy system to today’s Veteran demographics. The success of the realignment will depend on how effectively the agency can move resources while sustaining continuity of care.

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