I discovered in my dealings with the VA that they have a large number of seat-warmers who don’t want to do anything and will actively work hard to not handle documents in a timely fashion. So 80,000 sounds like a good start; now improve the hiring and management practices so you have employees that actually do their jobs and get canned if they don’t.
My wife was a Dr in charge of a clinic at the VA for many years. She worked there over 30 years before retirement.
Even though she was in charge, she had no authority over the many people who worked in her department. It’s all horizontal lines of authority.
All psychiatrists answer only to the chief of psychiatry. All nurses answer on ly to nursing, all psychologists only to their chief, same for every employee.
When she retired, they replaced her with four people and managed to create more baggage. The people spend more effort figuring out how to avoid work than actually doing work. That is also true of many of the Dr’s.
Her biggest frustration was that her appointments were scheduled three months in advance. If she got sick, there was no one else to see them so it was another three months for the rescheduled appointment. That was in a very large VA Hospital.
One big problem is that everyone tries to justify their job with meetings. With all the meetings it decreases patient time.
I audited hospital financials for many years as a CPA. The VA is one of the most inefficient run hospitals I have ever observed. They need a DOGE audit.