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.
My stepmother worked for the State Department. She was a great employee, but shortly before retirement, she was offered a promotion to a supervisory position, and she refused, even though it would have meant a step up in here pension.
She didn’t want to deal with employees who were uncontrollable due to the civil service protections. I said to her, why doesn’t she take the promotion anyway and just relax and get the bigger pension. But she didn’t want to do that.