the VA does not, (like the military does), consider its front line clinical workers as the key to the Mission. The military has supportive services, but all relate to the front line who have target on the enemy and are the key enforcers, ultimate enforcers, of the Mission.
while the military has its own issues with beauracracy it is nothing like the VA which is govt run through and through and easily can be adrift from its Mission: to provide access to quality care for our veterans. Thus you have a bulging top heavy upper management that is far removed from the Mission’s implementation and is an oligarchy unto itself within the govt.
Most veterans get good care, as best as is possible considering the inanities of upper management, from caring and professional front line workers. But when you don’t operate with Mission in mind and listen to the front line as to what resources should be and what needs changing in the structure...this is what you get.
You are exactly right. Being a fedgov entity the VA has 3-4 administrative staff for every medical provider in the clinics. There is no other healthcare entity in the USA that is that top heavy with REMFs.
Who gets the annual bonuses? The admin staff, of course.
The providers are tasked with finding a way to get care for the vets in spite of all of the administrative obstacles. You have to be persistent and practice the USMC philosophy (or at least it used to be) of over, under, around, or through.