The Department of Veterans Affairs (VA) is in the process of downsizing. In March, VA Secretary Doug Collins announced the agency aims to cut 15% of its workforce. At a recent town hall in Michigan, Collins confirmed the goal is to cut roughly 80,000 of the agency’s 470,000 employees.

People have gathered to protest the agency’s actions across the country, including outside the state capital in Cheyenne. The VA serves some 20,000 veterans in Wyoming.

The agency is also calling workers back to the office, in response to Pres. Trump’s government-wide return to work mandate announced at the start of his term.

According to the VA, more than 20% of its employees have telework or remote work agreements. Supervisors have already been required to return to the office, and others have been instructed to return as early as April 11 and April 14, according to sources who spoke with Wyoming Public Radio.

That’s brought up concerns from some remote providers about access to care, a lack of space and potential violations of patient privacy. Telehealth has become more common among medical professionals, and the VA has grown its infrastructure to expand its reach of telehealth and mental health services, especially to more rural areas.

In an email response to NPR, VA spokesperson Peter Kasperowicz called privacy concerns "nonsensical" and responded that the VA “is no longer a place where the status quo for employees is to simply phone it in from home.”

Wyoming Public Radio’s Hannah Habermann spoke with three Wyoming-based VA employees about how the return-to-office orders might impact them.

We first hear from Matthew, a psychologist who describes his job as a first stop for mental healthcare. He works for a remote telehealth program that serves veterans in the Rocky Mountain region.

Editor’s Note: This conversation has been lightly edited for clarity and brevity.

Matthew: The purpose of the program is really to extend the reach of VA care to places where it is hard to have VAs, including lots of places throughout Wyoming with lots of veterans across Wyoming and in both the Sheridan and Cheyenne systems.

It's hard to describe the scale by which our work has been impacted. To be honest, it has been a massive shift in the culture of safety and veteran focus.

So much energy is being devoted, both administrative energy and frankly clinical time, to what is going to impact life and impact the availability of services in the VA and availability of benefits in the VA.

[There’s] people I've been seeing, sometimes for years, who every session we're starting with, ‘I wasn't sure you were going to be here today.’ And for a person whose job it is to help others heal, for veterans to be put in the position of having to check on if I'm okay…

The other piece that of course selfishly impacts me, being a remote worker, is I've worked remote doing exclusively telehealth, before COVID. This is what my job was designed to be.

It's designed to be seeking people and treating people who are hard to treat, who are hard to reach, who live far away, who have mobility issues, who are in clinics that are overrun, that don't have access.

One of the benefits of being a remote worker is that as long as you're in the continental U.S., you can work from anywhere. We can recruit people from anywhere and retain people from anywhere. They don't have to move, they don't have to uproot their lives. So it makes this really great opportunity to recruit and retain the best possible providers for the roles that we're in.

They're calling it a return to office. But I've never been in the office. It's not a return to anything. It's being forced to report to a place where I've never worked and didn't agree to work, and didn't take a job to work there and don't know a soul.

It's against the law for us to provide healthcare outside of a private space. There's really clear rules of what kinds of conditions we have to meet in order for us to be following HIPAA. Being in a shared cubicle space with a headset on doesn't meet that.

I have a small private practice, I could scale up. It would not be hard, I have a waiting list as it is. But I don't want to. I want to work in the VA on purpose.

Hannah Habermann: Ira is a psychiatrist who also works for a fully remote program that serves veterans in the West. He’s also concerned about privacy. He’s been with the agency for 10 years and asked to be identified by his middle name for fear of repercussions at work.

Ira: The other day we were on a call with our director. You've been on meetings where somebody's got a hot mic and your skin is crawling, because you're like, ‘Turn that thing off.’

Well, it turns out that there was nobody with a hot mic. It was our supervisor who had to move back into an office with cubicles where there are so many people that that noise was infiltrating our meeting time. It's those kinds of things where, I think people are concerned that's going to have a pretty negative impact on the care that they provide.

I think the care has already been impacted. There's not a day that goes by where in the back of your mind, you're thinking, ‘Am I going to get another email requiring me to send my five bullet points’ or that the date of return to office is changing. The reduction in workforce, same thing, ‘Am I gonna be let go?’

I think a lot of us feel like our roles as clinicians are fairly safe, but in this environment, we just don't know. I think veteran care has been impacted in that manner where it's just sort of always gnawing at your heels.

I think that the temperature in the room among the group that I work with is, we're all really devoted to the mission of the VA and wanting to serve veterans. I think the collective pulse right now is we're going to do what we need to do to kind of stick this out.

I feel like the underlying issue is an administration that wants to do away with socialized medicine. That’s my worst fear: that the VA will no longer exist in its current form and it will be transitioned to the private sector. That is my worst fear right there, is that we will lose the VA as we know it.

Birgitt Paul:  My name is Birgitt Paul. I'm a VA nurse. I just got my 10 year pin this last summer. [I] came here as a second career, [I] used to be a public school teacher.

I currently am in a position where I help coordinate home healthcare, so helping to have skilled nursing [and] non-skilled care coordinated in people's homes. All of those jobs became remote at COVID time.

The most important thing that I want people to know is return to work orders will greatly impact us because so many of our staff, because we couldn't fit inside the building, have done this job effectively from other places. When they are required to come back, we'll have to make a pretty serious decision.

When we're told you could return to work and if there's not enough room at the Cheyenne station because it's within 50 miles, you could be required to go to Loveland, you could be required to go to Fort Collins, it's very disorienting.

In leadership calls, you are talking with people who you have every trust in. I am very proud to work at this VA. We have a leadership that is very calm, very sane. They've done everything they can within the chaos that's been created to help us stay focused on our mission of taking care of veterans and saying, ‘We will do the best we can to navigate for you.’

But they've been hamstrung. We're in meetings where they're like, ‘That's a great question. I don't have an answer for that.’

And when your leadership is saying that to you, you feel like you are on broken ground where you felt safe before. I don't think anybody does well in a job where everything was defined and you had clear parameters and boundaries and now you're kind of in a washing machine with everybody trying to get up to the top and breathe before the next thing hits.

I don't have a lot of time to not be taking care of the mission. I'm understaffed in my position already and have been since I started this position.

I'm close to [the] station. I'm only 10 minutes away if I get to go back to the Cheyenne station. And I think the irony is [in] all this, anybody that was 50 miles out, they're finding places for you to be in [any] federal building. So you don't have a manager, you don't have a supervisor, none of the people that you're working with do what you do.

How is that any different than remote work? But this return to work is not about us providing good care for veterans. It's about us deciding to quit our job because they're taking a benefit away from us.

The thing that's really sad for me is there is a lot of best case [scenarios]. I think every single person that works in a system, when brought to the table as a stakeholder, can tell you the things that we need to have fixed. I always have this best case: you want to find waste and fraud and you want to make us more efficient, bring us to the table and we'll be happy to help you.

I don't think that's going to come of this, which would've been my best case scenario.

Worst case scenario is because we're already understaffed, people leave and those people have institutional knowledge and we either have to train other people to take their jobs or we lose that altogether. In my department, we currently have five RNs. What does that look like if we only have three RNs, same workload, same everything, just less of us? Which is already a problem in certain departments.

I totally understand people's ideas that there's overstaffing in places, but I don't know how you come up with a list of people that are necessary and then have a byline that we're going to cut [about] 85,000 of them across the country.