VA South Dakota Staffing News 2026: Black Hills Shortages, Wait Times, and Community Care
VA South Dakota staffing in 2026 is marked by persistent provider shortages at the VA Black Hills Health Care System, where the Hot Springs campus ICU remains closed and dialysis services were paused from October 2025 until mid-2026. The Sioux Falls VA Health Care System reports wait times exceeding 80 days for spinal cord injury and rheumatology care. VA Deputy Secretary Paul Lawrence visited Sturgis in August 2026 and acknowledged nationwide provider shortages, stating the VA is expanding community care access for veterans facing delays.
Quick Facts
| Item | Details |
|---|---|
| Primary Facilities | VA Black Hills Health Care System (Fort Meade, Hot Springs, Rapid City), Sioux Falls VA Health Care System |
| Key Staffing Issue | Psychiatrist and mental health provider vacancies at Black Hills; primary care and specialty gaps at Sioux Falls |
| Hot Springs ICU | Remains closed as of September 2026 |
| Dialysis Services | Paused October 2025; $1 million secured February 2026; services expected to resume summer 2026 |
| Sioux Falls Longest Wait | 89 days for spinal cord injury, 75 days for rheumatology (established patients) |
| Black Hills Average Waits | 12 days primary care, 14 days mental health, 21 days specialty care |
| Community Care Trigger | 20-day wait for primary/mental health; 28-day wait for specialty care |
| VA Community Care Administrator | TriWest Healthcare Alliance (Region 2) |
| Official Agency | U.S. Department of Veterans Affairs (VA) |
| Updated For | September 2026 |
What Is the VA South Dakota Staffing Situation?
The VA South Dakota staffing situation refers to the ongoing difficulty that VA medical facilities in South Dakota have in recruiting and retaining clinical providers, particularly psychiatrists, mental health counselors, primary care physicians, and nurses. South Dakota operates two VA health care systems: the VA Black Hills Health Care System, headquartered in Fort Meade with campuses in Hot Springs and Rapid City, and the Sioux Falls VA Health Care System, based at the Royal C. Johnson Veterans’ Memorial Hospital.
South Dakota serves approximately 56,000 veterans, many of whom live in rural areas far from VA facilities. When staffing shortages occur, veterans in rural South Dakota face longer drives, longer wait times, or both. The VA has acknowledged these challenges and points to nationwide provider shortages as a primary driver.
Why this matters: South Dakota’s rural geography amplifies the impact of staffing shortages. A vacancy at a single facility can mean a veteran must drive two hours or more for an appointment that would otherwise take 20 minutes. When the Hot Springs ICU closed and dialysis services were paused, veterans in the southern Black Hills region lost access to critical services in their own community.
What veterans should do next: If you are experiencing delays at any South Dakota VA facility, ask about community care eligibility. Under the MISSION Act, you may qualify to see a provider outside VA at no cost to you. Contact your facility’s community care office or call 1-800-MyVA411.
VA Black Hills Health Care System Staffing Challenges
The VA Black Hills Health Care System is a multi-campus facility with approximately 1,300 employees serving veterans across western South Dakota. It operates the Fort Meade VA Medical Center, the Hot Springs VA Medical Center, and the Rapid City Community Based Outpatient Clinic. The system’s SAIL composite quality rating is 3.5/5, below the national VA average of 3.7/5.
Psychiatrist and mental health provider vacancies. The VA Black Hills Health Care System has posted multiple vacancies for psychiatrists, psychologists, and mental health counselors. A posting for a Permanent Psychiatry position in Hot Springs notes that the clinic team includes psychiatrists, psychologists, social workers, LPCs, physician assistants, and nurse practitioners, with on-call coverage for the emergency room and a 10-bed inpatient unit shared with other psychiatrists throughout the system. The VA describes the on-call coverage as “generally light,” suggesting the facility is operating with a thin margin of psychiatric coverage.
Veterans May Qualify for Extra Benefits
Check available financial assistance, healthcare programs and other opportunities that may apply to you.
Check EligibilityHot Springs campus service reductions. The Hot Springs VA Medical Center has experienced significant service reductions tied to staffing challenges. The ICU at Hot Springs remains closed as of September 2026. Dialysis services were paused beginning in October 2025. Senator Mike Rounds and other South Dakota leaders raised concerns about the pause, and in February 2026, Rounds announced $1 million in funding to restore dialysis treatment. Services were expected to resume over the summer of 2026.
Congressional roundtable on Hot Springs. In August 2026, Senator Mike Rounds convened a roundtable discussion in Hot Springs with state leaders and veterans to discuss the future of the facility. Participants raised concerns about the need for PTSD and substance abuse services, urgent or emergency care, and the staffing issues that prevent these services from being offered. “You shouldn’t have to drive two hours for a 20-30 minute appointment for a new hearing aid or for your dentist cleaning appointment,” said State Senator Amber Hulse. “Those are the types of services that our veterans are owed in their own communities, whether through community care or the VA.”
Rounds stated that the Hot Springs facility “is not closing, but it’s expanding.” Dialysis has been reinstated, but the ICU and other services have not returned.
What veterans should do next: If you relied on the Hot Springs campus for ICU care or dialysis, contact the facility directly at 605-745-2000 to confirm which services are currently available. If you need care that is unavailable at Hot Springs, ask for a community care referral or request a transfer to Fort Meade or Sioux Falls.
Sioux Falls VA Health Care System Wait Times
The Sioux Falls VA Health Care System, based at the Royal C. Johnson Veterans’ Memorial Hospital, has received a 5-star CMS rating for mortality, safety, readmission, patient experience, and timely care. However, established patients face extended wait times in several specialties that exceed MISSION Act access standards.
| Specialty | New Patient Wait | Established Patient Wait |
|---|---|---|
| Spinal Cord Injury | — | 89 days |
| Rheumatology | — | 75 days |
| GI Endoscopy | — | 63 days |
| Genomic Care | — | 59 days |
| Optometry | — | 46 days |
| Primary Care | 18 days | — |
Source: System Worth Saving Site Visit Report and VA Access to Care data, 2026.
Several of these wait times exceed the 28-day specialty care access standard under the MISSION Act. Veterans waiting 89 days for spinal cord injury care, 75 days for rheumatology, or 63 days for GI endoscopy are legally eligible for community care if VA cannot provide the service within the standard.
What veterans should do next: If your wait for specialty care at Sioux Falls exceeds 28 days, request a community care referral immediately. Do not wait for VA to offer it proactively. State clearly: “I am requesting a community care referral under the MISSION Act because VA cannot meet the access standard.”
VA Black Hills Wait Times
Average wait times at the VA Black Hills Health Care System are closer to national averages for primary and mental health care, but specialty care waits vary significantly by service and patient status.
| Specialty | New Patient Wait | Established Patient Wait |
|---|---|---|
| Audiology | 11 days | 111 days |
| Cardiology | 17 days | 162 days |
| Dental | 41 days | 34 days |
| Dermatology | 5 days | 332 days |
| Gastroenterology | 19 days | 138 days |
| Mental Health (Individual) | 4 days | 22 days |
| Neurology | 21 days | 55 days |
| Optometry | 5 days | 57 days |
| Orthopedics | 15 days | 72 days |
| Primary Care | — | — |
Source: VA Access to Care data, 2026.
The most striking figure is dermatology: established patients wait an average of 332 days for a dermatology appointment at the Fort Meade campus. This far exceeds any access standard and reflects a severe shortage of dermatology providers. Established patient waits for cardiology (162 days) and gastroenterology (138 days) also exceed access standards by wide margins.
New patient waits are generally shorter, with mental health at 4 days and dermatology at 5 days. However, new patient availability does not help established patients who need follow-up or ongoing care.
What veterans should do next: If you are an established patient waiting more than 28 days for specialty care at Fort Meade or Hot Springs, request a community care referral. If you are a new patient and cannot get an appointment within 28 days for specialty care or 20 days for mental health, you also qualify for community care.
Why Are South Dakota VA Facilities Understaffed?
South Dakota VA facilities are understaffed because of national provider shortages, a rural location that makes recruitment difficult, and pay disparities between VA and private-sector positions. VA Deputy Secretary Paul Lawrence addressed these challenges directly during an August 2026 visit to Sturgis.
National provider shortages. Lawrence stated that the VA struggles “like all providers in the United States” when there are shortages of healthcare practitioners. “To the extent that we have long wait times, we wonder about this,” Lawrence said. “Veterans have the choice to go into the community, so we want to make sure we afford that to them. We’re pretty good at that. Where we struggle like all providers in the United States is where there are shortages.”
Pay disparities. Despite benefits afforded to VA doctors as government employees, they are generally paid less than their peers working in non-governmental hospitals. Lawrence specifically noted that psychiatric salaries in VA fall below their counterparts in the private sector, creating a barrier to recruiting and retaining mental health providers.
Rural recruitment challenges. The VA has documented difficulty recruiting providers to rural areas. South Dakota’s vast geography means that a single vacancy at a rural clinic can leave veterans without local access to care for months. The roundtable discussion in Hot Springs highlighted that veterans in the southern Black Hills region face drives of two hours or more for services that should be available locally.
National workforce reductions. The VA lost more than 40,000 employees in fiscal year 2025, with 88% of those losses in health care positions. Nationwide, VHA officials reported 4,712 severe occupational staffing shortages in FY 2026, the highest in seven years. Medical officers (97% of facilities), nurses (86%), practical nurses (59%), and psychologists (58%) were the most commonly reported shortages.
What veterans should do next: Document your experiences with delays or unfilled positions. Share them with your congressional representative or a Veterans Service Organization. South Dakota Senators John Thune and Mike Rounds have previously intervened on behalf of veterans at Hot Springs and other VA facilities.
Community Care for South Dakota Veterans
The Veterans Community Care Program allows veterans to receive care from approved non-VA providers at VA expense when VA cannot meet designated access standards. This is a legal entitlement under the MISSION Act, not a discretionary benefit. In South Dakota, TriWest Healthcare Alliance administers the community care network for Region 2.
What it is: A program authorizing VA-funded treatment by community providers when VA cannot provide care within published access standards.
Who qualifies: Veterans enrolled in or eligible for VA health care who have approval from their VA health care team before receiving community care. At least one of these must also be true:
VA does not provide the needed service at any VA facility.
You and your VA provider agree community care is in your best medical interest.
VA cannot meet designated drive time or wait time standards.
South Dakota access standards:
| Care Type | Wait Time Standard | Drive Time Standard |
|---|---|---|
| Primary Care | 20 days | 30 minutes |
| Mental Health | 20 days | 30 minutes |
| Specialty Care | 28 days | 60 minutes |
How to request community care in South Dakota:
Call your VA facility or 1-800-MyVA411 and ask to speak with the community care coordinator.
State clearly: “I am requesting a community care referral because VA cannot meet the access standard for [your care type].”
Confirm the provider accepts TriWest Healthcare Alliance.
Keep a written record of your request date, the person you spoke with, and their response.
If denied, ask for the denial in writing and contact a Veterans Service Organization for help appealing.
Why it matters: With dermatology established patient waits at 332 days, cardiology at 162 days, and spinal cord injury at 89 days, thousands of South Dakota veterans are legally eligible for community care but may not know it. The VA does not automatically offer community care in every case — veterans often must ask.
What veterans should do next: If you are experiencing delays at any South Dakota VA facility, request a community care referral. The VA Black Hills Health Care System and Sioux Falls VA both have community care offices staffed to handle these requests.
VA Leadership Visit and Future Plans
VA Deputy Secretary Paul Lawrence visited Sturgis in August 2026 to highlight department priorities and address veteran concerns. His statements provide insight into how the VA is approaching staffing challenges in South Dakota.
On wait times and community care. Lawrence acknowledged that long wait times exist and pointed to community care as a solution. “Veterans have the choice to go into the community, so we want to make sure we afford that to them,” he said. “We’re pretty good at that.”
On mental health treatment. Lawrence said the VA is looking for new avenues toward successful mental health outcomes, emphasizing alternative therapies over medication. “More and more it is not drugs,” Lawrence said. “It is alternative therapies. It is different things to try and understand what it is and how we can help our veterans.” However, alternative therapies still require mental health practitioners, and psychiatric salaries in VA remain below private-sector counterparts.
On facility closures. Lawrence stated clearly that the VA is not downsizing. “We are not closing facilities, we are not cutting care – we are expanding it,” he said. “We’re reaching out to veterans who are not connected to our system, tell them ‘come to the VA.’ We have connected to over 200,000 veterans since January who had previously not connected to us. Please come back. We are here.”
On electronic health records. Lawrence announced that new electronic health records will be implemented at VA facilities, modernizing the tracking of veteran conditions and allowing more time for practicing medicine rather than gathering patient information. The new system is expected in 2027.
What veterans should do next: If you have been hesitant to seek VA care, Lawrence’s statements suggest the VA is actively trying to reconnect with veterans. Call 1-800-MyVA411 to enroll or reconnect with VA health care.
Common Mistakes South Dakota Veterans Make
Mistake 1: Waiting silently for an appointment. If your wait exceeds 20 days for primary or mental health care, or 28 days for specialty care, you may be eligible for community care. Ask — do not assume VA will offer it.
Mistake 2: Not documenting delays. Write down dates, names, and what you were told. This documentation is essential for appeals, congressional inquiries, and VSO assistance.
Mistake 3: Assuming community care is unavailable in rural South Dakota. TriWest has providers across South Dakota, including rural areas. Ask specifically about community care options in your ZIP code.
Mistake 4: Giving up after one denial. If your community care request is denied, ask for the reason in writing. You can appeal through the VA’s clinical appeals process or ask a VSO for help.
Mistake 5: Not contacting a VSO. Veterans Service Organizations provide free assistance with VA claims, appeals, and access issues. They can also help escalate staffing-related complaints.
Mistake 6: Not knowing that Hot Springs dialysis has resumed. Dialysis services at the Hot Springs VA Medical Center were paused in October 2025 but restored in 2026. If you were told dialysis was unavailable, call the facility to confirm current availability.
Common Questions
1. What is the current VA staffing situation in South Dakota?
South Dakota VA facilities face persistent provider shortages, particularly in psychiatry, mental health, dermatology, and specialty care. The Hot Springs ICU remains closed, and Sioux Falls reports wait times exceeding 80 days for spinal cord injury and rheumatology.
2. Is the Hot Springs VA Medical Center closing?
No. Senator Mike Rounds confirmed in August 2026 that the Hot Springs facility “is not closing, but it’s expanding.” Dialysis services have been restored. However, the ICU remains closed and some services have not returned.
3. Why was dialysis paused at Hot Springs VA?
Dialysis services were paused beginning in October 2025. South Dakota leaders raised concerns, and in February 2026, Senator Rounds announced $1 million to restore the service. Dialysis treatments were expected to resume over the summer of 2026.
4. How long are wait times at Sioux Falls VA?
Established patients at Sioux Falls VA wait an average of 89 days for spinal cord injury, 75 days for rheumatology, 63 days for GI endoscopy, 59 days for genomic care, and 46 days for optometry. New patient primary care waits average 18 days.
5. What is the longest wait time at VA Black Hills?
Established patients at the Fort Meade campus wait an average of 332 days for dermatology. Cardiology established patient waits reach 162 days, and gastroenterology established patient waits reach 138 days.
6. Can I get care outside VA in South Dakota?
Yes. If VA cannot schedule you within 20 days for primary or mental health care, or 28 days for specialty care, you are eligible for community care under the MISSION Act. TriWest Healthcare Alliance administers the community care network in South Dakota.
7. Who is the VA Deputy Secretary and what did he say about South Dakota?
Paul Lawrence is the VA Deputy Secretary. He visited Sturgis in August 2026 and acknowledged nationwide provider shortages. He said the VA is expanding community care access and is not closing facilities or cutting care. He announced new electronic health records coming in 2027.
8. What mental health services are available at VA Black Hills?
VA Black Hills offers addiction and substance use care, mental health counseling, psychiatry, psychology, and social work services. The system has posted vacancies for psychiatrists and mental health counselors. Wait times for new individual mental health patients average 4 days.
9. How do I file a complaint about VA staffing in South Dakota?
Contact your facility’s patient advocate, call 1-800-MyVA411, or file a complaint through the VA’s online system. You can also contact a Veterans Service Organization or your congressional representative. South Dakota Senators John Thune and Mike Rounds have intervened on VA issues in the past.
10. What is the Veterans Crisis Line number?
Call 988, then press 1. This is available 24/7 for veterans in crisis and their families. You can also text 838255 or chat online at VeteransCrisisLine.net.
11. How many veterans live in South Dakota?
South Dakota has approximately 56,000 veterans. Many live in rural areas far from VA facilities, making access to care a persistent challenge.
12. What is the VA doing to address staffing shortages in South Dakota?
The VA has posted vacancies for psychiatrists, psychologists, registered nurses, and primary care providers at South Dakota facilities. The VA is also working to expand community care access and plans to implement a new electronic health records system in 2027. VA Deputy Secretary Lawrence said the VA is “not downsizing” and is reaching out to veterans who are not connected to the system.
Key Takeaways
VA South Dakota staffing in 2026 is marked by persistent provider shortages, particularly in psychiatry, mental health, dermatology, and specialty care.
The Hot Springs VA Medical Center ICU remains closed, but dialysis services were restored in 2026 after a $1 million funding allocation secured by Senator Mike Rounds.
Sioux Falls VA established patients wait 89 days for spinal cord injury care, 75 days for rheumatology, and 63 days for GI endoscopy — all exceeding MISSION Act access standards.
Fort Meade VA established patients wait 332 days for dermatology, 162 days for cardiology, and 138 days for gastroenterology.
VA Deputy Secretary Paul Lawrence visited Sturgis in August 2026 and acknowledged nationwide provider shortages. He said the VA is expanding community care and is not closing facilities.
Veterans waiting more than 20 days for primary or mental health care, or 28 days for specialty care, are eligible for community care under the MISSION Act.
TriWest Healthcare Alliance administers the community care network in South Dakota (Region 2).
The Hot Springs facility “is not closing, but it’s expanding,” according to Senator Mike Rounds. Dialysis has been reinstated, but the ICU and other services have not returned.
The VA plans to implement new electronic health records at South Dakota facilities in 2027.
Veterans should document delays, contact patient advocates, and reach out to VSOs or congressional representatives for help accessing care.
Official Resources
VA Black Hills Health Care: va.gov/black-hills-health-care — Fort Meade, Hot Springs, and Rapid City facility information
VA Sioux Falls Health Care: va.gov/sioux-falls-health-care — Royal C. Johnson Veterans’ Memorial Hospital information
VA Community Care: va.gov/communitycare — Eligibility criteria and how to request community care
VA Access to Care Data: accesstocare.va.gov — Wait time data by facility and specialty
VA Workforce Dashboard: department.va.gov/employees — Monthly workforce data and hiring trends
Veterans Crisis Line: 988 (Press 1) — Free, confidential support for veterans in crisis
VA Benefits Hotline: 1-800-MyVA411 — General VA information and assistance
South Dakota Department of Veterans Affairs: vetaffairs.sd.gov — State-level veteran services and claims assistance
USA.gov: USA.gov/elected-officials — Find and contact your congressional representatives
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