The Veterans Affairs Medical Center in Atlanta reported the most severe occupational shortages among 140 facilities in the nation for the second year in a row.

Doctors and nurses top the list of occupations that are the most difficult to fill, according to the report from the VA Office of Inspector General. It was based on a survey of hospital directors last spring. In all, the Atlanta hospital director identified severe shortages in 76 categories of clinical jobs — from surgeons to social workers — and eight other non-clinical jobs, such as human resources workers and police officers.

An online VA database listed 113 open positions in Atlanta at the end of September, including seven doctors and 31 nurses and nursing assistants. That was better than the Augusta VA Medical Center, which lists open positions for 28 doctors and 171 nurses and nursing assistants.

An emailed statement from the Atlanta VA said it has recently increased some salaries to be more competitive. The medical center uses national recruiters and offers other incentives, such as a program to help pay down key employee college debts. It also uses local non-VA doctors for treatment, but picks up the tab.

Christina Mandreucci, a spokeswoman for the national VA office, said the agency fulfilled 58 million appointments in 2018, which is 623,000 more than the year before.

Success should be measured in the growing number of people served, she said.

Two private studies in 2018 by the Rand Corp. and Dartmouth College found the VA system generally delivers care as good or better than other providers.

Still staff shortages can mean delays in services provided to veterans, such as making the wait for doctor appointments and test results longer, the inspector general’s report said. Shortages also have a negative impact on morale on hospital staff.

Medical center directors say non-competitive salaries, competition from other health care facilities, too few candidates to choose from, and difficulty recruiting staff to some locations, such as in rural areas or cities with high costs of living, are the main problems.

The inspector general’s report was completed Sept. 30, about two weeks after the VA regional director, Leslie Wiggins, was placed on administrative leave while the VA reviews a number of issues at facilities in the region. An Atlanta VA spokeswoman did not answer a request for information about the issues under review.

Wiggins came to Atlanta as the hospital director in 2013 and was promoted two years later to oversee the region, which includes most of Georgia, as well as South Carolina and and Alabama.

There have been a number of problems in the region, including retaliation against a whistleblowing employee, a recent case of a dying vet being found covered in ant bites at a VA facility and low hospital performance scores in 2018. Out of eight medical centers, the scores of five dropped, including Atlanta. Two hospital scores stayed the same and one improved.

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