– As the nation prepares to honor its veterans Monday, many veterans in rural areas and some cities still face long wait times for health care because there aren’t enough doctors, nurses and support staff to provide it.

Almost 40,000 of the 335,000 positions in the Veterans Health Administration are vacant, according to the Department of Veterans Affairs, which oversees the VHA. The VHA serves about 9 million veterans.

The VHA’s turnover rate is less than half the rate for the health care industry overall.

However, a Stateline analysis of recently released federal figures shows the VHA has a severe vacancy problem in high-cost urban areas such as Los Angeles and Washington, D.C., and in largely rural states, such as Montana and Colorado.

Montana and Colorado have the highest state job vacancy rates at more than 20 percent, followed by Utah, Oklahoma and Maryland. At the other end, vacancies in Connecticut, Hawaii, Michigan, Minnesota, New Mexico and Rhode Island are less than 8 percent.

In some ways, the challenges facing the VHA are the same ones facing the industry as a whole, especially in rural areas, said Kristin Mattocks, associate professor at the University of Massachusetts Medical School.

Nationally, job openings in health care have nearly tripled to 1.1 million since 2010, according to Bureau of Labor Statistics data. Most of the communities with shortages of health care workers are in rural areas, said the Health Resources and Services Administration. There are also shortages in Honolulu, Los Angeles and Washington, D.C.

As more doctors and other providers in the VHA and elsewhere have been retiring, there’s more pressure on the remaining doctors. “Now the pressure is put on physicians, which is probably driving some folks” away, Mattocks said.

The vacancy rates, detailed in a report required by legislation that Congress approved this year, can cause long wait times for appointments, create waitlists for artificial limbs and lead to unsanitary conditions.

Most of the nearly 40,000 vacancies are for medical and dental staff such as doctors and nurses. Those professionals are hard to find and keep because VHA’s hiring process is time-consuming and the pay is lower than in the private sector.

And because there isn’t sufficient support staff, many VHA doctors say they are frustrated by having to do more paperwork and even clean offices, federal audits have shown.

In Colorado last year, the Denver Post found that the VHA postponed surgeries because it didn’t have enough anesthesiologists. Understaffing led to dirty storage rooms and canceled surgeries for anesthetized patients at the VHA’s flagship hospital in Washington, D.C.

And veterans in Connecticut had a hard time getting appointments for counseling because key jobs were vacant earlier this year. Sen. Richard Blumenthal, D-Conn., in a September hearing called the vacancies “really staggering.”

At the same hearing, Secretary of Veterans Affairs Robert Wilkie also expressed alarm about the number of vacancies.

“On its face it is staggering,” he said. “If we tried to fill all 40,000 we’d never get where we need. We have to concentrate on, I think, four areas: primary care, internists, mental health workers and women’s health.”

He added that this year’s Mission Act legislation, which President Donald Trump signed in June, will give him more power to raise pay and forgive student loans to attract more medical professionals.

The agency has stepped up hiring, Wilkie said, in response to a 2016 Government Accountability Office report that found that VHA lost an increasing number of employees each year between 2011 and 2015.

In the five clinical occupations with the worst shortages, including physicians, registered nurses and psychologists, VHA’s employee losses grew from about 5,900 in 2011 to about 7,700 in 2015. Voluntary resignations and retirements were the primary drivers.