This month, the federal government fired thousands of probationary federal workers spanning critical health agencies and the Department of Veterans Affairs (VA), taking a chainsaw to the workforce and fulfilling a longtime mission of conservatives to gut the "deep state."
These workers carry out the priorities of each administration but ensure a level of institutional knowledge—about public health, national health programs, drug reviews and research—remains stable every four years.
Thousands of those employees are gone now. Some were reinstated, but most won’t be replaced. Labor unions and state attorneys general are trying to win them their jobs back, or at least win backpay, but court proceedings are too slow for those needing relief fast, workers worry. And more cuts are promised soon as a blanket hiring freeze persists.
“As a country, I think this gutting of what they’ve done is going to impact our country for decades,” said Jesse Heffernan, a former behavioral health advisor for a regional Substance Abuse and Mental Health Services Administration (SAMHSA) office.
This somberness was the overwhelming view shared by federal workers speaking to Fierce Healthcare, who said they were illegally terminated. It’s a stark contrast from the run-of-the-mill, measured responses scientists and analysts might give about a technical payment rate change or new pilot model on the record.
While political appointees cast each administration’s decision in the best possible light, most federal workers are tasked with taking action behind the scenes based on nonpartisan expertise. They rarely raise alarm about the ability of health agencies to perform their bedrock, statutory duties, mostly because there is no question they will.
But in more than a dozen interviews, fired workers and those still within government shared how they feel discarded as their lives are upended. They explained how the new administration—led by President Donald Trump, Office of Management and Budget Director and Project 2025 co-author Russell Vought and Department of Government Efficiency (DOGE) architect Elon Musk—sowed unnecessary chaos in its quest to terminate thousands of employees. Workers detailed how firings seemed both calculated and indiscriminate, from the beginning of the "fork in the road" buyout offer to the Department of Health and Human Services (HHS) scrambling to rescind the firings of Indian Health Services and Food and Drug Administration (FDA) workers.
Many employees immediately felt the real-world impact on them and their families. Would they have to move? They hastily hunt for a new job and reliable health insurance to care for their medical conditions and loved ones.
Under the leadership of Musk at DOGE, a newly created body suddenly embedded within every aspect of the government, the new administration says the firings are a critical step to slashing unnecessary spending that amounts to waste, fraud and abuse. The government estimates to save $781 million a year from two rounds of firings at the VA and the initial firing of probationary workers at HHS. The country is $36 trillion in debt.
“HHS is following the administration’s guidance and taking action to support the President’s broader efforts to restructure and streamline the federal government,” an HHS spokesperson said in a statement this month. “This is to ensure that HHS better serves the American people at the highest and most efficient standard.”
The VA said it would redirect its savings back to the “healthcare, benefits and services” for its beneficiaries.
Other employees did not express worry about the loss of their own job. They’ve been offered far greater sums of money in the private sector before—and they will again, or already have.
The country spends nearly $5 trillion on healthcare costs each year yet underperforms greatly in health outcomes. Some argue that a "move fast and break things" Silicon Valley mindset is just what the government needs.
But each worker agreed the firings will almost certainly impair the nation’s healthcare system in countless ways, with the country likely to feel the aftermath for years to come. They worried how more firings will put divisions under further pressure. Some believe the nation’s core principles of democracy are falling stunningly quick to an administration obsessed with control.
These are just a few of the stories of fired government employees and the agencies they leave behind. Some shared their experience on background under the fear of retribution.
The firings begin
Raphael Garcia joined the VA as a management analyst in Seattle after sustaining major medical injuries through eight years in the military.
At his division, he and other employees handled all disability claims for service members across the Army, including active duty troops and the National Guard. For people in the military getting medically discharged, Garcia helped process claims so their information would be accurate once they are in the VA’s system.
“My dad is a Navy vet of 23 years,” he said. “For me, it was a personal thing. Handling medical separations for Army soldiers meant a lot to me. I had some other job opportunities but the mission of the VA to serve veterans is a lot of where my passions aligned.”
In his words, Garcia effectively worked two jobs for a department that was already understaffed in his seven and a half months in the role. He evaluated the medical history of service members, expediting veterans with the most severe disabilities. He responded to congressional inquiries from Washington, D.C., as their division didn’t have a liaison. He onboarded new employees and coordinated with IT teams to make sure new workers had the right designation levels to view information they were authorized to view. He started creating long-term strategic reports to improve the division’s records system.
The division processed, he estimated, 15,000 claims while he was at the VA. But once Garcia was terminated Feb. 13, the division was left with no management analyst. His termination notice read the same as others across the federal government.
“Unfortunately, the Agency finds that you are not fit for continued employment because your ability, knowledge and skills do not fit the Agency’s current needs, and your performance has not been adequate to justify further employment at the Agency.”
Except many fired workers that spoke to Fierce Healthcare said this rationale doesn’t make sense. Supervisors gave many employees the highest marks possible during review periods. Some workers won, or knew of people who received, employee recognition awards for top performance, while others were recently hired and couldn’t fairly be judged for performance yet.
"I cannot really comprehend why you fire subject matter experts the government needs so badly." — former FDA worker
The Trump administration targeted probationary employees, likely because they have the weakest civil servant protections out of most classes of federal workers. These employees are classified as probationary for one to two years, not because of poor performance, but because they are new to the agency or a specific job title. Some had worked inside the government for many years but recently were promoted—typically a sign of strong performance. Many workers were just several months or weeks from shedding probationary status.
“I’ve never seen a person who was laid off for poor performance say they were performing poorly,” countered National Economic Council Director Kevin Hassett during a press briefing.
Feb. 25, the Merit Systems Protection Board (MSPB) stopped the firing of six probationary employees who filed a class complaint, arguing the administration fired them with “no regard for performance or conduct.” This ruling could lead to broader relief, reported GovExec.
Fork in the road "harassment" and RTO confusion
Weeks earlier, and just days after the inauguration, the Office of Personnel Management (OPM) began sending the federal workforce highly unusual emails from a new email account, [email protected].
“The first one I got I reported as phishing because I didn’t think it was real the way it was worded,” said Scott Gagnon, a former regional director at SAMHSA.
That started a weekslong correspondence between the OPM, now completely controlled by Musk, and federal workers, urging them to take the Deferred Resignation Program, otherwise known as the "fork in the road" offer.
Musk’s message to employees was clear: Resign now and receive full pay and benefits until September. But, if you don’t take our offer, we “cannot give you full assurance,” an email read. A subsequent frequently asked questions page encouraged federal employees to move from “lower productivity jobs in the public sector to higher productivity jobs in the private sector.”
“We thank you for your service, but anyway, since you’re super lazy and don’t care, why don’t you just take this wad of cash and get going?” said one fired National Institutes of Health researcher explaining the tone of the messages. “It felt like harassment, almost.”
Many employees felt the offer was not genuine and looked toward Musk’s past takeover of Twitter, now X, for guidance. Would the government follow through on this deal, even if there is a shutdown in March? Yes, the OPM insisted. Once the dust was settled, some people who took the buyout reportedly were fired after all.
A recently fired VA employee sued (PDF) the department, alleging the firing was illegal and her performance was excellent. It is now one of many lawsuits attacking the firings.
Adding to the stress was a government-wide decree for all federal workers to return to the office by March 17. Workers living more than 50 miles away have until April 28 to move or resign.
"I think this will have very consequential and reverberating effects for a long time." — HHS spokesperson who did not want to be identified
That expectation is complicated. Many divisions do not have enough room to accommodate all employees five days a week, and the OPM is actively looking for agencies to downsize real estate footprints further. Workers felt these requirements could not be enforced because of their unions’ collective bargaining agreement.
Supervisors and middle management had little to say in the new office policy or flexibility to offer employees choices. Information itself is sparse and rarely written down and sent over email or chat, presumably to limit the success of Freedom of Information Act requests.
One department had real concerns over a limited amount of desk space and parking spots at their return to work site. Supervisors told their workers desks could be divvied up by seniority, with others forced to work in the hallways, recordings obtained by Fierce Healthcare show. Employees were encouraged to consider all transit and rideshare options because parking is limited.
DEI purge expands to health equity
Among those hit were half of the artificial intelligence team inside the Center for Devices and Radiological Health (CDRH). These subject matter experts complete AI consultations in the preapproval phase so medical device companies can receive critical feedback. AI is a burgeoning field, and many more AI medical devices are being authorized than ever before, so some of the top experts were hired in the last two years.
“I cannot really comprehend why you fire subject matter experts the government needs so badly,” one CDRH worker told Fierce Healthcare. “AI integration in medical health is so common nowadays.”
The team was later largely reinstated, but not before panic swept the industry. These researchers ensure the AI models for large companies and startups accurately represent all demographics—whether it be gender, race or age—otherwise they won’t work in the real world and can be dangerous. The FDA instructs companies to use diverse data.
The Trump administration campaigned on eliminating diversity, equity, inclusion and accessibility (DEIA). Since then, he has signed a slew of executive orders following through on that promise, remaking federal agencies in a few short weeks.
Many voters attribute to DEIA the use of pronouns—which employees removed from their email signatures—unfair hiring practices and controversial transgender rights issues, but government workers said they think most Americans would be surprised to hear how the new administration is rolling back commonplace health equity practices.
As part of the Office on Women’s Health, Danielle Augustin, a health education specialist, focused heavily on making information accessible and through a health equity lens. That means it is usable for all people, especially for those most in need, including low-income families, communities of color and women. But new executive orders felt purposefully broad and severely limited the scope of the office for several weeks.
“Is our office on the chopping block?” she recounted thinking. “And so much of our content talks about health equity. We didn’t receive any direction. Do we have to remove it?”
DEI, she says, touches every aspect of public health because there are many underresourced communities that need more support. Augustin was tasked with removing wide swaths of content for LGBTQ individuals, even though those resources are likely archived somewhere. That includes content on postpartum depression.
“It may be one of the only resources to support LGBTQ families in postpartum depression,” she said, calling it a “complete censorship” of information.
Bisexual and lesbian women are more likely to experience postpartum mood and anxiety disorder risk factors than heterosexual women, the Minnesota Department of Health tells its residents.
Suboffices focused on DEI initiatives were put on administrative leave, as well as DEI roles within other agencies. Agencies were required to remove specific wording from performance evaluations plans.
The new administration also wanted lists of personal social media accounts, and several workers expressed concern that newly instated HHS Secretary Robert F. Kennedy Jr. and the new team will push falsehoods about vaccines or other controversial topics through official channels.
RFK Jr. has made statements critical of vaccinations in the past, though he was emphatic under pressure during his nomination hearings that he supports vaccines.
Vicky Wang, a former management and program analyst for the Centers for Medicare & Medicaid Services (CMS), was about to complete her new employee orientation sessions when her DEI training was canceled. A yearly workplace harassment training scheduled for March 7 was also canceled, she heard.
“That one honestly was surprising to me because I know that is kind of lumped into the DEI trainings, but I thought that was just about fostering a sense of community and a safe workplace,” she said.
The CMS did not immediately return a request for comment.
Garcia with the VA was required to take down a Diversity Advisory Awareness Council page from the department’s regional office website. David Pasquino, a VA human resources specialist, said people were told to report if they noticed anyone suddenly receive a new job title or switch positions, even though their job responsibilities didn’t change. Banning DEI has even inhibited VA research, per a report in the American Prospect.
Others said they weren’t clear whether traditional job priorities interacting with minority-owned groups or tribal populations would change.
“In my corner in New England, one of our partners was the Massachusetts Asian American & Pacific Islanders Commission, and there was another group I was connected with that was running the first black-run respite home in Connecticut,” said Gagnon with SAMHSA. “I was concerned about how I was going to do that work for this new administration with those kind of directives.”
To some, these changes were alarming, but they are certainly are not out of place among some legislators and think tanks. One think tank has published the names and headshots of government employees working in the DEI space, listing them as “targets.” The website includes “dossiers” or biography pages highlighting issues the group, funded by The Heritage Foundation, finds offensive and dangerous.
“All Americans of good faith believe that human beings should be judged not by the color of their skin but by the content of their character,” said a spokesperson from the American Accountability Foundation, invoking Dr. Martin Luther King Jr., in a statement to Fierce Healthcare Feb. 5. “Yet unfortunately, a small minority of extremists have embraced a far-left racist ideology that contradicts that ideal. We created [the website] to expose those racist extremists who collect government paychecks and use their power to divide Americans.”
Institutional knowledge vanishes
Two weeks after the firings became official, the dizzying number of healthcare experts told to leave the federal government all at once is still difficult to fully conceptualize.
At the FDA, fired workers regulated tobacco products. Medical device employees funded entirely by private companies, and not taxpayers, were fired. Also let go were workers in the Center for Veterinary Medicine, which regulate “drugs, food and medical devices for animals” and those tasked with regulating Neuralink, a brain implant company created by Musk.
Within the CMS, those who were fired included employees who developed and implemented maternal health models, worked on lowering drug costs through the Inflation Reduction Act’s drug price negotiation program, oversaw the Medicaid program and enforced the No Surprises Act.
Inside the CMS is the Innovation Center, which creates pilot models for cell and gene therapy, organ transplants, Medicare Advantage, caregivers, value-based care, multipayer alignment, kidney care, dementia, diabetes, behavioral health, primary care and more. Some of these areas will be priorities for the new administration, but that didn’t stop cuts from hitting that department, too.
In the Centers for Disease Control and Prevention, public health scientists studying infectious disease, specialists overseeing monitoring and treatment of first responders after terrorist attacks and workers operating a maternal and infant health data collection system were terminated.
Civil servants inside the Health Resources and Services Administration managing the modernization of a complex organ procurement and transplantation network were fired. Throughout the National Institutes of Health, cancer researchers and grant reviewers were pushed aside. Employees at the National Institute for Occupational Safety were also shown the door.
Workers responsible for managing the the VA’s suicide crisis line were fired unceremoniously, though some of the employees were later reinstated. The agency’s site could be an easy target for cybersecurity attacks, putting veterans’ health data at risk.
All these employees had their laptop access and keycards promptly revoked, unable to get fellow coworkers up to speed before leaving. Fired workers had insufficient instruction as to when and how to return government equipment.
Pasquino served in the military for 18 years as an infantryman and joined the VA last year to work in talent acquisition to ensure the smooth running of patient tracking and electronic medical record systems. During his time at the VA, they reduced the time to hire by more than half. The department recently hired a host of new employees to make sure they kept pace with claims demands from eligible veterans, reported the Washington Examiner.
About half of employees throughout the country at SAMHSA regional offices packed their bags as well.
Through the SAMHSA, states get block grants for substance use and mental health services, which provide crucial funding to local community-based organizations, and should align with RFK Jr.’s mission of promoting preventive care, saving money in the long run.
In the region spanning Ohio, where Vice President JD Vance is from, nearly all workers were fired.
“I hosted a four-part webinar series last year and we covered resource proximity for Narcan and naloxone distribution,” said Heffernan, arguing SAMHSA offices were highly effective. “Ironically, we held one of our recovery summits in a federal building last year and his office was in there. We thought, ‘Oh, it would be interesting if he stopped by.’”
An executive order also terminated the Presidential Management Fellows program.
“Taking away a highly-competitive, merit-based program that has developed exceptional government leaders for over 40 years not only sends the wrong message to the next generation about public service, but also contradicts efforts to build a more effective and innovative government,” said Partnership for Public Service CEO Max Stier in a statement. “With just over 7% of the federal workforce under 30, this decision risks widening the talent and critical skills gaps even further, and the holes will be felt in our government for years to come.”
Addressing waste, fraud and abuse?
The Trump administration says it is on a mission to root out waste, fraud and abuse in every corner of the federal government. Not to be spared are national health programs like Medicaid and the individual market.
While federal workers acknowledged some level of fraud does exist and should be eliminated, they stopped far short of suggesting Musk’s approach is the right path. And they said the chaos of the last month systematically halted productive activity.
Wang works on the operations team for HealthCare.gov. She estimated 75% of employees were fired at the Center for Consumer Information and Insurance Oversight division. Now, fewer employees are tasked with overseeing these programs, and she expects there could be an increase in fraudulent or wasteful payments to agents and brokers.
Wang was developing an email help desk for individuals looking to receive support from agents or brokers, where feedback can already be slow for the digital age.
“I think they’re going to have a significant backlog, and that’s going to lead to real issues for people to get the insurance they need,” she said.
Immediately after the inauguration, Trump imposed a federal hiring freeze, a stop on all rulemaking and a ban on all external communications from agencies. Some of those actions are not unusual, but the broad nature of the orders slowed work to a crawl—even as a crisis unfolded.
To the surprise of many, a memo to agencies in February required a freeze of federal funding, in what immediately became an existential threat for university research projects, community-based organizations and health centers, and Head Start programs.
“Our work was shifted,” said Jessica Doiron, a program support specialist for the Administration for Children and Families (ACF). “I went into doing more internal training helping out my colleagues just because there was no outreach we could do. I’m very stressed about what is going to happen with funding.”
At least 50 people were fired at the ACF, which helps organizations and nonprofits with grants for mental health services, youth services, foster care and more.
Another fired SAMHSA worker said the external communications pause was debilitating on the agency’s ability to perform its duties. Once their office was reduced to essential functions, they had to request permission for every level of outreach. Some requests, to organizations desperate for support during the freeze, were not approved.
There are some workers who believe slowly degrading critical federal agencies is a tactic by the administration to justify future firings when performance is not reached and slowly privatize all areas of the federal government. That aligns with the approach of running the country like a business, but not may be in the best interest of consumers or the public health of the country, federal workers warned.
“I think that’s what they’re trying to work toward,” said Augustin. “There’s no way to make a lot of these resources profitable because we provide resources to the public. We’re not doing it to make money.”
Now, federal agencies are tasked with the monumental job of maintaining, or improving on, their performance with far fewer employees. The workers have confidence the remaining employees will do their best, but the cards are stacked against them.
“They won’t [meet statutory requirements],” said an HHS spokesperson who did not want to be identified and was not speaking for the agency. “I think this will have very consequential and reverberating effects for a long time. This will be a failure to launch from the disease outbreaks that are happening right now to misinformation and disinformation. I think this will be an absolute failure.”
The DOGE approach
Former HHS secretary and longtime Republican congressman Tom Price, who resigned seven months into his tenure during the first Trump administration after taking heat for spending nearly $1 million in taxpayer money on chartered flights and military planes instead of less expensive commercial flights, disagreed with the tactics the DOGE has employed when dismantling the government.
“I think you got to be cautious in the health sphere when it comes to reductions in force,” he said to Fierce Healthcare. “There are people working in these areas that have spent years and years gaining the kind of institutional knowledge that is so important in not just crises but day-to-day undertaking of health and wellness.
“I would recommend that they be more surgical in their approach,” Price added. “You don’t want to wake up one morning and have had a reduction in force, and find yourself in an emergency or in a crisis, and the person that knew the most about that … was let go. The folks that I met while working at HHS were, by and large, incredibly dedicated people with remarkable knowledge and life experience.”
But mistakes have already happened. During Trump’s first cabinet meeting, Musk, who is not part of the cabinet, said they “accidentally cancelled Ebola prevention” when shutting down the United States Agency for International Development. Musk said the situation was resolved, a claim that is not true, said Craig Spencer, M.D., an associate professor at the Brown University School of Public Health, in a thread on X.
While Price and others speak positively of the federal workforce, top officials in the Trump administration have not shared that sentiment. Vought said he wants federal workers to be “traumatically affected," ProPublica reported. And Trump mocked complaints about the demands to respond to a Musk-directed email with a meme on his social media platform, Truth Social.
The large-scale impacts of these cuts are starting to feel more concrete for some who are beginning to personally know fired workers, even among conservatives who generally support the efforts. For example, Fox News host Jesse Watters on air said he talked with a friend, who is a veteran and probationary employee, that got fired. He said those kind of employees should be spared.
“If you’re going to go out there and kill enemies, put your life on the line, you should not be in the same category as people that are doing DEI,” he said.
Federal workers routinely expressed how the ramifications of these cuts are not truly understood by the public yet.
“What’s that ‘leopards eating faces’ expression?” asked Wang. “I think there’s a lot of that going on.”
“I’m just trying to be a good scientist that does my job,” said one former FDA staffer.
No employee interviewed by Fierce Healthcare could point to an instance where DOGE representatives or political appointees ever sat down at their offices to discuss and learn about the inner workings of the governmental agencies they would soon cut. If anything, they said it seemed like the new administration avoided them. Some said they think the firings were random or while others believe the cuts to be part of a master plan birthed out of Project 2025, a conservative playbook for a Republican president to use once if elected to office.
“I do think that there’s always opportunity to look at an agency and think about ways that you can be more efficient,” said Augustin. “The way in which they’re going about it [is] where they’re just closing their eyes, spinning in a circle and pointing.
“People that voted for the current administration are very close to me, and now I believe they regret their vote seeing it affecting someone close to them,” she added.
Next steps
Workers are now assessing their next move and not assuming appeals to the MSPB and in lawsuits will be fruitful.
Many said they loved dedicating their time to public service and are forced to consider the possibility of joining the private sector. The firings impacted everyone differently, suddenly forcing people to juggle a multitude of pressing concerns—finding a subtenant, relocating, applying for unemployment, securing health insurance—all while facing other highly qualified federal workers in the job market.
Hanging over the immediate conversation is the reputation of federal jobs and if they can ever recover. Many health researchers and subject matter experts could make more money in the private sector but are drawn to the guarantee of a stable job, good benefits and a fulfilling mission. Now that the agreement is ripped up, will the government face a brain drain exodus beyond what even the current administration is wanting?
To Hefferman, even now, the allure is still there.
“If there was another administration that was willing to clean this stuff up and start the repairs … I’d come back in a heartbeat,” he said. “This service is very important to me and I think it’s important to a lot of other people as well.”