By Sandra Basu
WASHINGTON — The VA is set to welcome a new leader to the Veterans Health Administration. David Shulkin, MD, became the new VA undersecretary of health after the Senate confirmed his nomination by voice vote late last month.
In his new position, Shulkin will oversee the largest integrated healthcare system in the United States with more than 1,700 sites. Carolyn Clancy, MD, has been serving as interim under secretary for health since last July.
During a hearing on his nomination in May held by the Senate Committee on Veterans’ Afffairs, Shulkin pledged to work with lawmakers “to restore trust and pride in our VA healthcare system.”
“I recognize the gravity of the mission before us,” he told the Senate Committee on Veterans’ Affairs during his nomination hearing.
At that same hearing, lawmakers sought to know why he would want the position, given the controversies that have embroiled VA.
“A lot of the members of the VA, particularly over the last couple of years, have come here and sat before this committee and have been hammered with bad press and things like that,” Sen. Dan Sullivan (R-AK) noted.
Shulkin responded that he believed it is his “duty” to “serve those who have served our country and secondly because I believe I can help them.”
The past president and CEO of Beth Israel Medical Center in New York, Shulkin served most recently as president of Morristown Medical Center, a tertiary care hospital in northern New Jersey that is part of the Atlantic Health System. He also previously held leadership roles as the chief medical officer of the University of Pennsylvania Health System, the Hospital of the University of Pennsylvania, Temple University Hospital and the Medical College of Pennsylvania Hospital.
Trained as an internal medicine physician and a researcher in health policy and the assessment of clinical outcomes, he also has experience with the VA. During medical school and in his residency training Shulkin said he did stints at the Philadelphia VAMC, the West Haven, CT, VAMC and the Pittsburgh VAMC.
“Given that experience and continued engagements with VA during the course of my career, it was difficult for me to have watched from the sidelines last year as the failings of the system came to light,” he told lawmakers during his nomination hearing.
Asked if he was prepared to take over a system as large as the VA after coming from a medical center with only 658 beds, he responded, “It is a massive system … I can’t tell you that I have ever taken on a challenge like this, but I do believe that the principles of leadership are transferrable.”
When asked what his priorities would be, he cited addressing the access problem as among them.
Sen. Thom Tillis (R-NC) wanted to know if he had a plan to do that.
“Absolutely, this is what I have been doing throughout my career. This is operations,” Shulkin answered. “This is being able to expand capacity, being able to use weekend and evening hours … We have 11% no-shows in the VA, and I know how to deal with those issues. I think we can continue to make progress.”
As for recruitment and retention of clinical staff, he spoke of the value of loan repayment, competitive pay and recruitment bonuses.
“You have to have an environment that people want to come to work,” he said. “VA is blessed by training 70% of all doctors … If they see that the environment is one that puts the patients first and cares about the people who work there, they are going to want to stay there.”
Delay in ApprovalThe hearing for his nomination was held nearly a year after former VA Under Secretary for Health Robert Petzel, MD, resigned from the position amid the discovery of access delays at VA facilities last year.
After the Senate Committee on Veterans’ Affairs approved his nomination, Shulkin’s confirmation process met a brief snag after three U.S. senators put a hold on the required Senate vote. The hold on the legislative body’s full confirmation vote, as allowed by Senate rules, was put into place by U.S. Sens. Sherrod Brown (D-OH), Jeff Merkley (D-OR) and Ron Wyden (D-OR).
They explained the hold would not be lifted until the VA released a final decision on extending benefits to qualifying reservists who served on Fairchild UC-123 Provider (C-123) aircraft and might have been affected by Agent Orange. The issue of whether the veterans could have been exposed to Agent Orange has been controversial, with VA denying them compensatory coverage in the past.
“These veterans have waited too long to receive the healthcare and disability benefits they deserve,” Brown said in a statement announcing the hold on the vote. “Dr. Shulkin is extremely qualified, but we can’t move forward to confirm an under secretary for health at the VA until this pressing veterans’ health issue is addressed.”
On June 18, however, the VA published a new regulation that expanded eligibility for some benefits for the veterans in question, which resulted in the hold being lifted.
“Opening up eligibility for this deserving group of Air Force veterans and reservists is the right thing to do,” VA Secretary Robert A. McDonald said in a written statement. “We thank the IOM [Institute of Medicine] for its thorough review that provided the supporting evidence needed to ensure we can now fully compensate any former crew member who develops an Agent Orange-related disability.”
Please click here to participate in this month’s U.S. Medicine readership poll.
In addition to Shulkin’s confirmation, LaVerne H. Council’s nomination to serve as VA assistant secretary for information and technology was approved by the Senate last month.
In the past, Council has served as a Johnson & Johnson vice president and CIO and has held executive positions at Dell.
At a hearing on her nomination in May, lawmakers wanted to know how she would address the issues of interoperability of the EHR between the VA and DoD.
Council suggested the best way forward would be to address the interoperability of the data, rather than interoperability of the two different systems.
“If confirmed, I will spend time with the team to lay that out. It would be a part of the roadmap that we would put in place,” she said.
Sen. Richard Blumenthal (D-Conn) asked that Council provide the committee with a timetable and specifics about how she will address the issue.
“We’ve heard a lot about plans, blueprints and roadmaps, and the problem as you observed continues to this day,” Blumenthal noted.
Council assured him the committee would have “a roadmap,” adding, “One of the reasons I think I was called for the job was because of my reputation of being able to do what I said I will do.”
Research on fibromyalgia, a poorly understood, chronically disabling pain syndrome, generally has focused on its clinical presentation and treatment.
The VA is expanding remote management of patients to improve disease prevention and care.