The Honorable David J. Shulkin, M.D., is under secretary for health for the U.S. Department of Veterans Affairs. As the chief executive of the Veterans Health Administration (VHA), Shulkin leads the nation’s largest integrated health care system, with more than 1,700 sites of care serving 8.76 million veterans each year. The VHA is also the nation’s largest provider of graduate medical education and major contributor of medical research. Shulkin oversees the system that employs more than 300,000 people.

Prior to being nominated by President Barack Obama and being confirmed by the U.S. Senate as under secretary for health, Shulkin served in numerous chief executive roles, including serving as president at Morristown Medical Center, Goryeb Children’s Hospital, and Atlantic Rehabilitation Institute, and the Atlantic Health System Accountable Care Organization. Shulkin also previously served as president and CEO of Beth Israel Medical Center in New York City. He has held numerous physician leadership roles including 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. Shulkin has also held academic positions including the chairman of medicine and vice dean at Drexel University School of Medicine. As an entrepreneur, Shulkin founded and served as the chairman and CEO of DoctorQuality, one of the first consumer-oriented sources of information for quality and safety in health care.

Shulkin is a board-certified internist, a fellow of the American College of Physicians. He received his medical degree from the Medical College of Pennsylvania, his internship at Yale University School of Medicine, and a residency and fellowship in general medicine at the University of Pittsburgh Presbyterian Medical Center. He received advanced training in outcomes research and economics as a Robert Wood Johnson Foundation Clinical Scholar at the University of Pennsylvania.

Over the course of his career, Shulkin has been named as one of the “Top 100 Physician Leaders of Hospitals and Health Systems” by Becker’s Hospital Review and one of the “50 Most Influential Physician Executives and Leaders” by Modern Healthcare and Modern Physician. He has also previously been named one of the “One Hundred Most Influential People in American Healthcare” by Modern Healthcare.

 

Veterans Affairs & Military Medicine Outlook: Coming into the Department of Veterans Affairs (VA) from the private sector, have you seen opportunities to implement some private-sector health care best practices? If that is the case, are there also areas where those private-sector models just don’t seem to apply?

The Honorable David J. Shulkin, M.D.: Yeah, I certainly have. I’ve spent my career really running private-sector organizations. So I couldn’t help but come in with a private-sector perspective on health care. While there are many unique things about the VA, so much of what we do we share similarities with what’s going on in the private sector. And as you know, what is happening in the private sector is all of the old assumptions about how health care is delivered and ways of doing things are being challenged. And we’ve never seen, never been in a time where there has been so much change happening in health care, both in the way that we pay for health care [and] the expectations of consumers, and how we’re using new technologies. So my message coming into VA has been that we have to be looking at the changes that are happening in the private sector because we have to be changing just like they’re changing. So we’ve taken many of the challenges that we’re having in the VA and looked at how the private sector is looking at it. Some of them are very applicable and others don’t fit quite as well, but I think there’s never been a time where we’ve been more open to sharing what we’re doing with the private sector and learning from what the private sector does well.

The first is that our biggest challenge is to regain the trust and confidence of veterans and the American public in what VA is doing. And having gone through this crisis, which began in VA in April 2014, we clearly lost a lot of that trust and confidence.

What do you consider the biggest challenges at the moment that you’ve had to face?

Well, I think there are really a couple. The first is that our biggest challenge is to regain the trust and confidence of veterans and the American public in what VA is doing. And having gone through this crisis, which began in VA in April 2014, we clearly lost a lot of that trust and confidence. And if you’re going to be a health care organization, one of the key ingredients, in fact what I call our currency since we don’t operate in a financial for-profit sense, our currency is really the trust and confidence of those we serve. So that’s really been our biggest challenge:  to show people that we are being responsive and doing everything that we can to address the health care needs of veterans. And that’s how we’re going to regain trust. One of the challenges is that when you’re going through a crisis like VA has gone through, it’s been very hard to get the word out about the unbelievably good type of care that’s being delivered on a daily basis hundreds of thousands of times a day across the country. People aren’t open to hearing from you when they think that you’re not addressing the crisis. They’re not open to hearing the full picture of all the amazing things that are happening in VA.

So it’s been a challenge to adequately and accurately represent the scope of activities, and really what we do on a daily basis, because so much attention’s been focused on the negative or on the crisis aspects. One of the challenges that has resulted from that has been the morale of our workforce, who is demoralized by seeing how much negative attention has been put on the VA over the past couple of years. And that’s resulted in us seeing a decrease in applications for people wanting to come to work for the VA. So at the very time that we need to be attracting the best and the brightest and filling all of our spots, we’re actually seeing a decrease in applications related to this morale issue.