So I actually do this in two ways. I see patients as an internist in the Manhattan VA in New York City. And there I primarily serve in our walk-in clinic so that anybody … who needs to see a doctor, I will see that day when I am there. And it gives me a broad overview of the types of services that we provide in the Manhattan VA Medical Center. And more recently, I’ve started to practice internal medicine in Grants Pass, Oregon. Now I don’t even know where that is. But I see patients in Oregon from my office here in Washington, D.C., using tele primary care, where the staff in Oregon support me, and I actually see the patients right here overlooking the White House. And I can listen to their hearts and lungs, I can look in their eyes and ears and in their throat, I can have my staff in Oregon do parts of the physical examination that I’m not physically able to. And it’s been a terrific experience for me to work with a rural clinic that doesn’t usually have access to physicians all the time and for me to get to talk to and take care of veterans who are out in that part of the country. So it’s expanded my view of how to use technology. And both having time to see patients in person and do this via telehealth has really given me a much better perspective on the types of things that we’re trying to do across the VA health care system.

 

It sounds like in addition to informing your role it’s personally rewarding to you as well.

Oh, absolutely, it is. It is. But I think beyond that, it makes me better and more effective as a leader. It allows me, I think, to also understand what it means to be practicing in the VA system, because I’m one of the thousands of clinicians that are doing that every day.

Yearly, we usually do something with VA research. And this year one of the stories we’re covering is genomics. Could you update us on how the Million Veteran Program is coming along and explain why it is such an important initiative?

So the Million Veteran Program was actually started years ago. I think that’s the thing that I’m most proud of, that people in the VA had the foresight to start a program like this, because today it is now the largest database of genomic materials in the country. And that puts VA in a tremendous leadership position to be able to do research and discovery in ways that, frankly, no other organization in the country can do. So the concept was to collect the blood samples and then do genomic sequencing on a million veterans and be able to tie that to the VA’s long-standing electronic medical record of over 25 years. And now you have a very unique source of information in which to tie genomics to very detailed clinical data and do research that will benefit other veterans. And currently right now we have nine major research projects underway. I think the big landmark for us was actually last month, where, in Atlanta, the president announced that we just had gone over the 500,000th veteran enrollee in the program. I actually had a chance to meet No. 500,000 in person in Atlanta. And this is really the halfway point of us reaching that million figure. But already we’re able … to utilize this database in incredible ways. We tied this very much to a couple of other important initiatives. One is the vice president’s Moonshot initiative to be able to find new ways and discoveries to treat cancer. And in doing that we’re able to leverage the Million Veteran Program not only to help other veterans but really to help all Americans and to accelerate our work and understanding of how to treat cancer in a better way.

VA has really worked hard in the last couple of years to open itself up to doing strategic partnerships with outside organizations, whether they are federal programs or even companies around the country or organizations around the country. Whoever is able to provide help to make us take better care of veterans, we want to be partnering with.

But we’re also now working much more with other federal organizations. So the Department of Defense has just signed on as a partner in the Million Veteran Program. So now we can not only enroll veterans, but we can enroll active military service members. The NIH [National Institutes of Health] and VA are working together on the NIH’s Precision Medicine Initiative so they can learn from what we’ve done in the Million Veteran Program. And we’re also working now with the National Cancer Institute, FDA [the Food and Drug Administration],  the Department of Energy, and other federal agencies all to work together to advance our knowledge in how to care for both cancer as well as other genomic-related research programs. So I think that this program has really allowed VA to be central to helping the federal government in general and other programs around the country to know how to direct a program in genomics. And it’s going to be very important for the way that we deliver health care in the future, because this is clearly where health care is going.

Just one final thing on this: VA has really worked hard in the last couple of years to open itself up to doing strategic partnerships with outside organizations, whether they are federal programs or even companies around the country or organizations around the country. Whoever is able to provide help to make us take better care of veterans, we want to be partnering with. So out of the Million Veteran Program, we partnered with IBM Watson, which is providing 10,000 analyses of these gene sequences so that we can help patients who have cancer to be able to get the individualized care – the personalized treatment – quicker and better than if we were doing this alone. And so it’s these types of strategic partnerships and advances in technology that allow us to assure ourselves that we’re providing veterans with the very best health care that you can in this country.

This interview first appeared in Veterans Affairs & Military Medicine Outlook 2016 Edition.