President-elect Donald Trump surprised many when he chose one of President Obama’s appointees to run the Department of Veterans Affairs after pledging to overhaul the department during the campaign.
But the nominee, current under secretary of health David Shulkin, has a long history in the private sector turning around struggling hospitals.
Veterans groups called the choice a pleasant surprise, as they say Shulkin has overseen a turnaround in the Veterans Health Administration (VHA) and resisted calls for privatizing the federal system.
“While our membership has been clear in its preference to have a veteran leading the VA, I am heartened by the fact that Dr. Shulkin seems to legitimately ‘get it,’ ” AMVETS Executive Director Joe Chenelly said in a statement this week. “Even as the undersecretary for VHA, Dr. Shulkin has continued to personally see patients in an admirable effort to stay in touch with veterans and caregivers.”
As under secretary of health, Shulkin is the chief executive of the VHA and oversees 1,700 care sites serving 8.76 million veterans annually.
As VA secretary, he would be responsible for the entire $177 billion agency, from health care to benefits delivery and other support programs.
Shulkin would be the first VA secretary who is not a veteran, but he has military roots. Both his grandfathers served in World War I, and one became chief pharmacist at the VA in Madison, Wis. His father was an Army psychiatrist, and he was born on an Army base in Illinois.
Shulkin, 57, an internist, got his medical degree from Medical College of Pennsylvania in 1986.
In the private sector, he’s been credited with a $1.3 billion financial turnaround of Beth Israel Medical Center in New York when he was president and chief executive officer from 2005 to 2009. A year before he left, the hospital had a $20 million surplus, according to Crain's New York Business.
In 2010, he became president of Morristown Medical Center, an acute-care hospital in New Jersey. During his tenure there, the hospital was named the safest hospital in New Jersey by Consumer Reports and selected by Fortune magazine as one of the best places to work in America.
Then in 2014, the VA wait-time scandal broke. A whistleblower alleged that veterans had died while waiting for care at Phoenix, Ariz., VA hospitals, and in the ensuing investigation, it was revealed a number of hospitals around the country were falsifying data to make it appear veterans were being seen in a timely manner.
The under secretary of health at the time, Robert Petzel, resigned because of the scandal, and the VA formed a commission to search for his replacement.
The commission, which included veterans groups, VA officials, retired officers and others, recommended Shulkin, and Obama nominated him in March 2015.
Shulkin accepted Obama’s nomination, leaving behind his $1.3 million job at Morristown to take the $170,000 VA job out of what he says was a sense of duty.
"It was clear that VA was in need of reform, and when the president asked for help, I could not say no," Shulkin told the Philadelphia Inquirer this past May. "First, I felt I could help, and my private sector experience was relevant. Second, that this was my chance to give back to those that had stepped up to serve our country."
During his confirmation hearing in May 2015, Shulkin said the VA needs to change.
“The VA needs more doctors, more nurses and greater efficiency from its current systems,” he said. “The status quo is simply unacceptable.”
As under secretary of health, Shulkin has advocated for greater integration of private-sector providers with the VA, though he hasn’t supported plans blasted by many veterans organizations as privatization.
“I believe that addressing veterans’ needs requires a new model of care: rather than remaining primarily a direct care provider, the VA should become an integrated payer and provider,” Shulkin wrote March in an article for the New England Journal of Medicine. “This new vision would compel the VA to strengthen its current components that are uniquely positioned to meet veterans’ needs, while working with the private sector to address critical access issues.”
As under secretary of health, Shulkin has touted that the number of veterans waiting longer than a month for urgent care has dropped from 57,000 to 600 since he took office.
“If you have an urgent care problem, your wait should be zero,” he told USA Today in December.
In June, Modern Healthcare placed Shulkin at No. 12 on its list of “50 Most Influential Physician Executives and Leaders of 2016.” The publication cited Shulkin’s work to improve access and customer service and highlighted his plans for the “Annie App” that will text appointment reminders and messages asking how veterans are feeling.
But critics say problems persist at the VA. Wait times are still too high and few people have been fired for the scandals, they say.
Trump has been among the critics, saying during the campaign that the VA is a "disaster" and is “the most corrupt agency in the United States.”
But he expressed confidence this week that Shulkin can turn it around.
"I think you’ll be very impressed with the job he does," Trump said at the press conference where he announced his pick. "We think this selection will be something that will, with time, with time, straighten it out and straighten it out for good. Because our veterans have been treated very unfairly."
Concerned Veterans for America (CVA), a conservative advocacy group that has been highly critical of the VA and whose former president was in the running to be Trump’s VA secretary, said it’s hard to tell if the lack of progress is Shulkin’s fault or the fault of those above him.
“It’s clear that while he has been running the Veterans Health Administration, there have been continued problems,” said Dan Caldwell, policy director at CVA. “What’s unclear is how much is a result of his leadership as opposed to the policies he’s forced to implement.”
CVA is neither opposing nor supporting Shulkin, Caldwell said, as it waits to hear what he says during his confirmation hearing.
Other veterans groups, though, are enthusiastic about the pick, with many highlighting that he has been hands-on in treating veterans at VA centers.
“All veterans ought to applaud Mr. Trump’s decision,” John Rowan, national president of Vietnam Veterans of America, said in a statement this week.
“He has been relentless in his pursuit of improving medical care for veterans, working to increase timely access, all the while holding managers and other VA staff accountable. He continues to lead by example, practicing medicine and seeing patients on an ongoing basis, not only in Washington but also in New York City.”
