The testimony of Dr. David Shulkin should relax Veterans. His hearings and unanimous approval by the Senate transpired with little positive or negative excitement from anyone. In the short history of the new administration and 115th Congress, this is a sigh of relief. However, the lack of responsiveness may leave many not knowing much about our new Secretary of Veterans Affairs.
Dr. David Shulkin comes to the Secretary position after spending the last 18 months as the Under Secretary of Health for the VA. This experience enables him to start off with inside knowledge about the VA and its current beneficial programs and controversies. His years as a medical doctor, leadership roles in other healthcare settings, growing up in a military family, and practice experiences at VA medical centers outweigh the fact he never personally served in the military. The combination of these items affords him the knowledge to continue Secretary Robert McDonald’s initiatives, while establishing his own priorities. The VA’s scandals allured Dr. Shulkin into the Undersecretary position. He stated in his Congressional testimony, “I view my service at V.A. as a duty to give back to the men and women who secured the uniquely American freedoms and opportunities we all enjoy,” due to the barriers to timely service Veterans face. This sense of both urgency and duty stems from his Grandfathers service in WWI, father’s service as a Psychiatrist and Captain, and his own residency experiences in a VA medical center.
Dr. Shulkin’s 18 months as President’s Obama’s appointee to the Undersecretary fostered the belief “it was years of ineffective systems and deficiencies in workplace culture,” that lead to many VA problems. Numerous VA employees from healthcare providers and counsellors to departmental chief echo similar comments. Additionally, break down in communications between the various VA layers restrict the flow of information and knowledge throughout the entire system. Dr. Shulkin informed Congress it will require years to resolve the numerous concerns and barriers impacting VA’s service to Veterans, so his first act increased urgent care clinics and same day appointments for those in crisis. Just like anyone us, us Veterans sometimes just need these types of crisis based services to resolve many of our healthcare needs.
By attending many of the Veteran Service Organization’s annual conventions and conducting town hall forums throughout the country, Dr. Shulkin obtained direct input from individuals to major stakeholders in the VA. He realized Veterans receive the VA as “one V.A., and not as three separate administrations.” After all the VA consists of the Veterans Healthcare Administration (BHA), Veterans Benefits Administration (VBA), and the National Cemetery Administration. Supporting the thousands of VA employees, Dr. Shulkin informed Congress, “that V.A. has many dedicated employees across the country, and our veterans tell us just that every day.” I completely agree with this statement. Many of the frontline VA employees care deeply about Veterans services and will figure out workarounds when barriers exist.
For example, Blind Rehab Services acknowledge the barriers Veterans with visual impairments face, and often become our advocates when requesting prosthetics. Many Social Workers in case management roles will synchronize appointments to reduce travel barriers and fight for us to receive appointments in specialty clinics. Primary care managers will take advantage of the Choice Program upon request and justification.
Dr. Shulkin’s most impressive statement pertained to VA reform. “It is unfortunate that a few employees who have deviated from the values we hold so dear, have been able to tarnish the reputation of so many who have dedicated their lives to serving those who have served, but there should be no doubt that if confirmed as secretary, I will seek major reform and transformation of V.A. There will be far greater accountability, dramatically improved access, responsiveness and expanded care options, but the department of veteran affairs will not be privatized under my watch.” This answers many of the questions about Dr. Shulkin’s positions addressing VA issues. First, this statement coincides with legislative efforts over the last several years to eliminate loopholes used by VA employees facing putative actions. Secondly, he will continue efforts impacting Veterans’ abilities accessing everything from healthcare services to backlogs I benefits processes. Finally, Dr. Shulkin will not standby as legislators attempt to destroy the Department of Veterans Affairs by privatizing it. These stances mirrors the resolutions adopted by Veteran Service Organizations, like the Military Officers Association of America, Disabled American Veterans, American Legion, and Veterans of Foreign Wars.
Veterans groups and Dr. Shulkin do not oppose the Choice plan, but we do oppose privatization. Dr. Shulkin seeks to “strengthen system within V.A that are essential for veteran well-being, and use services in the community that can serve veterans with better outcomes and value to the taxpayerk.” Dr. Shulkin cited about 5,000 Veterans solely rely on the Choice plan for all of their care, but the majority of the 31% of Veterans who use the Choice plan prefers a combination of both VA and private care. The VA remains the best provider for many specialty care services and therapeutic interventions predominately found in Veterans populations, like Post Traumatic Stress, Agent Orange and other environmental exposures, and many other conditions.
When addressing Veteran suicides, Dr. Shulkin stated, “we have made significant progress in suicide prevention, including hiring more mental health professionals, implementing a predictive tool to identify those at greatest risk and fixing the crisis line to better serve our veterans.” By impacting access to urgent care and mental health services, Dr. Shulkin suggestions mirrors findings from a national Veterans suicide study from 2016. The study reported failure to access VA services on a regular basis, along with age are key lethality factors. The predictive tool and increase in mental health providers aims to resolve these concerns.
Based on Dr. David Shulkin’s Congressional testimony and supportive actions, I feel he will continue to positively impact the Department of Veterans Affairs. However, I say this with some apprehension. Dr. Shulkin is one individual, and many systems impact the daily to longitudinal operations of the VA. We still will have employees enhancing and diminishing VA services. We will still have legislative priorities assisting and hindering VA progress. We still have a Veteran population steadily dwindling, removing the percentage of the public who directly and intimately knows a Veteran. Therefore it is our job as Veterans to make sure decision makers and stakeholders know our thoughts about the Department of Veterans Affairs. We need to speak up at civic events, writing editorials to news outlets, and contact the offices of our elected officials.
All quotes used in this post come from Dr. Shulkin’s Congressional testimony.