Government and Regulations

New VA Under Secretary of Health Focuses on Access, Employee Engagement

David Shulkin outlines VHA strengths and weaknesses as he concentrates on reducing wait times and motivating VA providers.



In an address at the 2015 AMSUS meeting last week, VA Under Secretary of Health David J. Shulkin, MD, outlined his plans for improving both health care quality and employee morale across the VA, which has been sapped by recent scandals.

In June 2015, Shulkin was sworn in to the position that had been empty for more than a year following the resignation of Robert Petzel, MD, in the wake of the Phoenix wait-time controversy. Carolyn M. Clancy, MD, had filled the position on an interim basis.

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Access issues remain a top concern for the VA. “The first priority is access for the VA,” Shulkin insisted in his address. “For me, this is the most important thing. I would not be here today if it weren’t for this crisis. It really shook the confidence of the country in what the VA was doing.”

Shulkin also recognized the unique nature of VA care. “The care that is delivered in the VA is different from community care,” he said. “Only 1 in 5 physicians in the private community have any real competency in military culture… and only 13% of community-based mental health providers have any real knowledge about military deployment issues.” The VA, he noted, now delivers personalized health plans to every patient and is far more focused on posttraumatic stress disorder, substance abuse, and other conditions that impact veterans disproportionately.

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While increasing access to care was his top priority, Shulkin also focused on employee satisfaction. Although health care providers at the VA are extremely satisfied with some aspects of their work, many also report increasing frustration in other areas. According to the data that VA has collected, VA providers are “highly passionate about their work, they think that serving veterans is important, and they are really engaged.” But Shulkin admitted that providers remain frustrated by other workplace issues, such as dealing with poor performers, recognition for good work, and rewards for creativity and innovation. “We have to get our employees to feel better and more satisfied about working at the VA, we have to address [these issues] and that means that people need to feel better about their actual work environment… This is a road map for me in my priorities. I am trying to improve employee engagement.”

Shulkin also touted VA’s commitment to technology to improve access. “I don’t think people realize that VA is the leader in telehealth,” he argued. “Nobody is doing telehealth on the level of the VA: 2.1 million visits in 2014.” The VA has also developed an app store ( and patient self-care text message system.

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According to Shulkin, he came to the VA with a sense of opportunity. “I recognized that all these things that I felt were lacking in the private sector all come together in the VA. Whether we can take advantage of this… that’s what I am excited about.”

In addition to the presentation, Shulkin also sat down with Federal Practitioner for a conversation about his priorities and the challenge of maintaining the VA’s unique mission with increased use of private health care through the Veterans Choice Act. Here, Dr. Shulkin discusses the challenge of maintaining employee engagement at the VA and working with private health care providers.

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