Senate Unanimously Confirms David Shulkin, MD, as VA Secretary

February 13, 2017

The US Senate tonight voted unanimously to confirm David Shulkin, MD, as secretary of the US Department of Veterans Affairs (VA), where he promises to continue reforms he shepherded as its undersecretary of health to shorten notoriously long wait times for veterans.

President Donald Trump's pick for the VA was swept into the cabinet position by a huge wave of support. The US Senate Comittee on Veterans' Affairs unanimously voted in favor of his nomination. The American Legion, the Veterans of Foreign Wars, and four other national veterans' organizations asked the Senate leadership to swiftly confirm Dr Shulkin, who was appointed undersecretary of health and chief executive of the Veterans Health Administration (VHA) by President Barack Obama in 2015.

"He has successfully managed the largest healthcare network in the country, helping to lead the transformation of the system following the wait-list and access scandals uncovered in 2014," the veterans' groups wrote. Dr Shulkin also picked up the endorsement of the National Association of State Directors of Veterans Affairs, which said he will be a "great leader for the VA."

Veterans Affairs Secretary-designate Dr David Shulkin at his confirmation hearing before the US Senate Committee on Veterans' Affairs on February 1, 2017. Alex Brandon/AP

The VHA serves almost 9 million veterans per year at more than 1700 facilities.

Dr Shulkin, an internist, has vowed that veterans' healthcare "would never be privatized under my watch," as some Republican lawmakers have proposed. However, the internist touts his commitment to partner with the private sector, as in the Veterans Choice Program. Launched in 2014, the program allows veterans to receive care from local non-VA physicians and hospitals when using a VA provider would mean significant delays or trips exceeding 40 miles. Dr Shulkin said that during his tenure as VHA chief, the percentage of veteran healthcare services delivered outside the VHA had increased from 21% to 31%.

Dr Shulkin has pushed for a shorthanded VHA to hire thousands of additional physicians and nurses to give veterans better access to care. Another access fix is his recent decision to permit advanced practice registered nurses (APRNs) in the VHA to treat patients without physician supervision. Certified registered nurse anesthetists are an exception because the VHA determined that, in contrast to other medical specialties, VA anesthesiologists are not in short supply.

Giving APRNs the ability to practice independently did not make Dr Shulkin popular with the American Medical Association and other major medical societies. They argued that substituting APRNs for more highly trained physicians would mean inferior care for veterans. In a recent interview with the publication Federal Practitioner, Dr Shulkin said that allowing APRNs to practice without physician supervision was "a tough decision," but a necessary one to fill gaps in the workforce. "We're moving forward with that," he said.

Another decision awaiting the new VA secretary is whether or not the VHA should replace its ancient electronic health record system, called VistA, with an off-the-shelf commercial system. The VA appears to be leaning toward such a switch.

A longtime hospital executive, Dr Shulkin was president of Morristown Medical Center in New Jersey from 2010 to 2015, and president and CEO of Beth Israel Medical Center (now Mount Sinai Beth Israel) in New York City from 2005 to 2009. He also served as chief medical officer of the Hospitals of the University of Pennsylvania and, later, of the University of Pennsylvania Health System.

In 1999, he founded a company called DoctorQuality, which sold software for collecting and reporting adverse events and near misses. Another company in the healthcare analytics field called Quantros acquired the software in 2004.

The magazine Modern Healthcare ranked Dr Shulkin among the nation's 50 most powerful physician executives in 2008, 2009, 2011, and 2016.

Follow Robert Lowes on Twitter @LowesRobert

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