Narrator:
You're listening to Your Career in Healthcare on ReachMD - The Channel for Medical Professionals. Your host is Tim Rush, President and CEO of the HealthJobsNationwide.com network, featuring over 1.5 million healthcare jobs daily from over 60,000 employers nationwide.
Mr. Rush:
The Veterans Health Administration operates one of the largest healthcare systems in the world, provides training for a majority of American medical, nursing, and Allied Health professionals. Roughly 60% of all medical residents obtain a portion of their training at the VA hospitals. The VA Medical Center program benefits society at large. So, what is the current state of the VA system? How do clinicians and patients benefit from this large healthcare organization?
I'm your host, Tim Rush, and joining me today is the Honorable Dr. David Shulkin, Under Secretary of Health for the United States Department of Veterans Affairs. As a Chief Executive of the Veterans Health Administration, Dr. Shulkin leads the nation's largest integrated healthcare system of over 1,700 sites of care serving 8.8 million veterans each year.
Well, I'd like to welcome Dr. Shulkin.
Dr. Shulkin:
Thank you, nice to be here.
Mr. Rush:
Well, tell us a little bit about yourself, Dr. Shulkin. What led up in your career in healthcare to your nomination for this very important role?
Dr. Shulkin:
Well, I think throughout my career I've always been attracted to service and to situations where my help was really needed. I actually think it goes back to when I was a child. I grew up on a street where the volunteer fire department would come right down my street, and every time the sirens went off I'd run to the window to look, and as soon as I was old enough at 16, I joined the volunteer fire department. And I actually thought I'd go into emergency medicine because I loved being in the situation where I'm needed. It turned out that I ended up feeling the greatest need in being able to help improve on healthcare systems and impact many, many people by helping lead and manage healthcare systems, and that's where I've spent my career. So, when I was asked to come and to help the VA, there really wasn't much question about what I'd do because this was an opportunity not only to serve, but it was an opportunity to jump in where I thought I was really needed.
Mr. Rush:
With the firestorm that hit the VA last year, what was it that attracted you the most about accepting the challenge of leading this organization upon your nomination?
Dr. Shulkin:
Well, I have to say, like most Americans watching the crisis unfold for the VA on TV and in the newspapers, it was actually painful to see that we weren't able to help veterans, those who had stood up and really put their life on the line for the country. And so sitting there watching that, I, being in healthcare, not knowing that I would get a call to actually help, sat there saying, "Wow, I wish there was something I could do." And when I eventually got the call and I had to think about whether I could help or not, I thought to myself, you know, I could say no, which would mean that somebody else would have to come in and help turn around the VA healthcare system, and why should it be somebody else and why shouldn't it be me? And especially if I feel like I have the skills and capabilities to help, I really have a duty to the country to do it, and so for me it was a pretty easy choice.
Mr. Rush:
You're now the leader of arguably the world's largest healthcare system, but you're also a physician, so how as a leader and chief executive do you effect patient outcomes in the role of a physician executive?
Dr. Shulkin:
Well, Tim, I've always identified myself first as a physician. That's my primary identity. And it's how I approach looking at most of the problems and what I do during the day. It's one of the reasons why throughout my career as a chief executive officer and now at the VA I've always maintained an active clinical practice. I'm a general internist, and I see patients, and for me, it's not that I don't have other things to do -- I certainly do -- but it's one of the critical parts of the way that I think I do my job better, because when I'm reminded that everything that we do should be for the patient and focused on the patient, it actually helps me get grounded in all of my decision-making, that what we should be doing is focusing on what's right for the veteran and what's right for the doctors and healthcare professionals that work in our system. And by identifying myself as a physician first and as an administrator second, it actually helps me, I think, do my job better.
Mr. Rush:
With over 300,000 employees throughout 1,700 sites, can you tell us a little bit about your greatest rewards and your greatest challenges in the role that you are in?
Dr. Shulkin:
Yes. I think the size of the organization was something that was very hard to prepare for, and I think very few people ever have the chance to lead an organization of this scope and magnitude, and so I think that something of the size of the VA healthcare system accounts for both the rewards and the challenges. The rewards are obvious. In fact, I think I have the best job in the Federal Government; that is, being able to dedicate my career to helping assure that those that served our country get the best healthcare, and that's truly a noble mission being able to give back to those who have worked to preserve our freedom in this country. And to be able to impact 9 million veterans a year and change people's lives I think is very, very rewarding.
But the challenge of being able to communicate and to lead over 300,000 people is really daunting. I'm used to being a chief executive in a location, so I could bring all of my people together or communicate with people over the course of a number of shifts by walking the halls of a facility. You can't do that. So, what I have to do across the country is I have to use social media a lot more effectively now. We have a VA equivalent of Facebook that we call Pulse, and I have to be very active in communicating with our staff on Pulse. I do Town Halls like I used to do when I ran hospitals, but now I have to do it virtually. On our last Town Hall, we had over 10,000 employees who were dialing in and webcasting in from every location across the country. And now I spend a lot more time on airplanes because I have to be out there visiting our medical centers in our remote locations. I was up in Alaska in some of our remote areas up there to get out and to put a face to the message as well. So, it's one of the challenges that we have, and I'm learning every day on how to do that better.
Mr. Rush:
If you are just tuning in, you're listening to Your Career in Healthcare on Reach MD, and I'm your host, Tim Rush. Joining me today is Dr. David Shulkin, the Under Secretary of Health at the VA.
The press and the politicians continue to have a feeding frenzy about what's wrong at the VA, but it really boils down to a number of administrators that have wreaked some havoc throughout some of the system. Can you talk to us about your recent successes and your long-term strategy for turning this around?
Dr. Shulkin:
Yes, it is one of the difficult parts of coming in to the VA that it seems that whenever you picked up a newspaper or turned on the TV or radio, all you were hearing was bad stories, things that the VA wasn't doing right. And the more that I got to know the VA, I understood that we're doing amazing work here, incredible work with the vast majority of our employees being extremely dedicated and mission-driven. But it's true with the press that a bad story gets much more attention than a good story, and it's hard to get the messages out there about the things that we are doing well because it just doesn't make great headlines. So, I've stayed focused on the things that we need to do at VA to better serve and to address the needs of veterans: improving our access to healthcare, making the VA a better place to be a healthcare professional and to serve your patients in the VA system, ensuring that we're learning about what's working in one part of the VA and spreading it to be consistent across others, to work with the private sector in a more functional way to serve veterans, and then to regain the trust and confidence of the American public and of veterans most importantly.
And so, my response to all of the negative attention from the press is to stay focused on making progress, doing the right things, and little by little I believe our message is getting out there, our employees are feeling better about the environment that they work in, and people are hopeful about a future that serves veterans in a way that the place that they came to work at, to do the work that they originally signed up for, that we're really getting our mojo back, that we're moving in the right direction and have positive momentum in the VA.
Mr. Rush:
Has the negative press affected your ability to recruit top-level physicians and administrators of which are needed greatly to run an organization of this size and that affects our veterans at the level that it affects them?
Dr. Shulkin:
Of course it has. The constant negativity that people have been showing towards the VA turns out to be something that, unfortunately, I don't think is particularly helpful in serving veterans. Our applications are down 78% from the time that the crisis hit, and it makes sense, that if all you're reading about is the things that are going wrong in an organization, you naturally are going to think, "Well, I may not want to work there," and so we don't even get a chance. It's not that people come and talk to other health professionals in the VA and see the types of resources and the environment that they could work in. They don't even apply anymore. And that's what's so hurtful to me, because as coming from the outside, I never worked in the VA as a physician -- only during my residency I worked in the VA -- but coming from the outside and now seeing what the VA does, it is a miraculous place with dedicated healthcare professionals and great facilities and places to work, and therefore, it really hurts me to see that people don't think of this as an option or a first choice of where they'd want to work. We have 43,000 job openings right now in our healthcare system, and frankly, we need the most talented doctors and nurses and pharmacists and social workers who want to come and work at the VA.
Mr. Rush:
You bring up an excellent point about your residency at the VA. The Veterans Health Administration is the largest provider of graduate medical education in the United States, and many people don't realize that. Can you tell us more about that?
Dr. Shulkin:
Well, it's said that 70% of all United States trained doctors will spend some time during their training in the VA. I know that was true for me. I worked in three VA's during my residency in medical school, the Philadelphia VA, the Pittsburgh VA and the Yale West Haven VA, and to me, that was a vital and essential part of my training that helped me become a better doctor. And it's hard to meet doctors who don't say that the VA wasn't important to them as well. So, I think what most Americans don't realize, if it wasn't for the VA, we wouldn't have the type of well-trained, educated physicians that we have that serve the country. We are also, the VA is also, the largest trainer of nurses, of pharmacists, of social workers and many, many other professionals, and if it wasn't for the VA as dedicated to training future professionals, the country wouldn't be able to work the way that it does.
Mr. Rush:
With all the challenges the VA is facing today, what makes a career at the VA rewarding and fulfilling?
Dr. Shulkin:
Well, I think that there are a number of things that makes the VA a place that people should look at as a career option. The first is its mission. It really does have a noble mission, and I think so many Americans recognize the sacrifices now of the young men and women who volunteer to get up and to leave what they're doing to protect the country. You know that we only have 1% of Americans now serve in the US military, and the situations we're placing them in and what they are doing for us, I think many people recognize that helping treat them and helping take care of them when they come back is an important and vital function of our society.
The second is, is that if you work at the VA, you really are able to focus on your clinical work and not have to deal with the business of medicine. And while certain people enjoy that, I and everyone else knows that more and more physicians are becoming frustrated and dissatisfied with all of the burdens being placed upon them just to be able to get paid and to make a living, and at the VA you don't have to deal with that. You can focus on taking care of your patients. There's not the same financial incentives of churning patients in the VA that you would find in some settings in the private sector.
The last point about the VA that I think is quite different is the focus on working as part of a team. We really do have our doctors work together as part of team efforts to really make sure that veterans get the right care, and not just the right medical care, but really, this is a wholistic approach towards well-being that includes the psychological, the social, the economic and the health aspects of keeping somebody healthy and well. So, if a veteran doesn't have a place to sleep at night, if they're homeless, we know that getting them to get medications and to stay compliant with their medical regimen if they're living on the streets is really almost impossible, so the VA finds them homes. We have a huge program to end veterans' homelessness. And we also do this in so many ways, in getting transportation to and from appointments, in providing caregivers to people who need people to help them stay at home and not be institutionalized. So, this is truly being part of a system of care, one that frankly makes a lot of sense to doctors once they're part of the system.
Mr. Rush:
You mentioned earlier that there's 45,000 openings throughout ancillary, administrative and all the way up. What would you say the biggest staffing challenge facing the VA today is?
Dr. Shulkin:
Well, we have five critical areas that are our biggest shortages. Number one is physicians, no question about it, primary care doctors and mental health professionals, psychiatrists in particular. The second shortage area are nurses, no surprise there. We have over 60,000 nurses, and we have lots of opportunities for nurses. The third area are psychologists, and again, this relates to the intense mental health benefits that we offer and how important we think it is to integrate mental health into our other services like primary care. We also have a shortage of physical therapists, and physical therapists are in great demand by the VA, and finally, social workers.
Mr. Rush:
Many people don't realize that the VA also conducts and oversees many medical research programs. Can you tell us a little bit about that?
Dr. Shulkin:
Sure. The VA is the only federal agency that has research dedicated to improving the lives of veterans, and it's actually a very large effort. We have about $1.8 billion of research programs every year and, of course, the VA works with almost every major academic center in collaboration with many of the these research efforts, so we have some of the best researchers in the world as well. Our research focuses on conditions that veterans tend to have a predisposition to.
We've also launched a pretty big effort in genomics where we think the future of healthcare is going. We have a program called the Million Veterans Program where we're collecting the genotype material on a million veterans. And, of course, with our long history of an electronic medical record, that gives us an ability to marry the genomic material with the clinical databases from our electronic medical record so we can begin to answer questions from a research perspective that frankly almost nobody in the world is going to be able to ask and answer. So, we feel that we are able to help improve the lives of veterans and at the same time improve the lives of the American people.
Let me just say I'm not sure most people recognize that it was the VA that did the first liver transplant, that did the work that led to the CAT scan, that was the inventor of the nicotine patch, of the radioimmunoassay of the pacemaker, that found the association between an aspirin a day is good to prevent heart disease. So, it really is that VA research is good for American medicine and keeps us in this leadership position.
Mr. Rush:
That's fantastic. Well, Dr. Shulkin, thanks for being my guest today and sharing your insight into what's going on at the VA today.
Dr. Shulkin:
Great, thank you, Tim.
Mr. Rush:
I'm your host, Tim Rush, and thanks for listening.
Narrator:
For more information on careers at the VA, please visit www.vacareers.va.gov. That's www.vacareers.va.gov.
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