I worked in the VA for 13+ years. I worked at 6 different medical centers - very common to move often, to move up. When I left I was acting Assoc. Director (COO) at a large psych. facility in WI. Looking back, the system was dysfunctional beyond belief. As the VA was my first professional job, I didn't appreciate how bad it was until I left. During my tenure I worked in 1 of 4 Regional Offices (Ann Arbor) for a period of 2+ years. During that time, we had a revolving door of Medical Center Directors, Associate Directors and Chiefs of Staff who were detailed to the Office when "issues arose with their performance." The issues were almost always related to inappropriate conduct. After the PR storm blew over, they would be reassigned to another hospital or retire early. These were key leaders within the organization! During my last year of my employment, I spent about 20% of my time interacting with Federal Marshalls and FBI agents, working through criminal complaints filed against staff/employees. Incidents included theft from patients, sexual assault, etc. Inferior HR policies and practices did not allow us to deal with gross misconduct quickly and effectively. With my current employer, we effect the same changes within a few days (and the infractions are not criminal in nature). I really don't have a clue how to make the VA better. I worked with a lot of really good people when I was there, but it was all overshadowed by the 2% that were really, really bad.
6
Finally we have hope in the new VA Chiefs ability to actually make a difference in the system. He is listening from the ground up! Every great manager and leader and virtually all the scholarly articles basically say this is how you make a change! Congratulations and we must salute this brilliant choice!
5
...so I plan to write Dr Shulkin a letter about my issue@VAMC E23rd St...will be interesting blowback I'm sure...not personally concerned because of right now I am 'quit' of VAMC unless my issue is resolved...
1
So Shulkin is going to out-source "hearing aids" while hearing loss and tinnitus are respectively the number 1 and 2 service connected disabilities of all Veterans. The VA provides the highest quality comprehensive audiological services including cochlear implants for blast exposed Veterans at a cost far less than what they will pay private contractors for those services. If Shulkin is looking for efficiencies in the system, he may want to start at 810 Vermont Ave.
7
The VA hospital system is a single payor healthcare system. It has been a disaster for decades. Ask any sick vet. Is this what Americans want for everyone? I certainly hope not.
1
Just like with a lot of other federal agencies, the problems at VA are largely managerial and bureaucratic. The "grunt" employees, the doctors and nurses and techs and such, do a pretty darn good job. I use VA and couldn't be any more pleased with the service I've received, health-wise and in using my GI Bill. My father also uses VA and is equally as pleased. Hopefully the powers that be work with Dr. Shulkin to make the changes VA needs to undo the bureaucracy.
4
“Sometimes leaders get disconnected from their organizations,” Dr Shulkin.
This should be the topic a TED talk. And Trump and the entirety of his Camp should be forced to watch and listen. In a Clockwork Orange sort of way.
Disconnected is exactly whats most wrong with so much in this nation right now. In every company, every community, every church...hard to think of a circumstance where its not true. Be it economics, cultural, sexual identity, race, employment, the media, jurisprudence, policing, government, etc - there is serious disconnect within and without.
Kudos Doctor. We need more of you in government.
This should be the topic a TED talk. And Trump and the entirety of his Camp should be forced to watch and listen. In a Clockwork Orange sort of way.
Disconnected is exactly whats most wrong with so much in this nation right now. In every company, every community, every church...hard to think of a circumstance where its not true. Be it economics, cultural, sexual identity, race, employment, the media, jurisprudence, policing, government, etc - there is serious disconnect within and without.
Kudos Doctor. We need more of you in government.
4
Dr Shulkin needs to address all the issues of the VA, Benefits re-do, it is still delaying an loosing files, and adding to the wait times,Healthcare is still below par, Tri west is a joke, and MH care is so indifferent and lax, some of the outpatient clinics are bottom heavy (they have no Doctors, Psychiatrists, specialists, some have 1 GP Doctor who is supposed to see 20k or so Vets, suprise...it dosent happen as he is only availaible 3 days a week, tri west does not kick in as no VA employee dares to use them (fear of loosing their job) and there is still rampant corruption everywhere! 100 days in and nothing has changed.
1
Gee, where's the revenge factor in this appointment? Why on earth did Mr Trump appoint someone who was Obama approved? I can't help but feel that there is something fishy here. Or, just maybe our President is running out of options to fill positions from his own small and non-credible network of friends and business associates. Every other appointment (and decision) he's made so far has reeked of spite and revenge. Against a predecessor who outshined him in every possible way. It's really quite simple. Our adolescent President is jealous of Obama.
4
In response to those who think that the V.A. should be "working itself out of business," I respectfully and vehemently disagree. My husband has multiple service connected disabilities due to his combat service in Vietnam (and Agent Orange).
We have just now returned from one of two visits this week to our local VA Center. My husband receives OUTSTANDING care from his primary care provider as well as specialists such as psychologists, dermatologists. neurologists, etc. These dedicated providers make far less than their private sector colleagues, but they are committed to serving veterans. And they are trained and able to furnish all specialized care that is needed and often unique to veterans.
I cannot speak to the care others receive at other centers around the country, but if I would seize the opportunity to obtain MY healthcare at the Richmond Hunter Holmes McGuire Veterans Medical Center.
We have just now returned from one of two visits this week to our local VA Center. My husband receives OUTSTANDING care from his primary care provider as well as specialists such as psychologists, dermatologists. neurologists, etc. These dedicated providers make far less than their private sector colleagues, but they are committed to serving veterans. And they are trained and able to furnish all specialized care that is needed and often unique to veterans.
I cannot speak to the care others receive at other centers around the country, but if I would seize the opportunity to obtain MY healthcare at the Richmond Hunter Holmes McGuire Veterans Medical Center.
10
Dr. Shulkin, and Congress, if you are reading, please hire many more mental health and primary care providers in all VA facilities. Patients do not get access to good enough MH care unless there are enough staff to provide regular weekly appointments for MH care. Not all VAs are ensuring that providers can promise their patients they will be available at a regularly scheduled weekly time. Without this, patients can't 'attach' well with their MH provider. VA needs enough staff to see veterans who want therapy on a weekly basis. Also the VA needs to pay primary care doctors a more competitive salary and hire more primary care doctors. If you do these things--hire more MH and primary care providers--I promise you that morale in the VA will improve and quality of patient care will improve.
5
Thankfully for our Veterans the best man for the job got it! Finally someone wanting to support those an agency helps rather destroy it as seems often the case in Trump administration.
3
I am a veteran from the Vietnam era. I have been getting my care from the VA for about 15 years. My father in law is a WWII vet and also gets his care at the VA. We both go to the Tucson VA.
I work as a consultant and coach in the medical sector, usually with clinics, helping them improve leadership, teamwork, and patient outcomes. The Tucson VA has a lot going for it and some difficulties. I have had some five of my primary care docs leave the system and when I ask them why, I hear two themes emerge. The focus isn't always on providing direct care, rather tasks that take away from direct care, and not enough resources.
I actually find that many of the employees are mission driven, they really want to support the vets that come to the hospital. Many of them are vets themselves. I think the VA's greatest resource is their people and similar to the prior comments they need to listen to the feedback from their employees.
I wish Dr. Shulkin success. I think his greatest challenge may be his administrators.
I work as a consultant and coach in the medical sector, usually with clinics, helping them improve leadership, teamwork, and patient outcomes. The Tucson VA has a lot going for it and some difficulties. I have had some five of my primary care docs leave the system and when I ask them why, I hear two themes emerge. The focus isn't always on providing direct care, rather tasks that take away from direct care, and not enough resources.
I actually find that many of the employees are mission driven, they really want to support the vets that come to the hospital. Many of them are vets themselves. I think the VA's greatest resource is their people and similar to the prior comments they need to listen to the feedback from their employees.
I wish Dr. Shulkin success. I think his greatest challenge may be his administrators.
15
As a three tour combat of Iraq, I have firsthand have used the VA healthcare system. Its an unique healthcare delivery system that treats patients who have service connected and combat related injuries. They deal with the physiological psychological effects on a daily basis that civilian hospitals aren't designed treat on a consistent basis. I am glad we have a Obama appointee holdover sees that healthcare has to be 'patient centered' first and not just profit based first. Plus resist the call to privatize the VA healthcare system. Hopefully this type of thinking can trickle on down to the GOP backed healthcare plan where a tax cut for the wealthy was the driving force for a poorly crafted plan that is a sham at best.
10
It is very obvious that the Secretary does not have a clue, or chooses so, how veteran exposure to dangerous, unadulterated chemicals negatively affect sight, hearing, neuro, and a host of other maladies which he flippantly dismisses with the shrug of a non-veteran lucky enough to land in technology, brimming with verisimilitude.
2
People may assume that examination and testing will tell physicians all they need to know about a patient, but there’s a lot of personal history and narrative that patients have to fill in for doctors. At the VA, when you start from the beginning, you won’t have to start from all the way from the beginning. They’ll have a better appreciation of the situation—or they should.
6
I used to work for the VA--loved the Vets, felt like I was making a difference every day, appreciated working with colleagues who wanted to provide great evidence based care to those who had served. The EMR was pretty good too. So why is this all past tense? Simply I got worn down by administrators more concerned about VA Central Office than meeting the practical needs of the Vets in front of us and the complete inability to move along non performers.
I was honored to be part of the mission and the organization Ken Kizer built and I was so sad to leave. But it was too hard swimming upstream against the bureaucracy. Now that I'm in the private sector I don't think the answer is sending vets out to fend for themselves. If anyone hasn't noticed yet, it's pretty complicated out here.
I was honored to be part of the mission and the organization Ken Kizer built and I was so sad to leave. But it was too hard swimming upstream against the bureaucracy. Now that I'm in the private sector I don't think the answer is sending vets out to fend for themselves. If anyone hasn't noticed yet, it's pretty complicated out here.
16
Eye glasses and hearing aids ARE prostheses. The force produced by the variety of weapons and explosions results in the same damage to the organs of hearing as happens to a limb in an explosion. The physical structure and usage are severely compromised or missing. Just because the rest of us can't see the damage, doesn't mean the damage is less important. A physician should know this.
Listen to any Veteran who is suffering from the depression and isolation that results from hearing loss because he/she can no longer participate in the simplest to most serious things most of us take for granted such as understanding directions from our doctor, talking on the phone, holidays with family, dinner with friends, checking out in a grocery store, being able to detect the direction of approaching traffic, etc. Further, many Veterans also suffer sleep deprivation, significant stress, and an added source of depression from constant tinnitus caused by military noise exposure. Consider how you would feel and function (and eventually shut down) if everywhere you go, even to sleep at night, is a struggle.
The loss of any ability is devastating. When Veterans offer up their lives for us, it doesn't exclude their hearing ability. It should be as important as any other part of them requiring prostheses and rehabilitation.
Listen to any Veteran who is suffering from the depression and isolation that results from hearing loss because he/she can no longer participate in the simplest to most serious things most of us take for granted such as understanding directions from our doctor, talking on the phone, holidays with family, dinner with friends, checking out in a grocery store, being able to detect the direction of approaching traffic, etc. Further, many Veterans also suffer sleep deprivation, significant stress, and an added source of depression from constant tinnitus caused by military noise exposure. Consider how you would feel and function (and eventually shut down) if everywhere you go, even to sleep at night, is a struggle.
The loss of any ability is devastating. When Veterans offer up their lives for us, it doesn't exclude their hearing ability. It should be as important as any other part of them requiring prostheses and rehabilitation.
11
The question is, why do we have to use the VA for HA and glasses?
Shulkin is right--there are audiologists and optometrists/ophthalmologists galore who would be able to provide care for veterans, thereby increasing their own income, and freeing VA doctors and staffers to offer services not easily available off-site, and with the expertise that the VA has in dealing with we veterans.
Shulkin is right--there are audiologists and optometrists/ophthalmologists galore who would be able to provide care for veterans, thereby increasing their own income, and freeing VA doctors and staffers to offer services not easily available off-site, and with the expertise that the VA has in dealing with we veterans.
1
VA is the world's largest buyer of hearing-aid-technology - drives R&D, testing, etc - no audiology clinic [ or group of ] rates all at compared to this...
5
Here is how you can end partisanship: you can nominate someone who is actually qualified and experienced and passionate about the job he has been nominated for, as Dr. Shulkin clearly is. Since the Trump usual approach is to nominate the person least qualified, least experienced - much like Trump himself - Shulkin is some weird anomaly for Trump and his supporters - the geniuses who believe that a a President who has never had any experience in politics/public/military service is best qualified - as long as he can make money in real estate with ends justify the means tactics and is a reality TV star and Twitter troll and self-deal and scorched earth destroy our institutions. Dr. Shulkin is proof that the Democrats do not engage in partisanship when a qualified person is nominated and when that person benefits the country - that's how you get 100-0 Senate confirmation. Tragically, the Republicans are no longer capable of such bipartisanship and putting country above party. And, horrifyingly, the Trump and Republican scored earth policy based on propaganda and lies and hate and fear mongering actually has them in charge of the Presidency, Senate, House and soon Supreme and Federal Courts. Power to the Resistance and focus on stopping Trump's outrageous and greedy and self-dealing and cruel "policies" - and on 2018 - to get back Senate and House and block Supreme Court nominees like Gorsich - and on 2020 and the Presidency. Support bipartisanship in cases like Dr. Shulkin.
12
Until he spends some time firing and hiring some bad and good people, nothing will change.
5
Glad Dr. Shulkin is the leader of the VA, but a few words of caution. CPRS is an excellent electronic medical record. I have heard nothing but complaints from colleagues who use Epic. It's cumbersome, hard to find information needed for patient care, and not user friendly. But like another commenter said, no one seems to care what the doctors think at the VA (or anywhere else, apparently). For the benefit of non-medical people, doctors have little say in the way they practice anymore. They have become cogs in a giant profit generating wheel.
Second, another commenter provided a link to actual data in a reputable journal that shows that veterans get as good - if not better - care at the VA. VA docs are often clinical investigators who are highly trained and academically based. Think about that. Data shows their care matches private care. Makes sense to me.
Third, VA doctors do not get bonuses or benefits for doing expensive tests and procedures at the VA. They are asked to provide excellent care on less money. The evidence shows that we come through. Private hospitals, on the other hand, make more money by doing more billable things. There is much in medicine that can be justified by sketchy data. VA docs are not allowed to practice in that way, not without repercussion. Please stop putting down the VA. Bad things happen in private hospitals too.
Second, another commenter provided a link to actual data in a reputable journal that shows that veterans get as good - if not better - care at the VA. VA docs are often clinical investigators who are highly trained and academically based. Think about that. Data shows their care matches private care. Makes sense to me.
Third, VA doctors do not get bonuses or benefits for doing expensive tests and procedures at the VA. They are asked to provide excellent care on less money. The evidence shows that we come through. Private hospitals, on the other hand, make more money by doing more billable things. There is much in medicine that can be justified by sketchy data. VA docs are not allowed to practice in that way, not without repercussion. Please stop putting down the VA. Bad things happen in private hospitals too.
37
As I understand it from Best Care Anywhere by Phillip Longman, the VA medical records software was written by VA doctors in their off duty hours without the knowledge of the bureaucrats. It works and since VA Medical Centers are associated with Medical Schools most doctors know it and understand how to use it. One of my private specialists, VA Choice program provided, has been with his practice for 7 or 8 years and they are going to their second medical records system. First did not work, second he is not sure if it will and he thinks the world of the VA system.
VA Choice is a disaster, private sector providers not wanting to take part because they get paid late, very late, VA contractors having staff that knows very little about health care, phone lines with 2 hour hold time, not able to communicate to private sector providers the health care problem the VET has.
VA Choice is a disaster, private sector providers not wanting to take part because they get paid late, very late, VA contractors having staff that knows very little about health care, phone lines with 2 hour hold time, not able to communicate to private sector providers the health care problem the VET has.
1
If you are lucky enough to have access to a VA facility which is associated and staffed by a local medical school or university center, your care will probably be exemplary, and the facilities first class.
If not, you are to be pitied.
If not, you are to be pitied.
11
The Northport, NY VA is exactly as you described, staffed and run by SUNY Stony Brook medical school. As a patient there I saw a doctor every 3 months, specialists at the drop of a hat, and lacked for nothing. Tucson, while a great VA, is not like that. The demographics (much lower median income, far more vets as both a percentage of population and as an absolute number) tell the story. The medical staff, for the most part, try heroically to provide the care needed but are frequently stymied by lack of resources, and the intimidating, overbearing administrative culture as described by GeriMD above. They've saved my life, as I've said elsewhere here today and other days, but they do drop the ball sometimes, mostly because admin. ties their hands.
4
"No one has ever died from not having access to Health care."
Republican Raul Labrador, May 5,2017.
Tell that to the vets who died waiting for an appointment.
Tell that to the ones - 22 a day - that blow their brains out waiting for mental health care.
Tell that to the ones who die "after the sun goes down", because care is "distinctly worse" on the night shift.
"They can't go get care in the private sector", Dr. Shulkin says.
Yeah, Dr. Shulkin, go tell that to Republican Raul Labrador. He doesn't seem to understand that "access" isn't the same thing as getting it.
And neither do you.
You two need to get on the same page.
People with access to Health care, VA or 'private' sector, die all the time.
And just wait until Mediaid gets cut a trillion dollars to pay for those ungawdly tax reductions for the 1%.
It'll be dyin' time, then, won't it?
Single payer, not single prayer.
Republican Raul Labrador, May 5,2017.
Tell that to the vets who died waiting for an appointment.
Tell that to the ones - 22 a day - that blow their brains out waiting for mental health care.
Tell that to the ones who die "after the sun goes down", because care is "distinctly worse" on the night shift.
"They can't go get care in the private sector", Dr. Shulkin says.
Yeah, Dr. Shulkin, go tell that to Republican Raul Labrador. He doesn't seem to understand that "access" isn't the same thing as getting it.
And neither do you.
You two need to get on the same page.
People with access to Health care, VA or 'private' sector, die all the time.
And just wait until Mediaid gets cut a trillion dollars to pay for those ungawdly tax reductions for the 1%.
It'll be dyin' time, then, won't it?
Single payer, not single prayer.
12
Fabulous! Now I know that there is at least one caring, smart, responsible trump appointee who wants to make his department better, not destroy it as bannon/trump want. The veterans so need Dr. Shulkin's professionalism, his commitment, and his humanity and it looks like they have it.
11
..how far down the POTUS chain-of-succession is Dr Shulkin...?
“We make eyeglasses for our veterans. Last time I checked, every shopping mall in America has a place where you can get glasses in an hour. I don’t care about making eyeglasses. I care about getting that veteran his prostheses.”
If SecVA Shulkin thinks that the same high level of medical eye care provided by VA optometrists and ophthalmologists to veterans with multiple systemic diseases who are at great risk of sight-threatening eye diseases can be provided at the local LensCrafters, then he needs to get out a little more and find out what is actually happening in his own house.
If SecVA Shulkin thinks that the same high level of medical eye care provided by VA optometrists and ophthalmologists to veterans with multiple systemic diseases who are at great risk of sight-threatening eye diseases can be provided at the local LensCrafters, then he needs to get out a little more and find out what is actually happening in his own house.
19
To be fair, he was referring to basic optometry, not opthalmology. To de totally clear, though, be aware that after an eye exam by a VA optometrist, I go to the optical shop in the VA which is owned, staffed and operated by Korrect Optical our of Louisville, Ky. I assume they have an exclusive territorial, if not national contract with the VA. My first pair is free, 2nd pair is $19.00 unless I want non-standard frames (they offer dozens if not hundreds of basic styles to choose from). 4 years ago I wanted polycarbonate prescription safety sunglasses for shooting, which they made for me for $200.00. They might have cost less had I not chosen RayBan frames (classic cop/aviator style). I wanted that look, and maximum surface area for protection. A few mis-ejected .308 casings later, they're just like new. This was an indulgence, but I neither golf nor drink, allowing me to rationalize greater savings. I do cuss on occasion, if my 200 meter shots go beyond 2 M.O.A.
1
Sadly his comments show an utter disconnect with the numerous metrics and studies concerning the care/service VA provides. For example he mentions hearing aids...the choice program has been in place for some time and Veteran's have overwhelmingly returned to the VA for their care after waiting for service or being unhappy with providers (who receive poor compensation or bump VA patients for private pays). Hearing aids (which treat hearing loss and tinnitus) which he so flippantly talks about are the two of the most common service connected conditions yet he is willing to consider sending Veterans out for service that they prefer being treated at the VA for. Lastly there are numerous studies indicating how much more cost effective it is for VA to provide these services compared to sending them out to the private sector. He could simply be speaking off the cuff here. I assume he will look at satisfaction numbers and data before making his decisions.
5
Nothing beats a hands on manager who is not afraid of change and has vision. Everyone in the VA would be well-advised to adopt the same attitude as Dr Shulkin and start looking out for our combat vets as the first priority.
7
Who is going to see the many, many Veterans for the CHOICE/Medicaid/Medicare rates? No one in the private sector could keep their businesses open for those rates of reimbursement. The answer is not to put the problem on the private sector...they will be overwhelmed and I am afraid Veterans would not be put first.
5
One can talk about the benefits of off-loading care to private clinics and hospitals, but as anyone with health insurance knows, these have their own byzantine rules and bureaucracies. Who's to say that the intensivist rounding on a vet in a private hospital will accept the vouchers provided by the VA? Even if s/he does, who's to say the federal government will provide the voucher in a timely manner? There's a proud tradition amongst all payers to reject all claims first, then sort it out on appeal.
The beauty of the VA Health system is that it is an integrated, one-stop shop for all care. Your primary care doc refers you to a gastroenterologist who determines you need an endoscopy? It's all under one roof, with all records available to everyone. Move across the country and want you new health care team to see your records? It's already accessible.
It's by no means a utopia and there are real problems recruiting, hiring, and retaining trained health workers. The organizational table seems to be heavy on management, light on workers. Underperforming workers are allowed to continue on as zombies, potentially endangering people. But the underlying core principle, to create a place where vets can get all of their health care needs met in an integrated way, shouldn't be lightly discarded.
The beauty of the VA Health system is that it is an integrated, one-stop shop for all care. Your primary care doc refers you to a gastroenterologist who determines you need an endoscopy? It's all under one roof, with all records available to everyone. Move across the country and want you new health care team to see your records? It's already accessible.
It's by no means a utopia and there are real problems recruiting, hiring, and retaining trained health workers. The organizational table seems to be heavy on management, light on workers. Underperforming workers are allowed to continue on as zombies, potentially endangering people. But the underlying core principle, to create a place where vets can get all of their health care needs met in an integrated way, shouldn't be lightly discarded.
8
I am a physician at a VA medical center and have several relatives who receive their medical care at VA facilities. It has been my professional and personal experience that veterans, by and large, are quite satisfied with the care they receive on the provider side at the VA. The quality of care and the integrated approach are as good or better than in the private sector, as recent scholarly publications attest. The frustrations arise from the bureaucratic and administrative morass patients must navigate to make appointments and get benefits.
As a VA employee, I can say that my colleagues and I love our patients and feel very honored to serve them. Engagement with patients is much more personalized and tailored at the VA than I have seen at academic centers and private hospitals. That said, employee morale at the VA is very, very low. We struggle under a bloated managerial/administrative staff who are disengaged from patient care and disconnected from the concerns and needs of staff. Several of my colleagues, highly trained and wonderful physicians, have left for jobs in the private sector in the past year or two.
I am now considering leaving the VA as well. As much as I'd like to stay, the pace of change at the VA has been glacial, and there is little indication or optimism here that Dr. Shulkin will be able to effect the transformation that will entice healthcare providers like myself and veteran patients to stick it out with the VA.
As a VA employee, I can say that my colleagues and I love our patients and feel very honored to serve them. Engagement with patients is much more personalized and tailored at the VA than I have seen at academic centers and private hospitals. That said, employee morale at the VA is very, very low. We struggle under a bloated managerial/administrative staff who are disengaged from patient care and disconnected from the concerns and needs of staff. Several of my colleagues, highly trained and wonderful physicians, have left for jobs in the private sector in the past year or two.
I am now considering leaving the VA as well. As much as I'd like to stay, the pace of change at the VA has been glacial, and there is little indication or optimism here that Dr. Shulkin will be able to effect the transformation that will entice healthcare providers like myself and veteran patients to stick it out with the VA.
20
A point to consider about outsourcing or offloading so-called routine care to private facilities: those private facilities barely have the capacity to deal with the population they currently serve. Inject several million new patients formerly of the VA and the system would undergo some teething pains, to say the least. Wait times would likely increase for people in the private health care system; I can only imagine the outcry that would result.
8
He's creating a win win situation for veterans and the private sector has become part of that equation thanks to a man with passion and knowledge in venting that passion. What happened to that CEO who made a big splash on 60 minutes a year or two ago that was put in charge of this department.? Must be he left nothing but puddles in the wake of his demise.
"Example is not the main thing in influencing other." "It's the only thing."--Dr. Albert Schweitzer--
"Example is not the main thing in influencing other." "It's the only thing."--Dr. Albert Schweitzer--
5
I applaud moves to streamline hiring and firing. I quit my job as a physician with the VA because the nurse I was supposed to rely on was untrustworthy. After I left I heard his behavior was because he was an alcoholic. My patients loved me and I enjoyed my job, other than my concern about that nurse.
I approached my boss on multiple occasions before leaving about my concerns about patient safety with that nurse. He told me they could not fire him because he was in union.
I approached my boss on multiple occasions before leaving about my concerns about patient safety with that nurse. He told me they could not fire him because he was in union.
15
There is no uniform VA clinic or hospital. It depends on where you live. If you live in a place that is a large city where the VA is connected to a university or medical facility you will get good care because you will be getting it from non VA doctors. Otherwise if you live in a small town or someplace rural you are out of luck. And in serious ways. More incompetence than can be believed. Two of my brothers are no longer alive because they depended on VA care.
5
Your information is wrong. The care provided at VAs connected to universities is not provided by "non VA doctors." Unless they are what are called "contractors" (actual non-VA doctors), they are VA MDs, though some might spend a proportion of their time at the university affiliate in what is called a dual appointment. Please check your facts next time.
8
While I agree about urban centers offering better care, especially those with academic medical institutions, rural areas are generally, not just in the VA, at a serious disadvantage for good medical care. There are not enough doctors and related professionals to staff America's healthcare needs.
1
Eve is most certainly right - if near or associated with a medical school much of the care (especially specialty care) is provided by residents and others from the nearby academic institution.
Otherwise you get pretty lousy care.
Otherwise you get pretty lousy care.
1
"Dr. Shulkin wants to increase reliance on private health care..."
There it is in a nutshell.
This was a GOP goal for a long time, to close the V.A. and put all veterans into the for-profit medical community where it will cost taxpayers a lot more and provide windfall profits for politically connected medical firms.
To get this money grab past the people the GOP has short-funded the V.A. for many years to create the illusion that huge unsolvable issues will require to close the V.A. the turn it over to to vulture private medical providers.
The VA already has a program - the VA Choice program - to refer veterans outside the VA when VA health providers are not available.
Veterans and taxpayers would be better served if the VA was adequately funded so that it could employ sufficient doctors, nurses, and other providers.
What's interesting that on the campaign trail Trump castigated the Obama administration for its management of the VA, but now he has an Obama administration official running the agency.
There it is in a nutshell.
This was a GOP goal for a long time, to close the V.A. and put all veterans into the for-profit medical community where it will cost taxpayers a lot more and provide windfall profits for politically connected medical firms.
To get this money grab past the people the GOP has short-funded the V.A. for many years to create the illusion that huge unsolvable issues will require to close the V.A. the turn it over to to vulture private medical providers.
The VA already has a program - the VA Choice program - to refer veterans outside the VA when VA health providers are not available.
Veterans and taxpayers would be better served if the VA was adequately funded so that it could employ sufficient doctors, nurses, and other providers.
What's interesting that on the campaign trail Trump castigated the Obama administration for its management of the VA, but now he has an Obama administration official running the agency.
36
The purpose is to outsource treatment other than its core purpose, providing for wounded veterans.
Please re-read the article.
Please re-read the article.
11
You should reread the article. "Many of the agency’s patients have a complex mix of physical and mental health issues, he said. “They can’t go get care in the private sector,” he added. “At least not the comprehensive care the V.A. gives them.” This is true for many of the patients, not just the wounded ones.
7
@ Shawn Bayer @Ed West
Please re-read my comment.
"Veterans and taxpayers would be better served if the VA was adequately funded so that it could employ sufficient doctors, nurses, and other providers.", i.e. other than its core purpose like mental health etc. instead of outsourcing it.
Got it?
Please re-read my comment.
"Veterans and taxpayers would be better served if the VA was adequately funded so that it could employ sufficient doctors, nurses, and other providers.", i.e. other than its core purpose like mental health etc. instead of outsourcing it.
Got it?
6
This dedicated multi talented doctor should be given a loud voice in the constructing of what we have been told is a new health care plan for all.
Surely he is qualified to understand the complexities [as opposed to "who knew it was so complicated"] of health issues and costs. I don't know his position on tax breaks for the rich...which is part of the present plan, but it would seem that he puts the priority where it belongs which is getting the best care possible. Why is this only a legislative issue when it is clearly a medical issue as well?
Surely he is qualified to understand the complexities [as opposed to "who knew it was so complicated"] of health issues and costs. I don't know his position on tax breaks for the rich...which is part of the present plan, but it would seem that he puts the priority where it belongs which is getting the best care possible. Why is this only a legislative issue when it is clearly a medical issue as well?
9
It's great that Dr. Shelkin has introduced the personal touch, but can he pass it down to the Physicians Assistants?
4
I work for the VA healthcare system. So far I have not seen my difference. The same manager heavy staff is in place at the expense of first line providers like myself. The veterans don't complain about not being able to see this or that manager...they complain about not being able to see providers and phone calls not being returned. What I have seen, however is an autocratic tendency that makes me afraid. We walked in the other day to learn that we no longer would receive certain clinical alerts...some of us use this, yet Dr. Shulkin hated it so he had it turned off. Where was the shared governance? The collegiality? This decision actually directly challenges my ability to provide patient centered care. I think when one reads his work history in the article and reads that his "innovations" didn't hold after he left? very telling. If the rank and file are not engaged in the change it won't happen regardless of the buzzwords. Now he wants to migrate all of our electronic records to Epic...one of the absolutely most expensive EMRs. Why not get his friends in congress to actually fund us to update CPRS which was (hello FunkyIrishman) one of the FIRST EMR in the US.
29
Easy fix for the VA -- make ALL members of Congress, their families and staff go to VA hospitals. The problems would be fixed in one week.
15
um, actually, maybe the problems in private healthcare would be fixed, because altho the VA has it's problems, the overall care and outcomes are BETTER than in the private sector. I do anticoagulation, we rule in that category.
8
Two things jump out at me: First, this doctor understands that an administrator who does not lay hands on the actual work of the organization, has a difficult time keeping his/her finger on its pulse. Second, he is passionate about quality. If any segment of our society categorically deserves the very best our country has to offer in terms of health care, it is the veterans who put their lives on the line in service to our nation. To my mind, it is a moral imperative.
4
Bipartisan, pragmatic, idealistic but not an ideologue. What a concept! How about more of these types on the Cabinet? Compare Dr. Shulkin with Dr. Carson. Whoops.
3
As the old saying goes, "the proof is in the pudding". Hopefully the new Chief of Veterans Affairs will fill the bill and get things done. He was, however, appointed by Trump, not the smartest of people. If Dr. Shulkin can get past the stigma of Trump's reputation, than a better future for Veteran Affaires is possible. Let's wish him luck and hope he's not just another Trumpist.
1
But he was originally appointed by Obama. He is not the same stripe as the rest of Trumps men.
4
@Charles. My mistake. Sorry. Let's hope he perseveres then, despite Trump. Hope he's not fired for doing a good job.
1
Our greatest socialism success story in this country is the U.S. military. Our military provides free education, housing, medical and lifetime entitlements- for all who decide to serve. All funded by the United States taxpayer.
As for healthcare we have: Medicare for the elderly, medicaid for the poor, VA hospitals for the military and a special program for 5 million Federal Employees .. that just leaves the rest of us.. Let's bundle this all in one and get national healthcare going!!!!! We are almost there! Come on President Trump- stand up and lead!
As for healthcare we have: Medicare for the elderly, medicaid for the poor, VA hospitals for the military and a special program for 5 million Federal Employees .. that just leaves the rest of us.. Let's bundle this all in one and get national healthcare going!!!!! We are almost there! Come on President Trump- stand up and lead!
10
Free perhaps but not without cost as one must actually serve, not always an easy route.
2
As I wrote in yesterday in reply to Ami (http://www.nytimes.com/2017/05/08/opinion/gop-health-care-disaster-wrapp...
The VA, at it's worst, is no worse than the health care industry at large, and usually better. That's not to say it couldn't be better, as could the entire health care system. If you read that comment you'll learn I would not be here today without the VA.
After my trip to the ER, they couldn't get me an appt. with a cardiologist for almost 90 days so they offered me veteran's choice. V.C. couldn't get me in to see an established practice within 100 days so I had to settle for what turned out to be Joe's Live Bait, Transmission Repair and Cardiology. I lived to regret it, and am now scrambling to get back into the VA system where my care is coordinated across disciplines and specialties, my records are easily accessed and for the most part folks don't generally lie to your face. I hope Dr. Shulkin keeps plowing forward, I wish him the best. He appears to be the silver lining in an otherwise dark cloud of an administration.
The VA, at it's worst, is no worse than the health care industry at large, and usually better. That's not to say it couldn't be better, as could the entire health care system. If you read that comment you'll learn I would not be here today without the VA.
After my trip to the ER, they couldn't get me an appt. with a cardiologist for almost 90 days so they offered me veteran's choice. V.C. couldn't get me in to see an established practice within 100 days so I had to settle for what turned out to be Joe's Live Bait, Transmission Repair and Cardiology. I lived to regret it, and am now scrambling to get back into the VA system where my care is coordinated across disciplines and specialties, my records are easily accessed and for the most part folks don't generally lie to your face. I hope Dr. Shulkin keeps plowing forward, I wish him the best. He appears to be the silver lining in an otherwise dark cloud of an administration.
8
If I may say so, politely, you don't seem to understand a cardinal rule of our healthcare system: if they delay seeing you,
*it is good news*
if you were really having problems with your heart, they would see you
That is how the system works: most things, while they seem awfully serious to the patient, aren't that serious and can be put off
When you go in and more then one doctor suddenly appears, that is *really* bad news: trust me, I've been there, you do not want doctors suddenly showing up, it means they are really worried
*it is good news*
if you were really having problems with your heart, they would see you
That is how the system works: most things, while they seem awfully serious to the patient, aren't that serious and can be put off
When you go in and more then one doctor suddenly appears, that is *really* bad news: trust me, I've been there, you do not want doctors suddenly showing up, it means they are really worried
3
ezra, I understand triage better than you may think. They discharged me 36 hours after arriving at the ER because I was "mostly" stabilized, and no cardiologist was available to consult. My sinus rhythm was still off, heart rate hovering in the mid 90s (down from 160+), but my continued inpatient status would have serious inconvenienced the cardiology staff. I never said they were perfect. When I first got to the ER there was that bevy of personnel hovering around me for a few hours, who as far as I can tell, saved my life. But yeah, not all that serious, not "really" having problems with my heart, as you so cleverly diagnosed.
Incidentally, I was once kept waiting at the ER in a major Long Island hospital for 6 hours to get a finger sewn up after a table saw mishap, mostly because the on call specialist was out on his boat, then went to dinner. That wasn't "really" serious either. A roll of gauze and a bottle of Jack Daniels would probably have done just as well. Next time I'll go for the leeches and twirl a dead cat in a graveyard at midnight.
Incidentally, I was once kept waiting at the ER in a major Long Island hospital for 6 hours to get a finger sewn up after a table saw mishap, mostly because the on call specialist was out on his boat, then went to dinner. That wasn't "really" serious either. A roll of gauze and a bottle of Jack Daniels would probably have done just as well. Next time I'll go for the leeches and twirl a dead cat in a graveyard at midnight.
4
And you know the details of Eric R.'s medical history based on what?
1
Very good article concerning VHA. I am a Vietnam veteran and have multiple Agent Orange related illnesses. My VAMC is very good. My primary care physician truly manages my care with compassion and professionalism. I have many friends that are doctors: they were trained at the VA and consider the VA Health Care system the Cadillac of health care What is not addressed in the article is the state of affairs in the Veterans Benefit Administration. Exceedingly long wait times for adjudication of benefit claims, complex regulations, inconsistent and confusing decisions. While I have a point of contact in the health care system, claims go into a black box (or a black hole) and the only way to contact VBA is the 800 phone line and talk with a person reading a script. I realize that for compensation claims the law must be followed but don't treat the Veteran as a person trying to take advantage of the system. We do get made at the system and can act like the individual mention in the article in Oregon. The last Agent Orange report was published in March 2016 and decisions concerning presumption of Bladder Cancer, Hypothyroidism, and hypertension as being related to Agent Orange have not been made.
11
Thisa great lesson to Any leader of ANY large organization but for the system to do it's best the reponse to any doctors referrals needs to be the same as the response to Shulkins. I hope he understands that how the system responds to him may not be universal.
2
From one Viet Vet to another, thanks a million for your service Dr David Shulkin! I spent many months recovering in the VA, after I was injured overseas. It left a indelible mark on me and I never wanted to go back to the VA again. Whether I had insurance or not, in those 45 years. I hope folks like you at the VA can turn it around. I meet a lot of young Vets at our local VFW and from what I'm told, it's a thousand times better then it was when I was injured. Never forget the sacrifices that are made by only 1% of our population for our freedom.
8
A lot of the comments here are commending Trump for his nomination of Shulkin. Did everyone miss the point that he was actually part of the Obama administration and the 5th pick of the new "president" to lead this organization? Also, he had to be convinced by someone else. So, bravo, OBAMA administration for finding someone who can make the lives of veterans better.
101
If the Obama administration under his "presidency" made the "lives of veterans better" why was there one scandal and disgrace after another, with little progress or change in years?
5
Guess you just love Scott Pruitt !
2
I am a veteran- Cold War era- and work in the Medical Field, so this is an issue of deep interest. Maybe we have the right person at the DVA to rethink the mission, structure and practice of the agency.
Like Dr Shulkin, I think the VA needs to get out of the business of providing broad healthcare to Veterans in stand alone government owned hospitals. Much of the care currently offered at DVA facilities could be just as easily accomplished at private sector Clinics and Hospitals. In a broader reform, we might be able to get the VA out of the hospital business completely.
Congress and the DVA should investigate the possibility of creating Veterans Centers within existing private hospitals that have space and special staffing only where needed to address the special needs of wounded veterans and let the partner hospital take care of the rest. Otherwise, concentrate VA staffing and funding on the special needs of veterans- not their routine medical care.
I realize that this is a sensitive issue with the many Veterans Organizations, with the Government Employee Unions that represent many staffers and politicians looking to make a mark posturing on the issue. Navigating the minefield of potential political roadblocks will be a difficult task, but the DVA healthcare system is not taking care of business.
We owe our line of duty wounded Veterans the care they need in a dignified, effective and responsive system- that is the prime directive here.
Like Dr Shulkin, I think the VA needs to get out of the business of providing broad healthcare to Veterans in stand alone government owned hospitals. Much of the care currently offered at DVA facilities could be just as easily accomplished at private sector Clinics and Hospitals. In a broader reform, we might be able to get the VA out of the hospital business completely.
Congress and the DVA should investigate the possibility of creating Veterans Centers within existing private hospitals that have space and special staffing only where needed to address the special needs of wounded veterans and let the partner hospital take care of the rest. Otherwise, concentrate VA staffing and funding on the special needs of veterans- not their routine medical care.
I realize that this is a sensitive issue with the many Veterans Organizations, with the Government Employee Unions that represent many staffers and politicians looking to make a mark posturing on the issue. Navigating the minefield of potential political roadblocks will be a difficult task, but the DVA healthcare system is not taking care of business.
We owe our line of duty wounded Veterans the care they need in a dignified, effective and responsive system- that is the prime directive here.
22
I'm also a Cold War veteran who thinks that moving the VA out of competition with Medicare make both economic and health-care sense. A Navy doctor I once knew during the Clinton Era has an assignment to study ways that the civilian health-care industry could adapt to military-type care, and vice versa. The move toward making civilian health care available to veterans under VA programs is a very good initiative that needs to be expanded and accelerated. The VA should be working itself out of business, for the good of us veterans.
5
In the UK, the Queen Elizabeth Hospital is a civilian hospital with a dedicated Military Ward. This model could make sense here in the US to replace DVA hospitals with DVA staffed Veteran's Wards in high quality civilian hospitals here in the US. The same is true for the Department of Defense.
A link to the Queen Elizabet Hospital for those who want to read up on it:
http://www.uhb.nhs.uk/rcdm.htm
A link to the Queen Elizabet Hospital for those who want to read up on it:
http://www.uhb.nhs.uk/rcdm.htm
3
In regard to outsourcing care
bear in mind that some of us
love one-stop shopping
where we get our needs addressed
in a single location
Many vets have challenges getting around and travel adds just one more obstacle
bear in mind that some of us
love one-stop shopping
where we get our needs addressed
in a single location
Many vets have challenges getting around and travel adds just one more obstacle
5
Why not incorporate the VA medical system with Medicare and have vets use the same medical infrastructure. Veterans would be able to see doctors close to home without all the extra paperwork. The military Tricare works with Medicare why not the VA?
12
Among other things, there is no profit motive at the VA. Pushing vets (under 65) into the Medicare system adds an additional layer of costs and doesn't necessarily increase access.
3
Great question. No one is stopping the vets from using Medicare. Medicare covers 80%. Vets can use medicare if they qualify and can afford coverage for the other 20% . Most vets who use the VA do so because they can't afford or don't want to pay for the 20% medicare doesn't cover.
5
The funding for the VA medical care would be transferred to Medicare too of course. Retired veterans do use Medicare and Tricare, but non career veterans, people who served only a few years, qualify for health care too. Many of them are without health insurance.
Why does the Times continue to frame the VA as a mess by using language like "the stumbling bureaucracy"? Is it to perpetuate myths like the one FunkyIrishman advances? I have news for ya FunkyIrishman: the VA does not use paper records. It was one of the first institutions to use an electronic chart.
It’s infuriating.
The fact of the matter is the VA is found to outperform non-VA facilities in most quality measures.
http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/26...
Regardless, I applaud Secretary Shulkin for continuing to see patients at the VA. It will make him a better leader.
It’s infuriating.
The fact of the matter is the VA is found to outperform non-VA facilities in most quality measures.
http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/26...
Regardless, I applaud Secretary Shulkin for continuing to see patients at the VA. It will make him a better leader.
49
It's a "stumbling bureaucracy" because of the actions (or inactions) of many of its bureaucratic leaders who were rarely if ever sanctioned perhaps beyond a transfer without any punishment. While I'm not familiar with the quote you cite, it does seem to fit an agency where there appears to have been little to no accountability and greater focus on managers getting bonuses (an obscenity in the civil service) and focusing on rigging stats to make themselves look good - in other words, uncaring, self-serving bureaucrats.
2
I keep trying to get critics to visit my VA in San Francisco to see excellent health care delivered with efficiency
5
I'm responsible for the complex care of a family member and regularly negotiate public and private systems on his behalf. the idea that the private sector is somehow more efficient or better able to deliver care than the VA or any other public entity is a joke---both systems can be painful to negotiate and the "privileging" of the private sector and its supposed strengths is something that any person in my position (and I've discovered I have many peers) is an assumption that should not be made. The growth of large health care systems means that you have unwieldy, poorly coordinate care all over the place and the list of offenders includes some of the most prestigious and highly regarded medical systems in the country.
29
Finally. Someone in this administration who cares, knows what he is doing and is intent on "building his organization" instead of tearing it down. In the immortal words ---- "Serve long and prosper."
13
The VA has certainly had their fair share of criticisms, some rightly so, some misplaced. Regardless, I will be forever grateful for the level of care, service and most of all empathy everyone from the doctors and nurses, social workers, to the food services and cleaning personnel. My father a Korean War vet enjoyed the VA services throughout his life and was in and out of the VA hospital for most of his last years. I saw first hand the comprehensive care provided to my my father and other veterans (some with multitudes of physical and psychological problems). But, most of all I was able to compare and contrast the level of service provided by the VA and that of private hospital chains in the East Coast. The private hospitals in our area was nothing more than a body shop banging patients for cash. Whenever my father was in a private hospital we would fight tooth and nail to get him transferred out to the VA as soon as possible.
I've seen the bureaucracy that is the VA, but contrast that with corrupt practices of the private system, I'll deal with the bureaucracy. One thing that many veterans sometimes miss is that there are a myriad of volunteer groups that will assist them in navigating the paperwork which in some cases are necessary because of the nature of the services.
The VA is a shining example of a great national healthcare system. The minute you privatize it you will see profiteering off of our Vet's health and quality diminish.
I've seen the bureaucracy that is the VA, but contrast that with corrupt practices of the private system, I'll deal with the bureaucracy. One thing that many veterans sometimes miss is that there are a myriad of volunteer groups that will assist them in navigating the paperwork which in some cases are necessary because of the nature of the services.
The VA is a shining example of a great national healthcare system. The minute you privatize it you will see profiteering off of our Vet's health and quality diminish.
40
I worked in a Community Based Outpatient Clinic providing primary care, part of the VA system. I feel we gave great care but think that the VA system is trying to do some things that can better and more efficiently be done through the community health care providers. The VA should provide the insurance coverage for treatment of primary care in the community and leave it to the VA to provide what the VA should: service connected injuries, mental health problems. BTW, I loved working for the VA and the veterans!
9
I thought the same before I started dealing with the private outpatient clinics that provided services the VA didn't handle on an ongoing basis. For example, dialysis, the VA offers the service only as part of their in-patient cases, in my father's case we used an approved private dialysis center. Every month I would have to comb through a two page invoice because they would sneak in bogus charges and exploit reimbursements. If we were in any other first world country I would agree that working within a network of private providers would be more efficient, but in this country it would just be more expensive, profit over care motivations.
9
I agree with your concerns and have heard other complaints about the VA not paying their bills easily or in a timely manner. But, surely this is fixable! I thought th VA was doing a great job with their electronic medical record system. They should be able to improve billing!
It is all well and good to have a competent and qualified manager ( that is actually a physician ) leading the vast bureaucracy of the V.A.
However the bureaucracy still exists and probably will after the man is gone.
I can give you a primary example ; the VA still insists on paper records.
Every attempt to digitize is slowed down, aborted or worse; enacting a system that does does not work\communicate with other agencies or medical systems.
When you have a large chunk of your budget tied up in gross mismanagement such as that, then of course you are continually going to be underfunded for absolutely required staff to do actual medical work.
However the bureaucracy still exists and probably will after the man is gone.
I can give you a primary example ; the VA still insists on paper records.
Every attempt to digitize is slowed down, aborted or worse; enacting a system that does does not work\communicate with other agencies or medical systems.
When you have a large chunk of your budget tied up in gross mismanagement such as that, then of course you are continually going to be underfunded for absolutely required staff to do actual medical work.
4
The VA pioneered electronic medical records. Get your facts straight!
15
You couldn't be more wrong. The VA led the charge towards electronic records, and everyone else is still playing catch-up. I've seen this in person, up close and personal, in my many years as a VA patient and volunteer worker. That's a nice hat you're wearing, but you're talking through it on this one.
12
to mirror the other comments, here is the wed portal for VA medical records. Mis/disinformation you have provided.
https://www.myhealth.va.gov/
https://www.myhealth.va.gov/
5
Finally, we read about compassion, as well as passion, for others who aren't disproportionately wealthy or male. These men and women who've suffered for their service deserve better. A friend, a social worker at the Bronx VA, says that Viet Nam vets are showing up frequently, and for the first time. Another person I've known, a Marine sniper and squad leader, who served in Beirut, picked up his "brothers" body parts after the bombing that killed over 200 Marines. His PTSD symptoms didn't appear until ten years later.
Psychiatric suffering, substance abuse, physical disabilities: I will always against war, its profits for military contractors, its protected saber-rattlers, and its terrible effects.
Finally, we have someone in this administration committed to public service, who's literally hands-on, and with passionate focus. Balm for the mind, heart, and spirit.
Psychiatric suffering, substance abuse, physical disabilities: I will always against war, its profits for military contractors, its protected saber-rattlers, and its terrible effects.
Finally, we have someone in this administration committed to public service, who's literally hands-on, and with passionate focus. Balm for the mind, heart, and spirit.
16
Now if the President, his staff, and Congress will stay out of his way and let him do his job.
18
Or, perhaps they will support him. Why always so negative??
4
I hope Mr. Shulkin can reform the VA Health Care System (VHA). The VHA is a cumbersome bureaucracy that can't be reformed during one person's administrative leadership. I have recently retired from the VHA. A major problem I have seen within the system is that each VHA facility functions with a different set of rules. There is no consistency in care across the system. I also have a great deal of concern regarding quality of care at those facilities in the community that contract with the VHA to provide care for the veterans. These facilities do not function within the VHA system of care; are payed per veteran they see, and are only herding veteran patients in and out like cattle at an auction. Also, morale among VHA staff is at a very low point, thus affecting their ability to provide good health care with a positive attitude to our veterans. Each veteran deserves consistent care throughout the VHA system; if Mr. Shulkin can address this issue, he will have done a great service to the veterans who depend on this system for their health care.
17
"president" trump has been a complete dumpster fire, but I do respect this appointment.
4
See a comment above: 'Did everyone miss the point that he was actually part of the Obama administration and the 5th pick of the new "president" to lead this organization? '
3
All the positions could have nominees like this, except trump wants to destroy America
5
Good luck Dr. Shulkin. You are certainly going to need alot of it !
Vn - 67-68
Vn - 67-68
3
Running an agency of this size is tough. Running one that's been mired in mediocrity for 50 years is a nightmare. Dr. Shulkin is an honorable man who really understands what must be done to organize, develop, discipline, and make management accountable.
Congress must streamline most of it's constraints on the agency, and give Shulkin the direct authorization authority to make changes quicker, with widespread "instant" results. There's never been a Director with the power, determination, and most importantly, the determination to make it happen!
Congress must streamline most of it's constraints on the agency, and give Shulkin the direct authorization authority to make changes quicker, with widespread "instant" results. There's never been a Director with the power, determination, and most importantly, the determination to make it happen!
11
Wonderful article. It is so refreshing to read of someone diving headfirst towards public service. Unfortunately this quality seems more rare with every passing year.
I would only add that Dr. Shulkin is not alone: He is just one of thousands of selfless medical professionals who quietly labor day and night on behalf of our veterans. Often they work for much lower financial rewards than they might receive in the private sector. Many, many of those professionals are themselves veterans.
The VA currently faces a severe shortage of health care professionals, much like the rest of our medical system. I hope this article inspires other ambitious physicians and nurses, especially young ones, to join Dr. Shulkin and his colleagues to "care for him who shall have borne the battle."
I would only add that Dr. Shulkin is not alone: He is just one of thousands of selfless medical professionals who quietly labor day and night on behalf of our veterans. Often they work for much lower financial rewards than they might receive in the private sector. Many, many of those professionals are themselves veterans.
The VA currently faces a severe shortage of health care professionals, much like the rest of our medical system. I hope this article inspires other ambitious physicians and nurses, especially young ones, to join Dr. Shulkin and his colleagues to "care for him who shall have borne the battle."
50
Strong work Dr. Shulkin! As a health care provider for 42 years, I have witnessed the success of first hand engagement and a commitment to "figuring it out," because that is what physicians and nurses are trained to do. Individuals' lives depend upon our ability to continuously problem solve and persevere tirelessly.
Highlighted in this article is the "Physician/Nursing Process," that we must employ daily :
1. Assess
2. Plan
3. Implement
4. Evaluate
This process is repeated continuously until the best outcome is at hand. Thank you Dr. Shulkin for staying close to patients, making first-hand observations, and employing the physician/nursing process. You will make a difference.
Highlighted in this article is the "Physician/Nursing Process," that we must employ daily :
1. Assess
2. Plan
3. Implement
4. Evaluate
This process is repeated continuously until the best outcome is at hand. Thank you Dr. Shulkin for staying close to patients, making first-hand observations, and employing the physician/nursing process. You will make a difference.
8
Finally an appointment to be proud of.
13
What a refreshing and encouraging story. Having volunteered with a number of veteran service organizations and represented veterans before the VA over their rights to benefits, I had concluded that the massive, moribund VA bureaucracy could not be reformed. This article offers a faint glimmer of hope that I might be wrong. If Dr Shulkin succeeds where so many before him (you need only read Robert Gates's memoir regarding his enormous frustration with the VA) have failed, he will deserve the nation's highest honor and appreciation.
44
We used to say about the vets: first they fought an army of soldiers and now they fight an army of bureaucrats.
The fundamental premise of the VA Health system is to preserve itself: not to provide healthcare. Services provided by high volume high quality private sector resources should be on a competitive basis available to vets. The absurd arcane complexity of each vets eligibility gives bureaucrats cover to deny care. Each vet should have a essentially a portable " health credit card" with a coefficient of coverage that they can spend wherever they get the best care. If that is in a VA hospital-which it should be for wounds, rehab, pharmacy, long term care, etc-then that is where the vet should go. Its too bad they do not have the type of coverage the Congress has made available to itself.
The fundamental premise of the VA Health system is to preserve itself: not to provide healthcare. Services provided by high volume high quality private sector resources should be on a competitive basis available to vets. The absurd arcane complexity of each vets eligibility gives bureaucrats cover to deny care. Each vet should have a essentially a portable " health credit card" with a coefficient of coverage that they can spend wherever they get the best care. If that is in a VA hospital-which it should be for wounds, rehab, pharmacy, long term care, etc-then that is where the vet should go. Its too bad they do not have the type of coverage the Congress has made available to itself.
21
I agree with Damma. If you want to quickly reform the VA, make every member of Congress get his or her medical care from the VA
6
Let's start with an easy question -- you say "each vet" should have this health credit card. Is that what you mean? All 20 plus million veterans -- regardless of age, income, period or type of service, and whether his/her health condition bears any relationship to that service -- should be accorded free health care (that is, health care paid for by taxes) for life?
And one other quick question to start with -- this care that veterans are going to get under your proposal, what if any role should the government have in monitoring that care, checking the quality of that care, determining the need for that care, coordinating that care with other care received by the veteran?
And one other quick question to start with -- this care that veterans are going to get under your proposal, what if any role should the government have in monitoring that care, checking the quality of that care, determining the need for that care, coordinating that care with other care received by the veteran?
1
"The fundamental premise of the VA Health system is to preserve itself: not to provide healthcare."
I'm confused---how is this different from the private sector?
I'm confused---how is this different from the private sector?
2
At first glance, it appears the DT administration made a very unusual mistake - they have nominated someone of competence and decency. What is the world coming to! G-d bless this man in his endeavors for our true national heroes who served, perhaps despite having a heel spur.
40
Seems like the first Trump appointee that is qualified by experience and training to lead. Let's hope he is able to fix this huge system and provide the necessary care to young and older vets.
15
Please monitor and update this story over the months and years. We can only hope this guy is for real.
30
I was a college classmate of Dr Shulkin, and I can tell you he is absolutely "for real," and his compassion, diligence and intelligence are certainly a stand-out for the Trump administration. Let's keep rooting for David!
79
I knew Shulkin when he was in the Wharton Healthcare Management program in Philadelphia . . . the article is accurate: he's the real deal.
16