Wednesday, January 18, 2017


Ø  This is a Cabinet Level appointment made by the President of the Unites States and subject to confirmation by the U.S. Senate.
Ø  The major responsibilities include administration and management of the Nation’s largest Healthcare System; administration and management of the Veteran’s Benefit System including the G.I Bill; administration and management of the Nation’s largest Cemetery Complex; Liaison with all related Federal Agencies; management of over three hundred and fifty thousand full and part time employees.
Ø  Compensation for this position is commensurate with the individual’s experience starting at a minimum of $450,000.00 per year plus all appropriate benefits and expenses. Included is a generous Pension and Retirement award package.  
Ø  Minimum tenure for this position is four years.
Ø  The successful applicant must have a proven record of accomplishment in dealing with people and solving complex management and business structural problems in a lean business environment.
Ø  The successful candidate will be given preferential consideration for prior business, medical, military, and/or governmental experience at the National level.
Ø  Comprehensive paid relocation to Washington DC is included for the candidate and his/her immediate family. The candidate will also qualify for paid government housing and full consideration for all family transportation needs and obligations while employed in this position.
§  Mission Statement. To fulfill President Lincoln's promise “To care for him who shall have borne the battle, and for his widow, and his orphan” by serving and honoring the men and women who are America's Veterans.
  • There are currently 152 VA Medical Centers and approximately 1400 community-based outpatient clinics in the US.
  • Veterans Integrated Service Networks (VISN) of the U.S. Department of Veterans Affairs is a regional management structure that provides comprehensive inpatient and outpatient health care, limited community living centers and domiciliary care, to eligible veterans of the U.S. Armed Services.
  • With a total 2017 budget of about $163.5 billion, the Department of Veterans Affairs employs over 350,000 people. 
FUN FACTS.............................
1.    Four U.S. cities have gotten new VA Hospitals over the past few years:  Denver, Las Vegas, Orlando, and New Orleans.
2.    The Department of Veterans Affairs has earmarked about $792 million of the fiscal year 2012 budget toward the final stages of completion for the new hospitals. That is less than one half of a percent of the VA’s massive $140 billion budget for 2012.
3.    New Orleans: 1.5 million square foot hospital; 120 inpatient beds and 60 beds for transitional care.
4.    Las Vegas: 1 million square feet on about 150 acres; 201 beds in both inpatient and nursing home/extended care.
5.    Orlando: 1.2 million square feet; 314-bed split between inpatient services, a community living center and a domiciliary; cost = $665 million
6.    Denver: 180-bed; $580.2 million
7.    The next four cities on the VA’s list for new medical center: Seattle, St. Louis, Dallas, and Palo Alto, Calif.
8.    Oddly, no mention of the decrepit squalor that is the VA Medical Center in Northport, NY which has well over 150 acres of available land on which to build a new 1.5 million square foot, 420-bed, state-of-the-art Hospital, before demolishing the original Facility. And, yes, the VA has the money!

If a candidate for this position were to read the recent article -
“the grisly work of va secretaries”, by Jessica L. Adler, for “”/blog, 01/13/17 - he or she would most likely turn tail and run for the hills. It does take a certain type of person to be able to withstand the rigors of a high-profile Federal Government job especially at the Cabinet level. In the case of a large Bureaucracy such as the Department of Veterans Affairs, a firm grasp of large-scale management techniques is essential. The work can become complex at times, but in no way is it “grisly” as this article portrays.

Are there serious problems within the Department of Veterans Affairs? Yes and many problems are a result of misdirection, mismanagement, and neglect over the course of the last fifty years. For too long the Agency’s management has simply considered the “problems” without coming up with concrete, logical solutions. It seems reasonable that, if you are going to complain about something, you should also be willing and able to come up with a workable solution to the problem.

This brings us to Dr. David Shulkin who was the VA Undersecretary for Health in the Obama Administration. He is said to be the person of choice for the Federal Government position listed above. He does not appear to be a political hack/crony. He has experience in how the Department runs, and he appears to have the intestinal fortitude to turn this Agency around from its decades of neglect.

The restructuring and reformation of this Department is not as daunting a task as some, like Jessica Alder, would make it out to be. All the necessary parts already exist within the system. Reinventing the wheel is not necessary, here. A little tweak, a little reorganization, and, voila, you have a fully functioning, lean, efficient Government Agency that will actually live up to its Mission Statement. What a novel idea!


“The grisly work of VA secretaries”
David Shulkin will be expected to play at least three roles if he is confirmed as President-elect Donald Trump’s Secretary of the Department of Veterans Affairs (VA): veterans’ advocate, fiscally responsible bureaucrat, and dependable political appointee.
As Sen. Alan K. Simpson, (R-Wyo.), put it in August 1982, at the height of a scandal surrounding Ronald Reagan’s first VA chief, “It’s the greatest no-win shot I’ve ever seen in Washington.”
In some ways, David Shulkin is an aberration. He is the first non-veteran, and the second doctor, to be tapped to oversee the VA. He also does not fit the mold of a string of Cabinet nominees who, some fear, and others hope, will dismantle their respective departments. But his nomination makes perfect sense given the history and challenges of the agency he has been nominated to lead.    
Before David Shulkin, there was Harry Walters. Two weeks after being nominated by President Ronald Reagan to oversee the Veterans Administration (VA) in November 1982, Walters made his opening remarks to the Senate Committee on Veterans’ Affairs, and raised a thorny issue before anyone else did.
“As you know, I am not a combat veteran.”
Walters knew that some in the room were concerned that he was the first VA Administrator nominee to have served on active duty only during peacetime.
“I will never feel personally the emotions that millions of our combat veterans experienced, nor the pain and anguish they suffer,” he told the committee. But, he added, he had seen the faces and “torn bodies” of his friends, and had come to empathize with the “terrible effects of war.”
Walters, like Shulkin, was nominated at a moment of turmoil – to replace Reagan’s first VA Administrator, Robert Nimmo, who had proven to be, as an assistant to the president told the Los Angeles Times in July 1982, “a nightmare”.
A decorated World War II veteran, Nimmo refused to support studies on the long-term impacts of Agent Orange and publicly wondered whether the chemical’s effects were any worse than a case of “teenage acne”. As he advocated for cutting spending on veterans’ benefits, investigations revealed that he spent thousands of dollars redecorating his VA office and hiring a chauffeur to drive him to and from work.
A remorseless Nimmo told the New York Times in August 1982 that his workspace needed refurbishing because its bright blue furniture and wallpaper were “unsettling”. As for the driver, he was hesitant to park on his own in the garage near his office, because it was “big”, “empty”, and “dark”, he explained. “There is simply no security.”
It hardly helped Nimmo’s case, according to the Times, that the previous head of the VA, Vietnam veteran and triple amputee, Max Cleland, proved perfectly capable of driving himself to and from work every day.
In the wake of Bob Nimmo, Harry Walters’ lack of combat experience was a drop in the bucket, and veterans’ advocates widely supported his nomination.
In fact, Walters’ limited service experience may ultimately have helped during his tenure. As a veteran of neither World War II nor Vietnam, he was less likely to be accused of prioritizing one group over another. He could weigh the concerns of aging veterans, who feared new limits on their entitlement to free medical care, with those of Vietnam veterans who worried that the VA was not doing enough to combat the impacts of Agent Orange and PTSD.
Shulkin, too, is something of an outsider, and his nomination comes on the heels of widespread reports that the VA — especially its healthcare system, which serves aging veterans alongside a new generation — is in need of reform.
Even though advocacy groups are mindful that Shulkin is not a veteran, they generally support his nomination, in part because they recognize that veteran status is one of a bevy of qualifications for a job that is none too easy to fill. Trump said his team interviewed more than 100 candidates before settling on Shulkin.
Many were likely unwilling to take a job that has long been recognized as challenging and thankless. Omar Bradley wrote in his autobiography that he was “devastated” to be tapped by Harry Truman to head the VA in 1945. Frank Hines, who led the agency between the two World Wars, told the New York Times in 1922 that his friends wondered why he would leave a cushy position at a steamship company to take “a devil of a job” in Washington.
Hines, like other VA heads, was selected because of his military, government, managerial, and business expertise, but he had no background in medicine. It was not until George W. Bush’s 2007 nomination of physician James Peake that a doctor was tapped to lead the agency.
During his Senate confirmation hearings, Peake noted that he would seek to “complement” the efforts of his Undersecretary of Health: “With my medical background, I anticipate being able to more quickly make the decisions that he might bring to me since I do not anticipate needing ‘Medicine 101.’"
Shulkin’s selection highlights the centrality of VA health care in the overall benefits system, and a tacit recognition of the complexity of the problems it faces.
As the current VA Undersecretary of Health, he can hit the ground running and, presumably, base recommendations and decisions on professional experience and hard evidence rather than politics or ideology.
He has unique perspective on studies like one produced in 2015 by the RAND Corporation, which examined, among other things, how to combat the problem of long wait times for services. The top three policy options, according to RAND: growing the number of VA physicians, expanding virtual care, and formalizing “full practice authority” for some nurses. “Options with a policy objective of increasing access outside the VA system,” RAND found, “have considerable uncertainty related to potential impact.” Sending veterans to non-VA providers could, for example, bring about new challenges in terms of “care coordination.”
That data calls into question the extent to which Donald Trump’s preferred approach of expanding access to private care would help veterans.
Shulkin, like his predecessors, is faced not only with the burdens of convincing veterans he is fighting in their best interest and showing Congress that he is fiscally responsible, but also with considering policy solutions like those presented by RAND, which could run counter to the political aims of his boss, the president of the United States.
To return to the wise words of Sen. Simpson: “I can’t imagine a grislier task.”
Jessica L. Adler is an Assistant Professor of History and Health Policy & Management at Florida International University. Her book, Burdens of War: Creating the Veterans Health System, will be published by Johns Hopkins University Press this summer.