S.O.S. (Stories of Service) - Ordinary people who do extraordinary work
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S.O.S. (Stories of Service) - Ordinary people who do extraordinary work
Inside the VA: Former Secretary Dr. David Shulkin on Leadership, Politics, and Fighting for Veterans | S.O.S. #262
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The VA is more than a healthcare system—it’s a lifelong promise to veterans, from the day they leave uniform through medical care, benefits decisions, and ultimately a dignified burial. I sat down with former VA Secretary Dr. David J. Shulkin to talk about what it means to lead that mission at scale, often under intense public and political pressure.
We dig into the VA wait time crisis and the leadership decisions required to fix access quickly, including why decisive priorities matter more than endless consensus when delays can cost lives. Dr. Shulkin also shares a defining realization from his tenure: many veterans need highly specialized, integrated care—behavioral health, substance use treatment, rehabilitation, and service-connected injury care—that the private sector isn’t always built to deliver. That’s why he argues against full privatization and instead supports a hybrid model that preserves VA expertise while using community care where it truly benefits veterans.
We also explore the complexity of disability claims and benefits, including how so-called “fraud” can emerge from a system that forces veterans to prove what the government often already knows. We discuss barriers like DD214 access, classified service records, and the need for a unified DoD–VA electronic health record to reduce friction and improve outcomes.
Finally, we cover public accountability, media transparency, leadership stability, and the often-overlooked importance of memorial affairs in honoring veterans. If you care about the future of VA reform, veteran healthcare, or disability policy, listen in—and decide for yourself: should the focus be on strengthening the VA, expanding private-sector care, or building a true hybrid system?
Stories of Service presents guests’ stories and opinions in their own words, reflecting their personal experiences and perspectives. While shared respectfully and authentically, the podcast does not independently verify all statements. Views expressed are those of the guests and do not necessarily reflect the host, producers, government agencies, or podcast affiliates.
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The Stakes Of VA Leadership
SPEAKER_02What's it like to be entrusted with the care of over nine million veterans, hundreds of thousands of employees, and and do health care across more than 1,200 facilities and face some of the most challenging leadership positions and leadership issues. Well, we're going to talk about that today. David, how are you doing?
SPEAKER_01Very good, thanks.
SPEAKER_02And everyone, I am Teresa Carpenter. Welcome to the Stories of Service Podcast, ordinary people who do extraordinary work. And to get this started, as we always do, I'm going to play an intro from my father, Charlie Pickard.
SPEAKER_00From the moment we're born and lock eyes with our parents, we are inspiring others. By showing up as a vessel of service, we not only help others, we help ourselves. Welcome to SOS Stories of Service. Hosted by Teresa Carpenter, hear from ordinary people from all walks of life who have transformed their communities by performing extraordinary work.
SPEAKER_02And I am speaking today with the Honorable Dr. David J. Shulkin, the Ninth Secretary of the U.S. Department of Veteran Affairs. From running some of the nation's top hospital systems to navigating the political crossfire in Washington, D.C., Shulkin brings a rare, unfiltered perspective on leadership, accountability, and what it really takes to serve those who served. And today we're going to be talking about a conversation that's more than just policy. It's about responsibility at the highest level and the decisions that impact lives at scale and why the mission to care for the veterans never end. So welcome again, David.
SPEAKER_01It's great to be here. And it was so nice to hear your dad open up. That was a great way to start.
SPEAKER_02Thank you. He is a or was a professional voiceover artist. And so it was very apt for me to have him as my first interview when I started doing this podcast. And I thought, you know what? I'm just going to have him record an intro for me and play it for every episode. And every time I hear it, I feel like it sort of frames the mood and gives a good feeling going into the show.
From Army Base To Medicine
SPEAKER_02But first off, where were you born and raised? And what inspired you to go down the journey into the healthcare industry?
SPEAKER_01Well, I was born on Army base. My dad was serving in Highland Park, Illinois. He was Army psychiatrist and we lived on base, and it was a good place to sort of start out life. And then we ended up moving to the East Coast where my mother is from. But you know, I think your dad said it well. I I'm just an ordinary person. I wasn't planning to go into public service. I, of course, you know, felt that it was important to for people to give back to the country, but it seemed like because of circumstances, that would be other people, not me. And so I I focused on my career in helping people in communities by running health systems. I'm a physician, but my career really was as a healthcare CEO. And I was there running a hospital in New Jersey and ultimately got a call from President Obama who asked whether I would come and help try to make the VA a better place for our veterans. And I thought, you know, I could say no because I was happy where I was, but that would mean somebody else would have to do it. And so I felt like, why not me? And I felt that really everyone should want to help their country. And so I wanted to go and do that.
SPEAKER_02I'm also going to put you on full screen and I'll sometimes be on half screen, but were you floored by the by the opportunity to even get that offer? Or was that something that you knew about and it had been talked about for and I'm talking about the original one with Obama. I mean, most people don't get tapped on the shoulder to do something like that. So how did you even get into a position where they would even know to ask you or know about your background?
SPEAKER_01Well, one of the things I've always enjoyed doing is meeting new people and being curious about people and expanding my network. And so I was in Washington for a conference, and somebody happened to call me and say, Look, I see that you're attending the conference. Do you want to have lunch? And so we had lunch. It was a very pleasant professional lunch where he talked about his career. I talked about my career and some of the common things. And I remember the very last question that he asked me is, he said, Well, you've had an extraordinary career, but do you have any regrets? And it was at the time that the wait time crisis was happening in the Department of Veteran Affairs. And I was reading about it in all of the newspapers and seeing it on TV. And it was a time when the Iraq and Afghanistan, Afghanistan veterans were coming back with horrible injuries, mostly from IED explosions. And our Vietnam veterans were turning on average age 75, requiring a lot more health care because of their age. And the VA was overwhelmed, and it turned into a national crisis that resulted in the resignation of the secretary at the time. And when he asked me that question, my response was, look, yeah, I feel like I've done lots of great things in my career, but I feel terrible watching this crisis happen to our veterans. And I just wish that there was something that I could do to help. And he said, Yeah, I understand that. And about two hours later, my cell phone rang and it was the White House.
SPEAKER_03Wow.
SPEAKER_01And they said, We'd like to talk to you about helping at the VA. And so it turned out that this was one of those people that when the White House is looking for the right people, they send out messages to people across the country that are well connected and say, look, you know, we're looking for somebody who can help us. And if you find the right
The Call From The White House
SPEAKER_01person, let us know. And he was one of those people. And he had called the White House right after our launch and said, I think I found somebody you should talk to. And that resulted in a conversation with the White House. I then had to go through about 11 months' worth of vetting at the time that these positions were well vetted, and you know, from FBI interviews through all sorts of financial records and everything else. And then ultimately, once I cleared that, then the president was able to call me and talk to me about whether I wanted to take this position.
SPEAKER_02And that was your first position within the VA. That was for the Veterans Health Administration. Is that correct?
SPEAKER_01That's correct. The President Obama appointed me as what's called the Under-Secretary of Health, which is essentially the CEO of the health system running all of the health system affairs across the country. And then after uh President Obama left office, that's when President Trump asked me to be the secretary, which runs not only the health system, but also the benefits and the memorial affairs or the cemeteries across the country as well.
SPEAKER_02Does it also include education?
SPEAKER_01It does. That's part of benefits.
SPEAKER_02Okay, benefits. Okay. Yep.
SPEAKER_01Yeah. The benefits program that most people know because it impacted all of America were really two programs. First, the home loan program.
SPEAKER_02Yep, home loan. Yeah.
SPEAKER_01Right. And that allowed so many Americans, particularly after World War II, to be able to go out and to get their own homes. And it actually really was the accelerator for the suburbs in many parts of the country. And then, of course, the GI uh bill or the educational benefits brought many people that may never have gone to college or higher education to be able to allow them to have an education. And now today, under the new GI Bill, they can pass those benefits along to their children if they want.
SPEAKER_02It's an outstanding benefit. I mean, I'm using my GI Bill now, and it's it's incredible that those benefits exist. And I know all the people who worked so hard to put the benefits in place that us GWAT veterans have today was nice, but was by no means easy. And I think that it was so enjoyable reading your book and hearing the the process too from going from the department from being with the the healthcare side of the VA to then being the VA secretary and just your story about how you actually got the job and the interview with Trump and just the behind the scenes of what it really took to get you into that position. And I think that a lot of people don't really understand how hard this is, and especially because you were coming in there while they were having the crisis with the wait times. And one of the things that stood out to me that you did when you first took over as VA secretary is you you held a stand down. And a lot of people said, no, you can't do that. You can't get that done in a month. I think you said you wanted to do it in about two months, and people told you you couldn't, and and you had to push past a lot of that, didn't you?
SPEAKER_01Yeah, look, I was in many ways given gift in that when I entered the government, I knew what the most important issue was, and that was addressing this wait time issue when people are waiting for care and their life could be impacted, really a life and death situation if they can't get the right care. That to me was something that you can't wait on. And so that was my burdening platform. And I made everybody understand that until we got that wait time issue fixed and I could be assured that there weren't veterans that were being harmed by waiting for care, that I wasn't gonna take any excuses. I wasn't gonna accept any delays. And so I just pushed very, very hard. And it was not a democratic process, it wasn't a committee decision, it wasn't consensus. It was there is a mandate, and we're gonna get this done until we could assure that no veterans were waiting for care anywhere in the country. And
Crushing The VA Wait Time Crisis
SPEAKER_01I was able to assure President Obama of that before he left office in in early 2017.
SPEAKER_02Now that's outstanding. And there was a lot of innovations that you did, even when you first initially got there. And I think I made some notes about them. Like you established shark tanks, you look took a real hard look at some of the hiring practices uh for the VA that I think were were rather lengthy, and you weren't able to get some of the good people that you wanted to get in there right away. What was it like to sort of push through some of that ingrained resistance in government? Did you find, at least initially, and we'll get into the political stuff later, but just initially within the VA and within the career VA employees, did you find that it was hard to come in and and and make change?
SPEAKER_01I I really didn't, but it took me a while to understand how the VA worked. And the way that I would describe it is that if you have a leader who is willing to take the political risk and explain why they are pushing in a certain direction or asking the workforce to respond in a direction, but saying, look, I understand this is different, and I'm gonna take all the risk personally. If this doesn't go well, I understand. I probably will get fired for it. But but I'm asking you to do these things because they are the right things to do. The VA workforce was very responsive and actually very appreciative that somebody was out there saying, This is our priority, this is what we're gonna do, and this is why we're gonna do it. And so interestingly, many of the things that I thought would be harder in government than when I ran hospitals in the private sector were actually easier to do. And many of the things that I thought would be easy to do in government were harder to do. And so I used to describe this as a Seinfeld episode where George, nothing in his life was going well. So whenever he decided he was going to say yes to something, he would instead say no. And if he was gonna say no to something, he would instead say yes. It was called the opposite day episode. And as soon as he did that, everything in his life started working and making sense. And in some ways, the experience for me in government was like that. The things that I had relied upon, my natural instincts as a private hospital CEO weren't working for me. But the things that that I tried that I would have never done in the private sector worked really well in government. And so, you know, once you found that sort of lane of how to get things done, you could get a lot done. You just you just needed to be bold and be willing to put yourself at risk. And, you know, for me as a political appointee, I never planned on this as a lifelong career. This wasn't a, you know, I went for one reason, and that was to fix the system and to make the system work for veterans. The only way I was going to do that was to impact change and to make big changes in some cases. And I knew if that meant that ultimately I would end up leaving, I said, that's okay. I'll go back to the private sector and do what I was doing before, but at least I know I didn't leave anything on the field.
SPEAKER_02Well, there were so many things about your book that stood out to me. Number one, you were bipartisan. I mean, by far, you had the respect of the Trump administration and you had the respect of the Obama administration. I mean, people knew that you were a straight shooter and you'd see things down the middle. People also knew that you were willing to take risks. You weren't going to be that kind of leader that said, oh, I'm only here for two years and I'm only going to do what's going to let me make it to the next level. That really wasn't what you were about. And one of the big issues that you took on that sadly, I think, led to you being let go just because of the political issue was the privatization of the VA. And I thought this was a really interesting issue because we do have privatization now with the VA in terms of community care. And I liked your approach about the hybrid model, but I did have
How Change Actually Happens Inside VA
SPEAKER_02some questions about for people who are on one side or the other. If you were to completely privatize the VA and dismantle this entire infrastructure and send everybody out to the community, can you tell us a little bit about what the detrimental effects of that would be? Because I think that's what the the kind of the rub was is that they wanted to really privatize and put it all into the corporate sector. And then you were sort of in a you wanted a hybrid approach where it would be a decision between the physician and the veteran about community care. And so I'm curious from your perspective, and you kind of touched upon it in the book, but I didn't get that full kind of grasp of that understanding of the issue of what's the what is the harm for a veteran to completely rely, let's say, on community care versus not going through the VA.
SPEAKER_01Yeah, yeah. Well, you know, you said you said a lot of things, and I do want to directly answer your question, which I will, but I do want to highlight something before I do that about managing or, you know, running the Department of Veteran Affairs, not as a Democrat or not as a Republican, but really just focusing on the issues. And the whole time I was in Washington, nobody knew if I was a Democrat or Republican because I didn't think that was relevant. I wanted to do what I thought was right for veterans, regardless of politics. And that's why I was confirmed twice by the U.S. Senate 100 to zero. And people would say to me, we don't know if you're a Republican or a Democrat. And that's a perfect way to be. Yes, exactly. So, but in Washington, even though it sounds good, it's very hard to manage or to run an agency from the middle, because today in Washington, everything is run from the spectrum of a, you know, you're either far right or you're far right. From the extremes.
SPEAKER_02And that's unfortunately baked into our election system. And that's a whole nother conversation, but that is the unfortunate part about it.
SPEAKER_01That is true. But the reason why I don't think many people understand why it's hard to be in the center is because you really truly have no friends. If you if you are in the center, the people on the far right and the far left say, I never know if I can count on this person because they're not always going to vote with me. They're not always going to agree with me, because sometimes they agree with the other side on something else. So so so, in some ways, it it's actually limiting to be a center person. But for me, I tried to be principle-based and I tried to make the decisions that I thought were the right things for veterans from the center. But you don't have a lot of friends when you do that. Now, going to your question about privatization, you know, you had asked me before about how I got into this, and I had said, well, look, there was a wait time crisis, and I thought it was terrible that our veterans weren't able to get access to care that we were making our veterans wait. I was running a hospital in New Jersey that was rated the number one hospital in New Jersey. And we we were very, very responsive to our patients. So I sat there thinking, well, when I get to the VA, I might find the system is so broken that I might say to the president, you can't fix this system. Let's just send everybody to the private sector, the system that I knew, the hospitals like the ones that I ran, and let's just give them vouchers and pay for it. And that would be the right answer. I I truly went in with that type of mindset. I might find that. When I got to the VA, one of the first things I did, because I've always done this as a CEO of a hospital, I would put on my white coat and my stethoscope and I'd go and see patients. Because to me, you know, you can sit in an office all day long and people are going to tell you what you want to hear. Yep. But the real way that you get to know if your hospital's working is by going in to where patients are treated and actually treating the patients and saying, does the lab system work? You know, can I get all the supplies I need? What are the staff like? You know, are there are the rooms clean? So so I did that. I went to my see my very first veteran at the Manhattan VA in New York City. And he turned out to be a 69-year-old African-American Vietnam veteran who was a bilateral amputee in a wheelchair. But that wasn't the worst of his problems. He was essentially a paranoid schizophrenic and a drug addict. He was very high on drugs and was drinking that night. And he was a challenging first patient, I will tell you. He spent most of the time yelling and cursing at me. And if it wasn't for my nurse assistant who helped me through that exam that day, because I didn't know how things worked in the VA, I don't think I would have made it through that. But when we finally got the veteran out of the exam room on his way to where he needed to go, I said to my nurse assistant, thank you so much for helping me. I have to tell you, I've been a doctor a long time. And if this were a doctor that if this were a patient that I was seeing in the last place I practiced, I would have called security. I would have had them forcibly removed from my office, and I would have sent him a registered letter saying, you can't come back to see me. And I give them three names of other doctors I don't particularly like. It goes through. No, I mean, I was being honest. And she said to me, she said to me right there, but these are our patients. This is who we treat. And if we don't treat them, who's going to? And we know how to. We have the system who can care for them. We got this veteran into substance abuse treatment therapy. We got him the type of care that he needed. And I realized right there that if we just closed the VA down and sent patients like this into the private sector and paid for them, they would never get the care they need. Because the private system, you know, I was seeing. Patients in the private system every 15 minutes, and I wouldn't have had the time or the knowledge or the people to refer to. So I realized that the VA was not only providing a level of extraordinary care, but it was providing a level of care that the private sector probably never could. And so if we really are committed to our veterans and to having a voluntary military system, we needed to honor that commitment to have a strong VA. Now, the reason I turned out to be for the hybrid model that you talked about is because I also knew in the wait time crisis, VA couldn't do it alone. It was just overwhelmed. So the hybrid model for me was a system where the VA focuses on those things that veterans really need help for: prosthetics and orthotics, rehabilitation care, behavioral health care, toxic exposures to you know war, you know, conditions that the private sector just doesn't have the knowledge, expertise, or capacity in, but that the VA didn't need to replicate every service in the world, quite frankly, that sometimes the private sector does better and has more capacity in. And so creating a system that used both the best of what VA can be and is, and a system that allows the VA to access the very best in the private sector, I felt was the right answer for veterans and what would serve veterans best. And I published that thesis in the New England Journal of Medicine. I would speak about it publicly. I let people know that I thought that was the right answer. And that's where I put my efforts trying to build that system.
SPEAKER_02Yeah. And I think it was unfortunate that there were others who who disagreed and and made their made their opinions known in such a way that I think really made it hard for you to do your job. And I think that's unfortunate. And I and I've thought about that issue too, the political appointees issues, not anybody in particular, but that system of where you've got these people, this group of people who have now given up their jobs to follow the camp, you know, the prospective president around and do all these things for the campaign. And so of course the president's going to think, well, I I have to give them a job.
Why Full Privatization Breaks Care
SPEAKER_02I have to pay them back. I mean, they've given up their lives for me. I owe them something now. So I'm going to give them a quote unquote job. And so one of the things I'm curious about from your perspective is how how how going forward do we fix that? Because I can under I understood both sides when the in the book, when when Trump said something along the lines of, well, if I don't have them in the office, they're just going to be a bigger problem on the outside. And I know what he means by that. In other words, if if you don't do something to pay them back or to give them or to reward them for their efforts, there it's just going to be a bigger problem politically on the outside. And so it's like, but but at the same time, these are people who don't have healthcare expertise, they don't understand the VA. So I'm really curious, since you've been through this, like what from a legislative standpoint, maybe, or a policy standpoint, what what could future leaders do to negate this conflict in some way?
SPEAKER_01Yeah. And and I just want people to understand what it is that you're talking about. When a president wins an election, there are a large number of people that helped get that president there, and they're generally paid back by finding jobs in the administration. They're called political appointees. There are 4,500 of them throughout the U.S. government. So it's not a small number, but this isn't a President Trump issue. This is half this is This is a government issue.
SPEAKER_02That's why I asked you from a government standpoint.
SPEAKER_01It doesn't matter whether you're Republicans, both sides of the aisle.
SPEAKER_02Yep. So I was really curious what you think. How do we fix this?
SPEAKER_01Right, right. So look, I think that there are a couple things. One is is that I probably think that there are too many political appointees. You know, number one. Number two is is that in reflection upon how any organization works well, whether it is a private company, whether it is a public, publicly traded stock company, or whether it's a government agency, the leader needs to have people around them that are both competent but are also trustworthy. And I think even President Trump recognized that in the way that he formed his cabinet in his first administration and his second administration. I think he felt that he didn't have all of the people around him in the first administration that he knew were politically loyal to him. So he made sure in his second cabinet that he was going to have that. And frankly, I understood that. You know, I always I always feel that a leader deserves to have the people that are on, you know, that he can trust. He can trust. He can trust and he can get things done because Washington is a tough place under any circumstances. And if you have to watch your back with your people right all around.
SPEAKER_03Yeah, you're not gonna be able to get it done. No.
SPEAKER_01So so so my advice to people that I talk to who go into government, and I've spoken to many people that have taken cabinet positions, you know, since since I left government. I say to them, look, it's really important in your selection of your political appointees to make sure that these are people that you want on your team and that are gonna work well with you, that you can trust and that are competent. And in retrospect, I probably didn't do that well enough. You know, I I was given a slate of political appointees, and I said, look, I like working with people. I'm gonna make this work. I'm generally good at building a team, and I'm gonna deal the card deal with the cards that were dealt with me. Sure. In retrospect, I wish that I had been much more selective in picking that group of initial political appointees. I think think things would have gone smoother. And I watched some secretaries actually do that and turn back political appointees that were assigned. I was I was anxious to get on and do the work. And in many ways, that that I think was was was a limiting factor in many of the things I did. Because while the people that you're talking about that were challenging for me and actually worked against my agenda, I'm not going to paint them as you know good or bad people, but they were much more political ideologues. They believed government should run a certain way, and they didn't have the experience in ever having run a large healthcare organization or a large agency of any type. And so they knew what they knew and they knew what they wanted to do, but I didn't feel like it was the most thoughtful way to get to the best result. So we ended up, you know, seeing things differently. And and and it's hard to run a big agency if you don't have those key people around you wanting to see you succeed.
SPEAKER_02Right. And and and and being on the same page with the things that you find important. I I mean, if someone else thinks all these other things are more important than the things that you think are important, there there comes a point where you're you're sort of at an impasse because they're gonna see it the way they want to see it. But what's interesting about this, David, is that to this day, the VA is still strong and intact. And we still, you know, I use the Biloxi VA services here, and the majority of my care I go to the VA. Very few things I use community care for. So I it has stood the the test of time. And and to that point, I want to switch gears from the VA administration to then the veterans themselves. So one of the biggest topics in the VA, I mean the veteran community that we hear about over and over again, doesn't matter which administration it's in, is this issue with fraud. And I want to address it from two aspects. I want to address it from the aspects of the claims agents and the people that are commercialized to do claims, and whether or not the if we think the things with claim sharks are overblown, and then the things with the veterans themselves, are veterans really scamming the system, in your opinion and just so everybody's clear, we've made a switch from talking about healthcare to now talking about veterans' benefits and disability payments.
SPEAKER_01And you know, the way that I look at this is that the veteran, when they get out of the military and come to the VA
Political Appointees And Trust Problems
SPEAKER_01and try to get a service rating for a disability, enter a system that is extraordinarily complex and stacked against the veteran. And what they learn is, and what many people that are there to help them get through that system is, is that you have to know the ways to work in a very complex Byzantine system, and you have to know the rules of the game to get to the other end, and that results in many, many decisions that can easily appear like that they're inappropriate or that they're fraudulent, but it's really a person who's trying to work through a system that is almost impossible to get through in a straightforward manner. I felt as secretary that this system needed to be completely revised. It was a system that worked against the veteran, where the veteran always had to prove their own disability. They had to prove that they served, they had to prove where they served. And it was a constant denial process until you could essentially prove it or get it overturned. And I felt like the system was backwards. That when a person gets out, they should be given essentially a benefit of a doubt that they're telling the truth, and they should be given an appropriate rating that they can feel certain about, and that if it turns out that that isn't the case, that then those benefits can be narrowed down or even withdrawn. But if you simply gave the veteran a disability rating when they first left service, it would solve a lot of problems. And the way that you give those ratings doesn't need to be nearly as complex as it is. But every VA secretary that I've talked to, and I've talked to all the ones that are still living, felt the same way that this was a system that needed to be revised and wasn't working and overly complex, but that the political implications of taking that on were so intense that none of them felt that they could accomplish it. And I was willing to take on those political consequences. I don't know if I would have gotten to the finish line, but I didn't have a long enough term of secretary to get that done.
SPEAKER_02Yeah. I mean, I think it's unfortunate because it should be something that you can navigate without the help of a VSO. And it should be something that I believe starts while you're still on active duty. I know we we do have the benefits delivery at discharge, and that's that's very helpful. But I feel like it's something that we should be educated on throughout our careers, which we're not. It wasn't until I was coming up on my TAPS class that I realized that this was something I was gonna need to be ready for and that I was gonna need to have records of, and I was gonna need to start seeing doctors for because there was a lot of things that I was cut, quite frankly, a lot of things that I just didn't want to go to medical for while I was on active duty because I was afraid it would disqualify me for deployment or it would it would just cause an unnecessary hurdle while I was just working and trying to do my job. So uh and I think a lot of veterans do that. I I think a lot of people think that they can't go see medical for certain reasons, and then it all stacks up at the end, and then they realize that they didn't get the documentation that they needed. So it does need to be streamlined, and I I really hope to see that happen. There is a lot of different differing opinions on it. There's a a lot of people who who feel it's it's being gamed, or maybe some who don't, who aren't very popular with the veteran community who have said that, one in particular who I had on my show. But I I think that the answer does lie in what you said in the book about using incentives and giving veterans options for certain types of uh ways to receive their disability compensation. Like you said, the lump sum, I think is one of the ones that you put in the book. So there could be ways to look at this.
SPEAKER_01Right. I I had started this process. I had sought help from some of the best business schools and professionals in the private disability insurance industry and gone and sought consultation and advice and developing a new model that would both simplify but give veterans more surety about the benefits. You know, the whole process, what people who haven't served in the military know when you leave active service, you are given your authoritative record of service called the DD 214. And when you go and you apply for benefits, the question is, well, did you serve in the military? Well, show me your DD 214. If you don't have that, you stop. And until you can prove where you are and prove what locations, you know, the the people that used to come to me and I would just shake my head is they would say, look, I was I was injured in in a very specific part of the country, but it was under a secret mission, so it's classified, and I can't get the documentation because it's classified where I was. And so therefore, I can't get my benefits. And you know, the fact that the veteran has to be the one who proves it when the military sent you there, and it was the same with electronic medical records. The fact that the VA had no idea what medicines the active duty soldiers were on when they left and they became patients in the VA didn't make any sense to me that we didn't have the ability to be able to share information. And we always put that burden back on the veteran. And so those were things that I wanted to fix.
SPEAKER_02Yeah, it blows my mind that there isn't just one database between, like right now, we're using Genesis for TRICARE and then VA. I I but I mean, I read about it in your book. There is an electronic system, medical system for the VA. But when I moved my care from which I'm in the process of doing now because I realized that the copies definitely stack up on Tri-Care. So I'm moving a lot of things over to Tri-Care over to the VA. And it's
Disability Claims Complexity And Fraud Fears
SPEAKER_02interesting because the VA has records of some things like blood work or or some other things from my act from my TRICARE record or my you know Genesis record, but then doesn't have records of other things. And in my mind, it's like, why aren't they all on the same contract? Why isn't the the VA and the and the Department of War saying, or the DH Defense Health Agency, why aren't they partnering on a single source contractor who would run the medical records for both the for both the active duty side and for the VA? Do you think that's possible?
SPEAKER_01Well, that's the exact decision that I made. I made that decision when I was secretary that we would be moving to a single system, a single instance of an electronic medical record. So this nonsense would go away. And that is a decision that is still being implemented now. There will be it will it will take a long time to get it completely rolled out in the VA, but this year there will be 13 VAs that will convert to that system, and then next year, hopefully a lot more. And this will roll out throughout the country.
SPEAKER_02No, I think that's that's excellent because a lot of people want to be able to seamlessly move through TRICAR and through the VA. And it's very, very difficult to be on both systems and then trying to navigate which one you should be on. I don't even want to think about what's going to happen when we turn 65 and then have to deal with deal with Tri-Care for Life and Medicare at the same time, but I'm not there yet. But it can be it can be a lot for for people to to navigate. And I think it's great that those things, because that's one of the things that you worked very hard to do while you were the secretary was get the IT infrastructure in place and to see that pass must have been, must have, must have been very satisfying for you and the team that you had at the time.
SPEAKER_01Yeah, I but you know, I knew I knew getting the decision to do it and the budget to do it was important, but that was the easy part. The hard part is actually implementing a system that complex. And again, you know, I wanted to be there to help guide the system through that because I had done electronic health record transitions in two private hospitals that I ran. But but you know, unfortunately, I had to pass that on, and that has been turned out to be a pretty challenging task for my successors.
SPEAKER_02Sure. No, no, I agree. It is definitely a challenging uh situation to be in when there are there's just so many different structures at play uh when these things happen. Another piece about your book that that really stood out to me is the fact that as a communications person who has done public affairs for most of my naval career, you were very responsive when it came to the media and to correcting misinformation and really working to ensure that the story of you and your team was the correct story. I'm curious what where did that come from? Because that's pretty unheard of. Most of the time when somebody is let go, they just go away quietly and we never find out what really happened. But what you did, and and I really admire you for it, is you you stood up not only for yourself, but for your team, and you said what happened, you dispelled the rumors about the travel, which you were cleared of, and and and those things. And you didn't have to do all that. There's so many people that just get let go who just go into oblivion and they stay quiet. And I'm just curious, where where did that come from for you? Because it was it was very admirable.
SPEAKER_01I looked at my relationship with the media in in several different ways. The first was was that I felt, and I don't know where this came from, it's just a belief that I've held, and I believe is the right thing, that when you are running a public agency and you're using taxpayer dollars and you're representing people because it's a government agency, you have an obligation to be responsive to the press. And as you can see, not everybody adheres to that. There are some people who never give pre press conferences, there are others who don't respond to press inquiries. And maybe that's the smart thing to do, quite frankly, in Washington, you know, just stay under the radar screen. But I felt even when it was uncomfortable, it was my duty to respond to things, whether they were true or untrue. And it was also my duty to tell people not only when we did good things in the VA, but when things were going bad, because I needed to tell people what the problems were so they knew why I was focusing my time and asking for resources to fix them. And a lot of people would just shake their heads and say, we don't understand why you would ever tell the press something bad about the organization. And to me, it was just the only way I knew how to operate. Now, when I was five. People said to me, Look, here's what happens in Washington. When you're fired, you go away and you go away quietly. And I said, I understand that, but I never signed up for that. I only came to Washington for one reason, and that was to make the VA a more effective and impactful place for veterans. And if I go away quietly and I don't tell people why I think it's important that we have a strong VA when there are all these people pushing to privatize it, if I don't tell them why this is important for the country, and if I don't tell them what are the things that I was working on to fix it, to make it a better system, then I'm not adhering to the reason I went there in the first place. So when I left in my official capacity, I didn't stop. And by the way, I haven't stopped yet.
SPEAKER_03No, you haven't.
SPEAKER_01I will continue, I will continue for the rest of my life to advocate for the right things to do for veterans, for the right things to do for the VA, for the right things to do for taxpayers, to be able to continue to seek that type of improvement. And I've maintained good relationships with, you know, the secretaries and other people in the VA because I think they understand that when I speak out, they may not always agree with me. And by the way, I'm not always right, but I'm not doing it from a political point of view. I'm doing it because I believe it is in the best interest of veterans.
SPEAKER_02No, I mean, it was very clear, even the couple interviews I I watched to prepare for this show. I mean, Trump really liked you. I think it was hard for him to let you go. And I and I really appreciated the story that you shared. I
One Medical Record From DoD To VA
SPEAKER_02think his name was John Kelly, the chief of staff. And just the the way that he went out on a limb and and really it really hit a lot of people when when when they let you go, because I could tell that people understood that you were this down the middle centrist person who was just trying to make the VA better. And it was just it's just so hard, sadly, in our in our political system to get certain things done because we've we've sadly let these extremes get in the way of just good people getting good work done. And I think one of the things that you mentioned in another show that I was listening to, a colleague of mine, Danny Lee, was the fact that a secretary might be more effective if they don't have to be limited themselves to one term. So can you speak a little bit more about that?
SPEAKER_01Well, interestingly, Congress had put together a group called the Commission on Care. Back in 2016, Congress paid $78 million, I think, to be able to have this commission done.
unknownWow.
SPEAKER_01Where it took over a year to come up with, I believe, 16 recommendations about how to make the VA a more effective place. One of those recommendations was that the undersecretary, the position I held that at the time in the Obama administration, should not be a political appointee. It should be a 10-year term with a board that it reports to to oversee what's in the best interests of the VA healthcare system. That recommendation was rejected outright by the Obama team. And I was a strong believer it was the right thing to do. But, you know, I'm not gonna argue with the president or the president's team. That's you know, that was really their decision to make. But I felt that that would have been the better thing to do for making a better system that was free of politics. And you know, so that's really the last time that this has come up at a national level. But as you've said in my book, and what I continue to advocate for is that I think that the continual, you know, changing of the leadership at VA every two or three years, the under-secretary or the secretary, you know, changes over, it's a startover period.
SPEAKER_03Sure.
SPEAKER_01And if the administration changes as the result of an election, it's a startover period. And you know, healthcare systems need stability, they don't need to be in the midst of political fluxes, and so I do believe that that is a change that would be beneficial to do, but in a political environment, I think unlikely to occur.
SPEAKER_02Yeah, definitely. What do you think about the way the VA is being run right now? Like what are you seeing when you look at when you look at some of the initiatives that the current administration is doing, the Trump 2.0 for the VA, what are what are some of your overall thoughts on on how things are going?
SPEAKER_01I like to call balls and strikes. I think it was a pretty rough start to the administration. They started with these doge efforts where it was announced that there were gonna be 80,000 VA employees let go.
Media Accountability And VA Stability
SPEAKER_01And that resulted in a lot of really good people looking and leaving the VA, finding jobs in the private sector. It also resulted in people with experience saying, I'm gonna take my package now, my retirement package, and leaving. And so I think that those first couple months were really, really tough times. The morale was low, and I was very concerned about VA. But I think that now that there's you know 15 months under the belt of the administration, they've gotten a undersecretary confirmed at the end of December, and they now understand that this is an organization that needs this stability, and they've begun to start making, I believe, some really good decisions in investing back in the VA to build 18 new facilities where where veterans are currently underserved, where they're investing dollars back into the infrastructure to build up the VAs that need those types of investments. They're continuing to roll out even more aggressively the electronic health record system. They're looking at new ways of doing things from a technology point of view and investing in AI and other types of things that are important. So there are many things that are encouraging in terms of where I think that they're headed and in terms of where they're focused at this point. And of course, my desire is to see them continue to be successful.
SPEAKER_02Post VA, what what has been some of the highlights of for you professionally since this point? And how is has working, how did working at the VA shape what you're doing today?
SPEAKER_01Well, you know, I thought that when I went into VA, that I was at the top of my game in running hospitals in the private sector, and I was going to go in and I was gonna show government how a good health system was run, and I was gonna use private sector efficiency to fix the system. And in fact, it turned out to be exactly the opposite. I saw models of care in the VA that I firmly believe are more effective and better than what the private sector can offer right now. And so I spend my time really talking to my colleagues in the private sector, like I used to be, about the tremendous things that I saw at VA and what they can learn from the VA that they should be doing back in their hospitals. And at the same time, I continue to let people know why it's important that we have a strong VA system so that the public continues to support, you know, this type of system that I think is unique in our country, but an essential part of our national security system.
SPEAKER_02Yeah, that's a great question. When you went around to all the allies, did they have anything similar to what we have with the VA?
SPEAKER_01None of them have it.
SPEAKER_02Interesting.
SPEAKER_01They they, if you go to the United Kingdom, they have some what they have some old age homes, you know, called soldiers' homes, where you know, people at the end of their life who are veterans are given a place to live, but they have no medical system or no benefit system in the way that we do. Right. And so, so it it's very different. And the allies say that they struggle to develop specialized programs. In, you know, in the case of the United Kingdom again, in their national health system, it's very hard to develop that type of expertise.
SPEAKER_02Yeah. I mean, I I served at a NATO one of my last jobs before I got out over in London. And they marveled at the preparation and the care and the offer and the things that that we get in terms of our pension, in terms of, like you say, the benefits. Before we close out, we didn't even talk about mortuary affairs. I just have one quick question about that. And that is well, what were some of the things that you did to work on on that end? Because that that's kind of the part of the VA that nobody really talks about or understands or knows. Everyone knows the benefit side, everybody wants to talk about the disability side, but people don't really talk about the mortuary affairs side too much. And I wanted to touch on that.
SPEAKER_01And just so everyone understands, this is a commitment that the country has that when you leave the military, they're going to take care of you with benefits and health care, but take care of you all the way through the end of your life. That means putting you, supporting you in
Memorial Affairs And A Dignified End
SPEAKER_01in, you know, in your in the senior years, if you did need to have care in what many people call nursing homes. They're called community living centers in the VA. But that commitment goes all the way through a dignified burial and then perpetual care of your gravesite so that your family never has to worry about that. And the dignity in which a veteran is buried, the respect that they're given during that time and that the family is given is extraordinary. And the Department of Memorial Affairs, which is what it's called, rates the highest level of satisfaction among veterans and their families of any part of VA by far. The the gratitude that people feel and the comfort that they feel that they know that they're going to be dealt with that way, and their families are going to be dealt with that way, is is remarkable. And it's a really important part of the mission of VA and something that I think is done just extraordinarily well.
SPEAKER_02Love it. Love it. All right. Well, as we're wrapping up the call, was there anything else that I didn't ask you about that you'd like to say to our audience?
SPEAKER_01I don't think so. I appreciate the opportunity to talk with you.
SPEAKER_02I appreciate the fact that you agreed to come on and have this discussion. I'm really honored to have you on. I'll just meet you backstage briefly to say goodbye. But thank you so much for taking the time to come on the Story as a Service podcast. If people want to know more about you or they want to check out your work, uh, where can they go?
SPEAKER_01Well, you know, you mentioned my book a bunch of times. It's called It Shouldn't Be This Hurt Hard to Serve Your Country. And they can learn more about that story. But people can reach me on LinkedIn or I have a website, dr shulkkin.com.
SPEAKER_02Okay.
SPEAKER_01Or shulkinsolutions.com also. Yeah.
SPEAKER_02I just put it on the on the screen right there. All right. Well, thank you so much, Dr. Shulkin. I appreciate your time. Appreciate you coming on the Stories of Service podcast. I will go full screen and then meet you backstage. All right, guys. Thank you so much for taking the time to come on the stories of service podcast. I think I went black screen for a moment, but I know you can all still hear me. I'll be back at it this Monday. I'm going to be hosting a former acting Navy uh secretary Thomas Modley, and who also has another amazing book that I'm in the process of finishing up. So as I always end these calls, please take care of yourselves and please take care of each other and enjoy the rest of your evening. Bye bye now.