'The VA Is On A Path Toward Recovery,' Secretary Of Veterans Affairs Says

Mar 30, 2017
Originally published on March 30, 2017 8:29 am

Secretary of Veterans Affairs David Shulkin says the Department of Veterans Affairs "is on a path toward recovery."

"We have a clear mandate to do better, [and] to make sure that we're honoring our mission to serve our veterans," Shulkin told NPR's Morning Edition.

Sen. John McCain, R-Ariz., and Sen. Jon Tester, D-Mont., are asking the Senate to approve an extension of the Veterans Choice and Accountability Act. The bill, passed in 2014, provided billions of dollars to the VA and was supposed to help veterans get medical care more quickly.

Three years later, VA hospitals are still struggling to add staff, and many veterans still face long wait times to see a doctor, as NPR has reported.

Shulkin discussed his current priorities for the Department of Veterans Affairs, including how the money from the Veterans Choice program has been spent, and his approach to the persistently high rate of suicide among military veterans, with NPR's Rachel Martin. The interview has been edited for length and clarity.


Interview Highlights

On renewing the 2014 Veterans Choice and Accountability Act

[Veterans] Choice was authorized for three years, and ... the end for that is this August. If that program expires and we don't get a reauthorization, or the ability to continue that program, veterans are going to be back waiting for care, and we're going to find ourselves exactly where we were. So we're working hard with our colleagues in Congress to make sure that we do get this bill extended.

On filling 45,000 vacancies in the Department of Veterans Affairs

Well, we have about 360,000 employees in the VA health care system. It's the largest health care system in the country, and we have many job openings. This is actually something you see across America, particularly in rural America, where there's a shortage of health care professionals.

We're out actively trying to recruit many health care professionals ... and the negative attention that's been put on VA has hurt the morale of our work force. So what we're trying to do is get people to understand that when they come to work at VA, this is really a terrific place to work. It's filled with dedicated professionals, we're doing great work every day, it's a way to serve your country and we want people to come join us.

On NPR's previous finding that money was not given to VA hospitals with the longest wait times

Well, we're talking about now something back almost three years ago. And when Congress authorized this [Veterans Choice] program, it was done with urgency. They asked the VA to get an entire national program up in 90 days. That's really never asked ever of any agency or any private company ever before. The VA had to make a lot of decisions really quickly. It went out to the field, and it said who thinks they can go and hire health care professionals? Who is able to use this money quickly?

I think many good decisions were made, but it wasn't done in the same way as if we would have had a year to implement this. So we ended up making some adjustments. In the end, I think that we ended up hiring where the wait times were the longest, but it wasn't done in the most thoughtful way because of the time that we had to stand this program up.

On the high rate of suicide among military veterans

There is no doubt that suicide is my number one clinical priority. I work on this, I think about this every day. ... I can tell you that nobody is doing more for behavioral health care in this country than the VA. We have extremely comprehensive systems. I have one thousand professionals who do nothing but suicide prevention every single day.

The problem is that we're responsible for the 22 million veterans in this country. And of the 20 vets who take their life every day through suicide, just six are getting care in the VA health care system.

We have to work with groups, with families and others, to identify the 14 that aren't getting care, that are out there right now [and] that we're very, very concerned about. One of the realities of our ability to address the suicide issue is that VA can't do this alone. We need help from community partners, we need help from scientists, we need help from technology companies.

On a report by the Office of the Inspector General at the VA about problems with the department's crisis hotline for veterans

Well, the suicide crisis hotline was one of those situations where the demand for our services was outpacing our ability to keep up with it. About four months ago, I made the decision to bring on an additional 200 Veterans Crisis Line responders. It took us a while to train them because these are highly specialized clinicians who have to answer these phone calls.

We opened up a second center in Atlanta, we have one in upstate New York and now today I'm pleased to say that, while we were not able to get to about 30 percent of the calls three or four months ago, really in the past six weeks we're getting to almost all the calls.

We are at a less than 1 percent rate of calls that roll over to another call center that is answered by professionals. But we want every call answered by our own Veterans Crisis Line responders, and now we're getting to more than 99 percent of those calls.

Copyright 2017 NPR. To see more, visit http://www.npr.org/.

RACHEL MARTIN, HOST:

The new secretary of Veterans Affairs is a man named David Shulkin, and he has his work cut out for him. The aging VA system is struggling to meet extraordinary demand. Wait times to get care are as long as they were before they became a scandal. And a program called Veterans Choice that allows some veterans to go outside the system to get care is set to expire this August. Secretary Shulkin is working with Congress to renew that program. Shulkin is also trying to get enough doctors and nurses to do the work. I asked him how the VA ended up with 45,000 vacant jobs.

DAVID SHULKIN: Well, we have about 360,000 employees in the VA health care system. It's the largest health care system in the country. And the negative attention that's been put on VA has hurt the morale of our workforce. And so what we're trying to do is to get people to understand that we're doing great work every day. It's a way to serve your country, and we want people to come and join us.

MARTIN: The Choice Act channeled roughly $2.5 billion to the VA to hire more medical staff, doctors, nurses. Yet, you still have this high number of vacancies. I mean, people will hear that and think $2.5 billion - what did you get for that?

SHULKIN: Well, we got a lot. We actually have about 13,000 net new health care professionals who were on board because of the Choice Act, so that program worked exactly as it was intended. The issue is is that we're seeing more and more veterans coming to us for care. The demand for our services is considerable. We are seeing that more veterans actually are choosing to get their care within the VA health care system.

MARTIN: An investigation that was done by our team here at NPR actually found that the Choice Act money wasn't given to those hospitals with the most egregious wait times. Why didn't that happen?

SHULKIN: Well, we're talking about now something back almost three years ago, and when Congress authorized this program, it was done with urgency. And they asked the VA to get an entire national program up in 90 days. That's really never been asked of any agency or any private company ever before. So in the end, I think that we ended up hiring where the wait times were the longest, but it wasn't done in the most thoughtful way because of the time that we had to stand this program up.

MARTIN: I want to ask about the president's hiring freeze. This is something he's put in place for the entire federal government. Does that affect all these vacancies you're trying to fill?

SHULKIN: Well, the hiring freeze does apply to all aspects of federal government except for defense and except for those that involve the safety and health of our citizens. So of the 45,000 positions that we talked about that we are looking to hire, we now have 41,000 that are exempt from the hiring freeze.

MARTIN: So is the solution about more money?

SHULKIN: No, I don't believe that the problems in the VA are necessarily about money. When I look back over the problems of the VA over the past decade, this is fundamentally a system that hasn't kept up with modernization in the way that the rest of health care in the private sector has.

MARTIN: For a long time, we've been talking about the suicide rate among veterans in this country. And since 2001, the suicide rate for veterans has surged 35 percent. For female veterans, that rate has gone up by 85 percent. How do you get a grip on what appears to be an epidemic?

SHULKIN: There is no doubt that suicide is my number one clinical priority. We are a system where I can tell you that nobody is doing more for behavioral health care in this country than the VA. We have extremely comprehensive systems. I have 1,000 professionals who do nothing but suicide prevention every single day. The problem is that we're responsible for the 22 million veterans in this country, and of the 20 veterans that take their life every day through suicide, just six are getting care in the VA health care system. So we have to work with community groups, with families and others to identify the 14 that aren't getting care that we're very, very concerned about.

MARTIN: Last week, the VA inspector general reported about ongoing problems at the veterans suicide crisis hotline. What's happening there?

SHULKIN: Well, the suicide crisis hotline was one of those situations where the demand for our services was outpacing our ability to keep up with it. About four months ago, I made the decision to bring on an additional 200 Veterans Crisis Line responders. And now today, I'm pleased to say that while we were not able to get to about 30 percent of the calls three or four months ago, really in the past six weeks we're getting to more than 99 percent of those calls.

MARTIN: Secretary Shulkin, thank you so much for coming into our studios.

SHULKIN: Thank you very much.

MARTIN: That was Secretary of Veterans Affairs David Shulkin. Transcript provided by NPR, Copyright NPR.