Recounts his time at the secretary of the Veterans Affairs department for the Trump Administration. Hes interviewed by jeremy butler. After words is a weekly interview program. They are also available to listen to as podcasts. Thank you for being with us today the v. A. Is an important subject to talk about one area of our government that dont necessarily know one of the details. Those that dont understand the breadth and the depth. Certainly about your book and your time of the administration. I would love to begin talking about the v. A. You are very successful with a civilian career making the transition from the civilian world into the government world can be jarring what would you to take up the mantle of work . During my twenties i didnt have a chance to serve in the way that you did. I spent my time in medical institutions building my medical training and one of the real regrets that i would have but later on in my career i was the ceo of the hospital and i had the opportunity to get a call from the white house. Ride at the time in 2014 when it was a very public wait time crisis in the v. A. Were there were allegations veterans were dying waiting for care. I remember sitting there is a citizen saying i feel terrible if anybody deserves the best care possible to veterans i wish there is something i could do to help and as itib happens i got a call from the white house to say would you consider coming to help lead the v. A. Healthcare system because we are looking people who understand how healthcare works from the private sector. So i made a list of the pro and cons the coin one the con side was much larger they on the pro but simply how could ii say no . This is my duty as an american citizen to give w back to the American People i didnt think too much about it i am prepared to come and help. Thats great. If you have read the book that was during the Obama Administration initially so you are one of the few who serve both and the obama and Trump Administration we look forward getting into that but i would love to read a brief quote from your book early on you write it iske important america understands with the v. A. System is and how it works and why it exist. A lot of people dont understand the scope of what the v. A. Has and what they are responsible for. Could you start off by giving and elevator pitch to everything the v. A. Does because theres so much more that the v. A. Does. One of the reasons i wrote the book is exactly what you talked about im not sure whatt if the American Public understands why it it exist and why it is an essential part of the National Security system that when we rely on a voluntary military that is now less than 1 percent of americans that are serving, these american razor hands and sacrifice themselves on behalf of all oflv us there is a commitment the country will make to them they will take care of them when they coment back and there is no other organization focused on that. So they provide healthcare for 9 million veterans but there really 12 million veterans so they have a large directive toward education, the g. I. Bill and should some of these require assistance and it also goes all the way through the time to make sure every veteran when the time comes is with dignity and respect that there are cemeteries around the country they do an amazing job supporting families during these tough times so this is the second largest in the Us Government 370,000 people and the veterans themselves it does an amazing job and does deserve the support and understanding of the American People. Thats great. I point out that it is the secondlargest department or agency the secondlargest budget and even from a civics mine point should be more informed. I think thats right and if i could even with the healthcare aspect to get more focus of the public attention on the v. A. But when i came from the private sector of government i never worked in government before i had a completely open mind reading all the Horror Stories in the press that i would go there and find the system was so broken and dysfunctional that my job would be to close up shop say the best i can do for the country is to eliminate the v. A. Healthcare system and move everybody into private hospital which is what i knew very well. After i got to the v. A. And i saw what it does, i put on my white coat and went out to visit hospitals acrossve the countrydo to see places like where we bring veterans and i began to understand what it does is very different than what the private sector does the private sector doesnt do the things the v. A. Healthcare does for example it is extensive and it is large for the private sector the Healthcare System is struggling trying to get access if they put 9 million veterans to the system that already is struggling. We know the veterans would not come out on the right side of that. So i became a very strong advocate to make sure this is a system that works well to modernize and improve that will be sustainable. Absolutely. And then go back to privatization very important topics are a large part of your book but i want to continue with the setting the scene because it reminds me of a common thing that even within the v. A. If you been to one youve been to one. So in the beginning you did a lot there were different so why is that even though we talk about an agency has so many different stories unfortunately its the Horror Stories that make it to the presske but and then the membership tells us they would like to get access to it faster but why is there such a variety of level of care one receives . The v. A. Is under public scrutiny that no other Hospital System in thede country finds with the hospital ceo in the private sector i can tell you Little Things that happen in the v. A. Would never come to the attention of private sector turn out to be the subject of congressional hearings and frontpage stories. But the public gets the sense there are a lot of things that are happeningheo in the v. A. Tt dont happen in the private sector but then even in the private sector comparison the question i get most frequently as a physician and ceo what is the best possible for me to go to . I would always say interestingly say there is no the best theres hospitals are areas maybe not another specialties. V. A. S the same in the system with over 1000 facilities you will have some that are excellent for certain conditions and those that need work w and thats what you will find in healthcare. So it needs to provide care to veterans no matter where they live in theisis country so therefore we have a large number of veterans who live in very rural areas in finding people, especially a specialist to work in the areas it is a challenge for the v. A. And private sector as well. So you have a tremendous variation between what works in the v. A. And another place thats where i work very hard to standardize some of these practices. That reminds me of a funny story from your first confirmation hearing the senator from alaska said come to alaska because we have a unique set of circumstances here in unique challenges to veterans you have to come here to understand that before he would vote for you. So people know about tha that, many people dont understand the Senate Confirmation process. In order to go through a senate process to go through an entire floor vote you have to have unanimous consent in the white house a good news you have unanimous consent you will be confirmed in the next couplemo minutes and write is that what was happening senator sullivan said not so quick. I need to have a conversation with the nominee. So he called me up and said im standing on the senate floor and im about to cast my vote. But i want you to commit to me in the first 30 days of your confirmed that you will come to alaska with me because alaska is very different than other states and their veterans have different needs. I said senator, were going to alaska. Yo i imagine that was your intention anyway because there is variabilitye geographically to get proper professionals to the rural areas. Alaska is one of the few states New Hampshire and hawaii that doesnt have its own v. A. Hospital so meeting the Health Care Needs of those is extraordinarily challenging. We have to partner with the Air Force Hospital actually. But i was absolutely delighted to travel with the senator as i was to other role states and maine with those senators as well because that is the way you get to understand the problems that are out there. See you continue to see patients during your time the wouldnt say the time to do it but in fact that is something you felt was necessary and vital to your understanding. I think every leader can do the job more effectively to understand the impact of their decisions. What the record that he would use how could i never make that decision ifci i never was working with patients or nurses or doctors understanding how they interact with the record . So to put on my white coat nobody knew i was secretary certainly would help me to understand what was working down at the ground level. And touch on the Electronic Health record but you remind me of a funny anecdote in your doctorate capacity that they dont necessarily know who you are you god a startling response from the veterans. I would see patients to ways. In person in the exam room either in new york city at the manhattan v. A. In my office in washington which is a very rural part of the country. But i was in the new york manhattan v. A. When a politician came and i said what can i do for you is that i need a physician to fill out thefi form and he said i need a certification because im suing secretary show can use actually homeless veteran and was trying to get additional benefits so he could get himself out of that situation and get himself back on track and needed the certification of the issues he was dealing with. So it turns out i said first of all we willll help you but i think im the person to do it and i said because imt 14. Im secretary shulkin but we got him on his way and got another physician to help him. [laughter] we mentioned High Priorities and how you arrived and how you did to achieve those . When i first came to the v. A v. A. , i not only had not only worked in government if i had waited until i truly understand injured in a time of crisis and not to feel like i had the time like a normal situation to study from the outside the best i could but the single top priority to address the wait time crisis with hundreds of thousands of veterans but most critical to me was the 57000 veterans waiting for the urgent consultation. And that was totally unacceptable to me. And for every Medical Center to be open on the following weekend and during that weekend we contacted those 57000 veterans and then we had that less one the list down to less than 1000. Once we essentially got the backlog taking care of i wanted to make sure we never got into that situationn again. One of my first decisions was to publicly post wait times today we are the only system of the role that publishes the wait times so people canse see. And then establish same day services by december 2016 with secretary mcdonald and president obama every v. A. Medical center on the same day basis to never be in that situation we ended up publishing an article where we studied where we put all these things in place for what the American Public knows and the v. A. Turns out to be better now and really with the commitment and the other priorities to establish employee morale with the 43000 vacancies for the organization has low morale and probably one of the most important priorities and then to say to our staff we are a Government Organization to follow the progress that what we can do is regain the trust we lost in thewe veterans and then that began to climb as well with the v. A. Today. And then to create best practices from one v. A. To another across the country to decrease some of v that variation. And that was very successful. Thats how we establish priorities. Some of these things you brought from the private sector between the ways the country can provide care to our veterans but other things we can continue to learn from the private sector . Interestingly as we one as i mentioned before we did not have a the time to learn the ways of government because i felt there were urgent issues. But also i didnt want to as a Government Employee i wanted to deliberately bring industry best practices of the private sector to government. What i ended up learning was that government could benefit from any of the practices of the privateti sector if it needs to challenge itself but if i actually learned there is more that i learned in the v. A. That the private sector would benefit from its truly a bio directional learning between the private sector and government and in this case, v. A. Right now there is an ongoing continue debate with the future of healthcare and that is the perspective thats brought into the conversation about what we can learn from the government side we could use from the government. People dont understand when you look at the outcomes of care across the population which is very popular right now, the v. A. Outperforms almost every major Healthcare System. There are some great Healthcare Systems out there that this country provides terrific car care, but on average it performs better than the private sector. So if you look at the things we did for example, i made the declaration i wanted to eliminate hepatitis from the entire veteran population of all those veterans that have it now fortunately we have the drug that can eliminate the virus 95 percent or higher cucure rate. So we should not have any veteran that has hepatitis. I went out in Congress Gave us a billion and a half dollars to proactively contact those that had hepatitis c today it is well over 100,000 of those veterans. We need to do more of that in the general population and not Many Health Systems think that way proactively looking at outreach and Patient Health these are some of the lessons we can learn. So the care that the veterans get through the v. A. And then not the positive story. And then we addressed it in the book in which the v. A. Continues the problem that not only the veteran of the military states are struggling to understand how to talk about. Do you have any insights from your time how we can address this issue to move in and out of the v. A. . That is to reduce veteran suicide. It is a staggering figure that i used to sit there to say if we let another week go by there goes another 140 veterans. There is still so much work to do that secretary wilkie has continued so one of the things taking a look only six are getting care in the system and the biggest worry is there not getting any help at all. One of the first initiatives we did was to start outreach for Community Partners veterans serviceun Organizations Community groups and churches and religious organizations with groups like the united way and others out there and local governments and then to identify veterans at risk. Every v. A. Medical center has a Suicide Prevention coordinator. Their job is to be out there for veterans at risk and one of the practicesiv because this is an American Public health issue. And we need to do a lot more in the underlying reason is to wake up one day and say i feel like doing this it could be ptsd or chronic pain to get to the underlying reasons and to make sure we are proactively identifying and there so much more work to do that is promising with the Predictive Analytics and therapies but much work to be done. And i v. A. And they have this is their number one priority as well. With the military and the v. A. That were not the problem and you started to talk about that. We shouldnt be looking at it as a Emergency Response issue but the underlying issues with chronic pain and things like that and Financial Issues clearly there has to be a society that has the leader for the Veterans Community within the government should be spearheadingg that. Im proud of the work the v. A. Is doing to address issues but many tough problems americans face we have to push through some of those barriers that prevented us from making progress for Suicide Prevention it is not a smaller number it actually went up a little bit. But this is not about keeping a scorecard its about making progress and im not sure we are there yet. And that how much the landscape has changed. With the combat rules and then we certainly here that they dont feel welcome in the v. A. And then to feel it is spouse or boyfriend or Something Like that. And throughout the country. And to realize this is meal veterans. And now have 14 percent and they are playing extremely important roles not to recognizee their service for something that cannot be tolerated by any part of society with the inflection of issues the broader society. What the v. A. Has decided to do rather than waiting for the changefo and to provide care and to have separate entrances and then not have to worry about any of the issues that we talk about as centers of excellence in some ways though it is a shame we do have to have several places and not to change attitudes at theme same timee and that the recent public issue where one was just walking through the halls and have the courage to come out and talk about that experience and that that is unacceptable on behalf of fellow veterans and to start changing these attitudes is not something that the burden should be placed and then to begin the process to drive a topdown understanding and the v. A. To frankly chang