WASHINGTON _ The country's new veterans' affairs chief got his start in Pittsburgh, and his early views on controlling health care costs were shaped by his research into operating expenditures at 70 hospitals in Western Pennsylvania.
Dr. David Shulkin conducted his research in the early part of his career in medicine while he was a resident at University of Pittsburgh Medical Center, Shadyside. He found that administrative costs were one of the fastest growing parts of hospital budgets and recommended further research to determine how the increases affected patient care.
That early research likely shaped the views that led to his promise this month not to privatize the VA's health care system while he is secretary of veterans affairs despite President Donald Trump's campaign-trail rhetoric.
Dr. Wishwa N. Kapoor, who worked alongside Dr. Shulkin as a fellow resident and remembers him as being smart, personable and committed to high-quality, cost-conscious care.
"From his early days he was interested in cost of care and had leadership capability," said Dr. Kapoor, now UPMC's chief of internal medicine. Being secretary "will be the culmination of his work."
During a recent Senate hearing, Shulkin, who has been VA undersecretary for health since June 2015, promised major reform but not privatization. He said he would follow his own values if pressured otherwise by Trump, who picked him as the lone holdover from the Obama administration to join his Cabinet.
His vision includes using outside providers without privatizing the system. It would allow more veterans to receive care from private providers who agree to submit clinical data and documentation to the VA.
The Department of Veterans Affairs press office did not respond to an interview request, but Shulkin has made his views clear in journal articles and congressional testimony. And he has not shied away from discussing problems wracking his agency, including "leadership failures and ethical lapses" that kept veterans waiting too long to access care.
His solution, which he outlined last spring in the New England Journal of Medicine, includes expanding the network of providers to include health care facilities run by other federal agencies and universities in order to increase access to specialized care and assist veterans living in remote areas.
That appears to be in line with the career goal he had in 1988 at age 29 when he spoke to The Pittsburgh Post-Gazette about his earliest research showing that doctors and medical students severely underestimated the costs of medical tests they commonly order.
Then a UPMC senior resident in internal medicine, Dr. Shulkin said he looked forward to a future in economic health policy.
"My career goal is to work as a liaison between organized medicine, government and third-party payers," he told the Post-Gazette then.
Twenty-eight years later, that is now just one part of his job, which also rooting out wrongdoing in the troubled agency, overseeing 370,000 employees, managing a $167 billion budget and reducing veterans' wait times within the constraints of Trump's hiring restrictions.
The Senate approved Dr. Shulkin's nomination 100-0 in an unusual bipartisan demonstration of approval. Most of Trump's Cabinet nominations have faced strong opposition from Democrats in the confirmation process.
Groups including Concerned Veterans for America have expressed their confidence in the new secretary, too.
"Dr. Shulkin has acknowledged systemic failures within the VA and the need for transformational reforms to fix them," Dan Caldwell, policy director for Concerned Veterans for America, said after this week's confirmation vote. "We remain optimistic that Secretary Shulkin will embrace the bold reforms President Trump laid out on the campaign trail so that American veterans will begin to see a more transparent, efficient, and customer-focused VA."
Other groups hope Dr. Shulkin makes good on his promise not to privatize the VA, a move Trump was considering as recently as December.
"For Dr. Shulkin to gain our support, he must verify, under oath, that he will not implement any plan that would lead to full VA privatization _ as Trump's Koch-funded advisers laid out during the campaign," said Iraq War veteran Jon Stoltz, chairman of VoteVets.org, a progressive non-profit that works to protect veterans' interests in their day-to-day lives.
Sen. Pat Toomey, R-Pa., said he was happy to vote for Dr. Shulkin, whose "knowledge and insight have been forged by a career as a top administrator in some of the nation's largest hospital systems and his personal experience as a physician."
Dr. Shulkin previously served as president of Morristown Medical Center, Goryeb Children's Hospital, Atlantic Rehabilitation Institute and the Atlantic Health System Accountable Care Organization. He was president and CEO of Beth Israel Medical Center in New York City and chief medical officer of the University of Pennsylvania Health Care System, the Hospital of the University of Pennsylvania, Temple University Hospital and the Medical College of Pennsylvania Hospital. He was chairman of medicine and vice dean at the Drexel University School of Medicine and was chairman, CEO and founder of DoctorQuality, one of the first customer-oriented sources of information for quality and safety in health care.
