Outside experts and groups representing VA employees are urging that the next secretary of the Department of Veterans Affairs
aggressively tackle issues such as the VA healthcare system's need for more clinicians, updated infrastructure and a more open culture that would identify problems quickly before they mushroom into crises like the one the agency is now facing.
The White House is urgently considering candidates to replace former VA Secretary Eric Shinseki
. Cleveland Clinic CEO Dr. Toby Cosgrove
reportedly is the top contender
. Shinseki, the retired Army general who resigned as secretary last week, was widely seen as a leader who was not particularly accessible to rank-and-file VA staff.
Dr. Samuel Spagnolo, president of the National Association of Veterans Affairs Physicians & Dentists, said that after years of not having much access to Shinseki, the VA's employed physicians
and dentists would like to have more dialogue with the new secretary. “You should be getting input from the people delivering the care,” he said. “I think you've seen what happens when that doesn't occur. You've seen the VA get into crisis.”
In addition, he said at least one physician should sit on the VA panel that evaluates salary levels for the agency's medical providers. As of now, doctors have no representatives. “We've been kept out of the conversation,” Spagnolo said.
Marilyn Park, legislative representative at the American Federation of Government Employees, also said her union hopes the new secretary will be more interested in working with employees to address challenges the agency is experiencing. Over the last decade, she said, her union has noticed an increasingly closed-door policy as it has attempted to weigh in on issues concerning the employees it represents. “We've been shut out,” she said. “We have almost no access to senior leadership.”
The agency is in major need of a culture change that encourages the reporting of bad news directly to the secretary and other senior VA leaders, said Dr. Elspeth Cameron Ritchie, a retired Army colonel and chief medical officer for the District of Columbia's Department of Behavioral Health.
In addition, the new secretary should continually assess facility infrastructure needs. “That's a critical management responsibility,” said Anthony Principi, VA secretary from 2001 to 2005. “Things change, circumstances change, and you need to change as well. Not change for change's sake, but a minimum assessment should be done that should lead to a realignment.”
Stepped-up recruitment of physicians and other clinicians also needs to be high on the list of the new secretary, said Dr. Atul Grover, chief public policy officer at the Association of American Medical Colleges. This will require raising awareness of the financial incentives and student loan forgiveness programs the VA offers. In addition, the new secretary will have to persuade Congress to appropriate more money to hire talented clinicians, he said.
As a stopgap measure, the new secretary should be more willing to rely on non-VA providers, especially academic medical centers, since it already has a relationship with many of those institutions, Grover said.
Shad Meshad, president of the National Veterans Foundation, recommended a greater long-term reliance on private providers, though most veterans groups say they want to strengthen the VA rather than privatize veterans' healthcare. Follow Virgil Dickson on Twitter: @MHvdickson