Gibson's name was one of several being mentioned as a possible permanent replacement, a move that would require Senate confirmation. Former Sen. Jim Webb (D-Va.), who served on the Senate Committee of Veterans Affairs, seemed to be gaining attention as a potential candidate for the role as well. Even before Shinseki's announcement, Webb received endorsements for the position from a newspaper in Staunton, Va., and a columnist with Bloomberg View.
Other possible nominees being mentioned in published reports include Army Gen. Peter Chiarelli, Rep. Tammy Duckworth (D-Ill.), and Army Chief of Staff Ray Odierno.
“(Odierno) is a well-known political general, but I think that's part of the problem here, too,” said Phillip Longman, a senior research fellow at the New America Foundation who has studied the VA system. “It's very tempting for politicians in both parties to say whoever is part of the VA should be some storied general. But that over and over again creates problems, and more so going forward.”
Longman attributes that to the cultural differences between the Department of Defense and the VA. “People give orders and expect other people to actually do stuff (in the Department of Defense),” Longman said. “It's just not how the rest of the world works, let alone the VA.”
Shinseki could never adapt to that difference, said Darin Selnick, a veterans' affairs adviser for the Concerned Veterans for America who was a political appointee at the VA from 2001-2009.
“He was a great guy who was a good general, but he was out of his element,” Selnick said. “Anyone who takes over the VA has to understand the culture and has to be respected in Congress and by veterans.”
According to Selnick, that leaves only one man for the position—Anthony Principi, who served as VA secretary from 2001-2005. “He understands the VA and has been effective in holding people accountable,” Selnick said. “He's well-known, well-liked, knows the issues, and could immediately jump in and begin fixing things.”
But Principi told Modern Healthcare he has neither been approached, nor expects to be, about returning to his role at the VA. “I don't know what will happen next,” he said. “I just hope the president's selection will be someone with a strong executive background and knowledge of the VA who can lead during a challenging time.”
Experts agree those challenges will require more than just a change at the top. “Just by replacing Secretary Shinseki, , it doesn't (solve) the systemic issues the preliminary report has shown,” said Mike Hartford, director of the veterans division at Zeiders Enterprises, which provides social and mental health services to the military.
One of those issues, based on interim results presented Wednesday by the Office of the Inspector General to which Hartford refers, seems to be a shortage of physicians. The VA most recently cited 400 vacancies for primary care doctors.
Hartford sees the strain on physician resources increasing. “There are 1.5 million service members who are going to be discharged over the next two to three years,” he said. “There are some real challenges as it relates to infrastructure to support not just the current veteran population, but also the increased population over the next couple years.”
That's why Selnick advocates what he calls blanket authorization for veterans to get care outside of their own system. For veterans waiting more than 30 days for an appointment, the normal preauthorization rules should be eliminated temporarily until the kinks in the rest of the system are worked out, Selnick said.
“If you've got a bleeding patient, you can worry about the rehab later,” he said. “You've gotta stop the bleeding. Veterans who are waiting right now need to be able to see doctors.”
Concerned Veterans for America had called for the firing of Shinseki in early May after allegations surfaced of long wait times, off-the-books waiting lists, and patients dying while waiting for treatment at VA facilities in Arizona and other states. At that time, the group voiced its agreement with the American Legion, which was the first major veterans organization to ask for Shinseki to step down. Following the secretary's announcement Friday, American Legion National Commander Daniel Dellinger said “(the resignation) is not the solution, yet it is a beginning.”
Follow Rachel Landen on Twitter: @MHrlanden
