Veterans Affairs Secretary Urges Med Graduates to Put Principles First

The University of Cincinnati College of Medicine awarded medical degrees to 159 graduates at the 2017 Honors Day ceremony, Saturday, May 20, at the Aronoff Center for the Arts in downtown Cincinnati.

U.S. Secretary of Veterans Affairs David Shulkin, MD, delivered a keynote address for graduates and their families. Shulkin, the ninth leader of the Department of Veteran Affairs, leads the nation’s largest integrated healthcare system, with over 1,700 sites of care serving 9 million veterans. 

Graduates along with their family members and friends also received opening and congratulatory remarks from College of Medicine Dean William Ball, MD, and UC President Neville Pinto, PhD.

Shulkin served as the VA’s undersecretary for Health for 18 months before he was tapped by President Donald Trump to lead the U.S. Department of Veterans Affairs. He acknowledged coming to a system in turmoil—more than 500,000 veterans nationally waiting regularly for more than 30 days to access to medical care, on average 22 veterans a day taking their own lives, and a system that was running out of money and had lost the trust and confidence of those it was tasked with serving.

"I was never known as being a particularly patient person, and when I ran hospitals in the private sector, I used to say to my management team when I wanted to get things done, ‘What’s it going to take? An act of Congress?'”

The comment drew laughter from his audience.  "Well, life has a funny way of getting back at you because now it takes an act of Congress.”

Shulkin said he had to get used to the VA operating under the microscope of public scrutiny. There have been 137 external reports from commissions giving recommendations along with 54 Congressional oversight hearings and countless reports from the government accountability office. All are asking for change, he said.

 "So how do you manage through crisis and change?” asked Shulkin.

He offered a few suggestions to new physicians. 

"Lesson number one: Reaffirm your values and purpose,” said Shulkin. "For me that means making sure that we are respecting those who have served. I’ve met amazing countless people who have unselfishly given for all of us to be able to stay free. 

"I recently attended the VA’s signature events where we take 400 veterans skiing down the mountains of Aspen, Colorado, who have lost their legs and were paralyzed, or who lost their eyesight as a result of war injuries,” said Shulkin. "These men and women deserve our respect and the very best we can offer them. High performing organizations always have technical competence, but mostly they are crystal clear on their purpose or values. Leaders are responsible for making sure everybody on their team understands the purpose of the mission. This is one of the things I have learned from the young soldiers. They can’t accomplish their mission unless they understand their objectives.”

Shulkin urged graduates to put principles before rules in order to have a successful career making a difference in the lives of the people they serve.

"The VA as a governing organization is a rules-based culture,” said Shulkin, to graduates, their friends and family and College of Medicine faculty. "What it needed to be was a principle-based culture. There is a story that I recently heard. A veteran didn’t show up for an appointment, and the nurse in their clinic understood this was not like this veteran.

"They always showed up for their appointment so she went to the VA police officers and then to the veteran’s home and when (the veteran) didn’t answer the door, they broke the door down, and they found the veteran had fallen between the bed and the wall and had been stuck there for three days,” said Shulkin.

The veteran was rushed to the hospital for care and would have died without an intervention, said Shulkin. "I am telling you, there is no rule that allows you to do that,” said Shulkin, who celebrated the incident as an example of what a principle-based culture can achieve.

Shulkin offered graduates additional advice such as: prioritizing one’s objectives, being willing to take risks and leading by example. Shulkin was confirmed February 13, 2017, to lead the U.S. Department of Veterans Affairs. He began with clear priorities.

"In a crisis, everything seems important,” said Shulkin. "The leaders establish those key issues that have to be addressed. For me in the VA, that was fixing our wait times. It is essential to communicate those priorities at every opportunity. A good leader must be able to explain the priorities in a way people can easily understand.”

Shulkin also asked graduates to fully commit to a task and to "don’t do anything half way.” He said leaders are best when they lead by example and are stronger when they invest time in developing the people around them.

"When people understand you, they know what motivates you as a person,” said Shulkin.

The VA secretary also took time to thank the University of Cincinnati leadership and the College of Medicine for its partnership with the Cincinnati VA Medical Center, noting that during the past academic year 40 fourth-year medical students and 144 third-year medical students did clinical rotations at the hospital, while 75 UC physicians were also providing care at the VA.

"It’s safe to say without the University of Cincinnati and our other academic partners the VA could not accomplish its sacred mission,” said Shulkin. "We have over 1,800 academic and institutional partners and we train over 120,000 healthcare workers each year including 60,000 medical students and residents.  An estimated 70 percent of U.S. doctors have trained at the VA.”

Graduates also heard from graduating medical student, Marcus Germany, who was chosen by his colleagues to give the class speech. During the ceremony, the Leonard Tow Humanism in Medicine Award was presented to Robert Neel IV, MD, vice chair of education and associate professor in the Department of Neurology and Rehabilitation Medicine, and to graduating medical student, Christian Gausvik Jr.

The U.S. Public Health Service’s 2017 Excellence in Public Health Award was presented to graduating medical student Aneela Reddy.

Four individuals were also presented with the Daniel Drake Award, the highest honor bestowed by the college to faculty, staff or alumni for their contributions to the field of medicine. The honorees were Kenneth Davis Jr. MD, George Deepe Jr., MD, Shuk-Mei Ho, PhD, and Elizabeth Shpall, MD.