Scope of the Position:

The Under Secretary for Health must lead the largest integrated healthcare system in the United States. The system consists, in part, of VA hospitals, which are often at the forefront of research efforts in multiple disciplines. The Administration's various tasks are all accomplished through the combined effort of over 300,000 employees who are ultimately directed by the Under Secretary.

Illustrative Management Challenges:

Given the VHA's critical role in administering healthcare to veterans, the decrease in clinical occupations in the VHA is cause for concern among the healthcare community. VHA has faced a growing demand for healthcare services, a trend that is likely to continue in the future. Despite hiring efforts in 2012 and 2013, there are concerns about VHA's ability to maintain the appropriate level of clinical personnel to meet the burgeoning demands. VHA lost about 7,700 employees from the five shortage occupations (physicians, registered nurses, physician assistants, psychologists, and physical therapists) in FY 2015, up from 5,900 in FY 2011.1 Discouragingly, voluntary resignations, along with retirements, were the primary contributor to these losses. Aggressive attrition rates are going to be a major obstacle to overcome if the VHA wishes to offer veterans the best healthcare treatments available.

Improving Data Reporting

Following the notorious VA scandal, Congress passed a law in 2014 that required the VA to report even more data on a number of criteria. The data are sent to a Hospital Compare website run by the CDC. However, it was recently confirmed that the VA stopped reporting its data on July 1, 2016. Joe Francis of the VHA claimed that lawyers at the Department of Health and Human Services advised the VA to stop reporting data until the two agencies could figure out a better deal governing the sharing of information.2 Additionally, the VA took down its own site that provided users with useful side-by-side comparisons of its hospitals, citing issues with inaccessibility to visually impaired users. The VHA is under heavy scrutiny following a slew of scandals and will need to work diligently to improve its data reporting in the coming months to avoid additional criticisms.


      1Personnel Data Show Losses Increased for Clinical Occupations from Fiscal Year 2011 through 2015, Driven by Voluntary Resignations and Retirements;   ; July 29, 2016.
      2VA quit sending performance data to national health care quality site;; September 12, 2016.

Under Secretaries for Health:

VA Under Secretaries for Health typically come from within the VA itself,from senior level roles in hospitals, or from regional VA centers. In addition, the majority of Under Secretaries possess an MD, which qualifies them for managing the largest healthcare network in the country.

Current Incumbent:

David J. Shulkin (2015-Present): Prior to serving as Under Secretary of Health, Shulkin served in numerous executive roles, including President at Morristown Medical Center, Goryeb Children's Hospital, and Atlantic Rehabilitation Institute. He also previously held a number of physician leadership roles, including the Chief Medical Officer at the University of Pennsylvania Health System, Temple University Hospital, and the Medical College of Pennsylvania Hospital. Shulkin earned his medical degree from the Medical College of Pennsylvania. 

Previous Under Secretaries:

Carolyn M. Clancy (Acting) (2014-2015): Clancy is currently one of the Co-Chairs for the Action Alliance for Suicide Prevention. Her previous positions have consisted of serving as the Assistant Deputy Under Secretary for Health, Quality, Safety and Value; Director of the Agency for Healthcare Research and Quality; Assistant Professor in the Department of Internal Medicine at the Medical College of Virginia; and as the Senior Associate Editor for Health Services Research at the George Washington University School of Medicine.

Robert A. Petzel (2010-2014): Prior to his appointment as Under Secretary for Health, Petzel was VA's Acting Principal Deputy Under Secretary for Health. Petzel's previous positions included Network Director of the VA Midwest Health Care Network, Director of Network 13, and Chief of Staff at the Minneapolis VA Medical Center. He received his MD from Northwestern University's Medical School.

Michael Kussman (2007-2009): Kussman is currently serving as the Principal of Michael J. Kussman & Associates. Kussman's previous positions at VHA consisted of Principal Deputy Under Secretary for Health, Chief of the Office of Patient Care Services, Deputy Chief in the Office of Patient Care Services, Chief Consultant with the Acute Care Strategic Health Care Group, and Deputy Medical Inspector. He was also with the Army Medical Corps for over 20 years in various positions and received his MD from Boston University's School of Medicine.

Jonathan B. Perlin (Acting) (2004-2006): Perlin currently serves as the President of Clinical Services and Chief Medical Officer of the Hospital Corporation of America (HCA). Perlin's previous positions included Senior Advisor to the Secretary of Veterans Affairs and seats on numerous boards and associations. He received his joint MD and PhD from the Medical College of Virginia Commonwealth University.

Robert Roswell (2002-2004): Roswell currently serves as the Senior Associate Dean at the University of Oklahoma's College of Medicine. Roswell's previous positions have consisted of Executive Director of the Federal Persian Gulf Veterans Coordinating Board, the Health Care Reform and Task Force under the Clinton Administration, and years of service in the U.S. Army, where he retired as a Colonel.

Thomas Garthwaite (1999-2002): Garthwaite is currently serving as the COO and VP of the Clinical Services Group with HCA. Garthwaite's previous positions included Executive Vice President and Chief Management Officer of Catholic Health East (now Trinity Health), Director and Chief Medical Officer of the Los Angeles County Department of Health Services, and Associate Professor and Associate Dean at the Medical College of Wisconsin. He received his MD from Temple University.

Kenneth W. Kizer (1994-1999): Kizer is currently the Director of the Institute for Population Health Improvement at UC Davis and the Board Chairman of Medsphere. Kizer's previous positions included President and CEO of Medsphere; Founder, President, and CEO of the National Quality Forum; Director of the California Department of Health Services; and Chief of Public Health and Director of Emergency Services for the State of California. He received his MD from UCLA.

John T. Farrar (1993-1994): John T. Farrar received his M.D. from the University of Rochester School of Medicine and Dentistry in 1981.

Additional Resources: