David Shulkin, M.D., the chief innovation officer at Sanford Health, has had a passion for care from a young age. He believes in the possibilities for continual improvement in veterans’ care, and he has a new book. Here, he shares his vision for innovation at Sanford Health.
Focus on care from early on
Dr. Shulkin was born on an army base in Highland Park, Illinois, where his father was serving as a psychiatrist. Upon his father’s discharge, the family moved to Philadelphia, where his mother, a social worker, was from and where Dr. Shulkin would grow up.
Dinner time conversation often focused on how they could help people, particularly those going through emotional problems.
From an early age, Dr. Shulkin wanted to help those facing crisis. As a boy in Philadelphia, he lived down the street from the fire department and would watch the trucks go by, responding to emergencies. This intrigued him, and at the earliest age possible, 16, he became a volunteer firefighter.
“I was really drawn to responding to emergencies, rushing in to help people and aiding people in need,” Dr. Shulkin said. “But my mother really wanted me to take the less dangerous route and be a doctor instead of a firefighter.”
Becoming a physician
As an undergraduate, Dr. Shulkin attended Hampshire College, a private liberal arts school that is part of the Five Colleges group in western Massachusetts. The college eschews credits and tests. Instead, students create their own curriculum and regularly demonstrate to professors that they have developed competency in key areas. It allowed him to focus on research, presentation and publishing early on.
“It really created a foundation for me to be a self-starter and a learner throughout my professional career,” Dr. Shulkin said.
At Hampshire, Dr. Shulkin’s program of study focused on gerontology, and his research focused on the effects of an antioxidant on slowing the aging process in nematodes.
He went on to Drexel University School of Medicine in Philadelphia, where he met his wife, Merle Bari, and completed an internship at Yale while his wife completed her residency roughly an hour away at the University of Connecticut.
The two then moved to Pittsburgh where his wife entered a dermatology program and he completed his residency at the University of Pittsburgh. Following that, they returned to Philadelphia, where they were both originally from.
There, Dr. Shulkin entered the Robert Wood Johnson Clinical Scholars Program at the University of Pennsylvania, which specialized in providing training in health policy to future leaders in the transformation of health care.
A forerunner in value-based care
Dr. Shulkin was then invited to write his own job description at the University of Pennsylvania. He created the position of chief medical officer — now familiar but then rare. The position would focus on directing hospitals and health systems to focus on quality outcomes, improving the patient experience, controlling costs and demonstrating value to outside entities, like third-party payers.
After 10 years at Penn, Dr. Shulkin turned 40 and decided he wanted to do something different. He took up residence in his basement and launched a startup company from there called Doctor Quality. Through the company, Dr. Shulkin would take what he had learned about measuring quality and apply it to doctors and hospitals so people could make more informed choices about their care.
“It would create this value-based environment that we’re all talking about today. The only problem was that this was back in 1999. So it was probably an idea whose time had not yet come,” Dr. Shulkin said. “As most entrepreneurs have learned, it’s not just about having the right idea or the best idea. It’s about having the right idea at the right time.”
While the company was able to attract investors and recruit talent, it dissolved after a couple of years, and Dr. Shulkin returned to academia. Drexel had recently expanded its medical education efforts, and Dr. Shulkin joined as vice dean of the medical school.
A leader in health care
After a while in that position, Dr. Shulkin received an offer to become president and CEO of Beth Israel Medical Center in New York City, a large, multibillion-dollar organization. While in that position, he helped lift the system out of a position of financial distress, grow the organization and improve services to the community.
Dr. Shulkin spent five years in that role before moving on to lead Morristown Medical Center in northern New Jersey. There, he worked to start an accountable care organization, grow the physician organization and improve the quality of care.
It was in Morristown in 2014 that Dr. Shulkin received a call from the White House to serve as under secretary of Veterans Affairs for Health under President Obama.
“The system was in crisis when I came there, and my priority was to fix it,” Dr. Shulkin said.
Transforming the Veterans Administration
Under his leadership, the VA expanded access to care by creating same-day services at every location across the country, improving its wait times and publishing its wait time data.
Dr. Shulkin coauthored a journal article in JAMA Open Network showing the results. In 2014, wait times at the VA and in the private sector were the same. From 2014 to 2017 — the time he began as under secretary to when he became the ninth secretary of Veterans Affairs — wait times at the VA were significantly shorter while in the private sector they remained unchanged.
Beyond that, Dr. Shulkin:
- Pushed forward a new GI Bill to increase veterans’ benefits
- Helped dramatically expand telehealth
- Advanced an initiative to cure 100,000 veterans of hepatitis
- Put the Veterans Choice Program permanently in place
- Modernized its electronic medical records system
Recording his experience
Dr. Shulkin’s new book — “It Shouldn’t Be This Hard to Serve Your Country” — addresses the improvements he made at the VA and his ongoing belief that the system can be fixed, though it will be a long-term effort. In the book, he provides a formula for doing so.
However, a key to change will be attracting talented people to government service. He says that’s difficult to do in today’s “toxic” and “distorted” environment in Washington, D.C. The book’s title addresses his two-fold concern: for those who serve their country in the military and for those who go into public service.
Sanford Health and the VA
As Under Secretary and Secretary of the Veterans Administration, Dr. Shulkin met many people who offered their help.
“A few people stood out to me when I met them, and one of those was Kelby Krabbenhoft,” he said.
Krabbenhoft called one day requesting a meeting, saying he had some ideas to offer about how to better serve veterans. The primary idea was to provide veterans access to the Sanford Chip, the DNA test for personalized medicine. Dr. Shulkin wanted to learn more about the Sanford Chip and advocated personalized genomic medicine, particularly for choosing cancer treatments.
Dr. Shulkin told Krabbenhoft he was interested in putting out a request for proposals regarding genomic medicine for veterans. If everything went smoothly, he said it could be accomplished in two years. According to Dr. Shulkin, Krabbenhoft responded, “I don’t want to wait two years. I want to help veterans now.”
In turn, Dr. Shulkin said the only way it could be done faster would be if Sanford Health gave the VA everything for free and also paid the costs of implementation. He gave Krabbenhoft a financial estimate.
A week later, Krabbenhoft called back saying he had talked to Denny Sanford, and they would be able to meet those requirements.
“You just don’t hear things like this,” Dr. Shulkin said. “A lot of people talk about helping veterans, but few are able to stand up and do what Kelby Krabbenhoft, Denny Sanford and Sanford Health have done.”
Joining Sanford Health
“When Kelby approached me about coming to work for Sanford Health, I really appreciated the uniqueness of the Sanford Family and how this is an organization that gets things done. That’s the type of organization I’m attracted to,” Dr. Shulkin said.
Dr. Shulkin views Krabbenhoft as a kindred spirit.
“He’s genuine, he’s candid, he doesn’t take excuses, and he has a vision and wants to see it implemented,” Dr. Shulkin said.
He now leads Sanford Health Innovations, an initiative he said is central to Sanford Health’s mission and vision.
A vision for Innovations
Dr. Shulkin describes innovation as bidirectional. In one direction: using ideas developed here at Sanford Health and pushing them out to the health care field. In another direction: attracting those who generate ideas in the health care field to Sanford Health.
First, Sanford Health providers may see a better way to do their job. They are able to take that idea and watch it come to life.
“A large part of what I want to do is reach out to employees and let them know that Sanford Health wants to hear from them and help them take their ideas and ultimately have an impact on patient care here and beyond,” Dr. Shulkin said.
Second, Dr. Shulkin sees a lot of new technological developments disrupting the way health care is delivered. He wants Sanford Health to be a place where those “disruptors” come to work with us.
“I think both of those ways of innovating will ultimately lead to us doing our jobs better here at Sanford Health,” Dr. Shulkin said.
Get to know Dr. David Shulkin
Hampshire College, Drexel University, Yale University, the University of Pittsburgh and the University of Pennsylvania.
Wife, Merle Bari, is a dermatologist in private practice. Son, Danny, works in health care on process improvement for Blue Cross in New Jersey. Daughter, Jenny, just graduated from Harvard Law School and is an assistant district attorney in the Manhattan District Attorney’s Office.
Traveling, reading and writing.