Senators voted 100-0 to approve the former Obama administration official, who was the VA's top health official since 2015, in a rare show of bipartisanship amid partisan rancor over Trump's other nominees. Shulkin secured the backing of Senate Democrats after pledging at his confirmation hearing to always protect veterans' interests, even if it meant disagreeing at times with Trump.
The 57-year old physician has ruled out fully privatizing the agency and says wide-scale firings of VA employees are unnecessary, describing the VA workforce as "the best in health care." Trump had made accountability and rooting out wrongdoing a cornerstone of VA reforms, having called the department "the most corrupt."
Shulkin is the first nonveteran to head the government's second-largest agency, which has nearly 370,000 employees and an annual budget of nearly $167 billion.
He'll have plenty to do once sworn in. Shulkin has acknowledged that Congress should hold him to a higher standard of faster results as a former VA official who has laid initial groundwork for changes. He says he should be fired from his job if, like some VA secretaries before him, he isn't able to significantly fix problems and regain veterans' trust.
"You're not going to hear me asking for a learning curve," Shulkin said at his hearing. "I don't have a lot of patience and I am going to be serious about making these changes and regaining that trust."
The immediate challenge includes revamping scheduling and access for VA medical appointments following a 2014 wait-time scandal. Shulkin is urging a more integrated VA network where veterans could seek outside private care only in coordination with the VA. He has not sketched out full details.
"We've yet to hear from him how he'll pursue President Trump's vision for a public-private partnership at the VA," said Dan Caldwell, policy director for the conservative group Concerned Veterans for America.
Shulkin also will have to address long backlogs for veterans who apply for disability payments — he calls its appeals system "broken — and grapple with the White House's order of a 90-day federal hiring freeze. According to Shulkin, the White House agreed to exempt 37,000 out of 45,000 VA vacancies, but major veterans organizations say much more hiring is needed to eliminate red tape.