His opposition to turning over vast parts of the system to private doctors and approach seeking gradual changes at an agency still reeling from a 2014 scandal over patient wait times puts Shulkin at odds with Trump advisers and some Republican lawmakers who are pressing for more drastic reform, particularly more private care.

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But Shulkin, now serving as VA undersecretary in charge of the veterans’ health system, is likely headed for swift confirmation by the Senate, say Republican and Democratic aides. He would be the only holdover from the Obama administration to serve in Trump’s Cabinet.

“… You will be fighting a war on multiple fronts. While trying to carry out the Department’s mission, you’ll have to deal with a Congress that has not proven itself to be the most productive or cooperative partner,” Sen. Jon Tester (D-Mont.), the committee’s top Democrat, told Shulkin as the hearing started. “And you’ll have to deal with a new president who has taken some public positions — on everything from privatization to his personal opinion of the VA workforce — that are in stark contrast to positions you have taken.”

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Shulkin, 57, was pressed by Republicans for assurances that despite his status as an Obama appointee, he would act swiftly to speed up a slow appeals process for benefit claims, improve accountability for poor performers and get veterans medical care faster.

“How can you be sure that some of the big focuses of President Trump and really shaking up VA will happen on your watch?” Sen. Dan Sullivan (R-AK.) asked. He read from a letter from a Vietnam veteran in his state who called for a leader who would “kick a– and take names.”

Shulkin acknowledged that many people “lost trust” in the agency after the wait-times scandal. “I don’t have a lot of patience,” he told lawmakers. “I’m going to be serious about regaining trust. If I don’t do it, you should replace me.”

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During his campaign, Trump called VA a “broken” system that treats illegal immigrants “better than our vets.”

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Tester asked Shulkin if Trump had “attached conditions” to his taking the job. Shulkin said no.

He was confirmed unanimously for his undersecretary post in June 2015, a sign he could move quickly through a Senate confirmation process that has become mired this week in partisan divisions over the president’s agenda.

Several senators asked Shulkin if he would overhaul VA’s existing program allowing veterans to seek care outside the system, as long as there is no VA care within 40 miles of their home. The Choice Program, a $16 billion fix Congress passed in 2014 to speed up medical care, has been slow to roll out, little-used and the target of complaints from frustrated patients and doctors, whose payments often are delayed.

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Shulkin said the program was in “disarray” largely because VA contracts with a third party to administer it, “an additional layer of complexity we need to take out.”

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An internist who came to government with 30 years’ experience leading private hospitals, Shulkin would be the first VA secretary who has not served in the military. He has led the sprawling veterans health system — the country’s largest, with 1,700 clinics and hospitals — for 18 months, working to improve patients’ access to care after the scandal exposed fudged wait lists for medical appointments.

Shulkin said of poor-performing VA employees, “It is unfortunate that a few employees who deviated from the values we hold so dear have been able to tarnish the reputation of so many who have dedicated their lives to serving those who have served.”

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Despite his lack of military background, Shulkin’s said that serving veterans “is personal to me.” The son of an Army psychiatrist, he was born on an Army base and trained at VA hospitals.

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He acknowledged that the benefit appeals system “is a broken process” that struggles to keep up because its technology is woefully dated. But he said Congress needs to appropriate the money to pay for upgrades.

VA currently has 45,300 vacant jobs across the country, mostly for medical providers, Shulkin said. About 37,000 of these are exempt from the hiring freeze for executive branch agencies that Trump announced last week.

Shulkin acknowedged that recruitment has been hurt by Republican attacks on agency employees.

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He expressed a willingness to expand “private-care partnerships” with VA hospitals by avoiding building new medical centers that are too costly or time-consuming to open.

But officials on Trump’s transition team and the president himself have said they favor extending those partnerships to medical care by giving veterans more options to use private doctors to give them faster access to care.

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Some veterans groups expressed cautious optimism about Shulkin.

“We are encouraged that Dr. Shulkin acknowledged continuing problems within the VA, which previous leadership has tried to minimize,” said Dan Caldwell, policy director for Concerned Veterans for America, in a statement. “Dr. Shulkin expressed the need for transformational VA reforms, such as an expanded ability to fire employees who engage in misconduct or under-perform.”

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CVA, backed by conservative billionaire industrialists Charles and David Koch, has been VA’s harshest critic in recent years and pushed for more private care outside the system.

Before the hearing, members of Iraq and Afghanistan Veterans of America, a group of former troops from the post-Sept. 11 wars gathered in Washington over chips and pot belly sandwiches for a pre-hearing huddle to discuss how to bring veterans issues to the attention of the Trump administration.

“This is already a victory for us and we have a strong relationship with him,” said Paul Rieckhoff, the group’s founder and chief executive officer. “The issue is he’s not a veteran and he will have to show us why he’s qualified.”