For those of you who are thinking about a career in military medicine, take a close look at PBD 712 and what it means for your future in which ever armed force you choose to serve it.

What this plan entails is basically reducing the non-fighting, non-deployable military force, and replacing them with civilians. What does this mean for the medical community?

It will be slightly different for each service, but bottom line, is that primary care billets will be replaced with a lot of civilians. Only people who remain on AD will be the specialists who will deploy over and over again (surgeons, anesthesiologists, EM, GMOs...)

The remaining AD who are not deployed will be treated to a healthy dose of cost reduction measures....meaning, no more easy days that used to be a draw for military medicine. Physicians will be seeing more and more patients per day...meaning you will be working just hard as your civilian counterparts.

Make sure to ask your recruiter about PBD 712 before you sign.

What does "replace with civilians" mean? Hiring civilians to work in military hospitals?

What could it mean for some who may be selected to do a specialty (ie rads, ortho, gas, etc) residency at the Army 3 years down the line?

So what is this PBD 712?

Originally posted by idq1i
What does "replace with civilians" mean? Hiring civilians to work in military hospitals?

What could it mean for some who may be selected to do a specialty (ie rads, ortho, gas, etc) residency at the Army 3 years down the line?

This is an initiative by the military as a whole to try to decrease spending.

What it means is that they don't want people to stay 20 years and retire. Retirement pay and ongoing benefits are expensive.

"replace with civilians" means just that. Billets are being slashed and positions replaced with civilian contracts.

Deployable billets with platform/unit designations stay so that they can be deployed. Billets with no operational significance (rads, derm, peds, etc....) with be replaced with contractors who probably won't have benefits.

Each of you need to talk to your respective services to see what it will mean for yourself.

Originally posted by militarymd
For those of you who are thinking about a career in military medicine, take a close look at PBD 712 and what it means for your future in which ever armed force you choose to serve it.

What this plan entails is basically reducing the non-fighting, non-deployable military force, and replacing them with civilians. What does this mean for the medical community?

It will be slightly different for each service, but bottom line, is that primary care billets will be replaced with a lot of civilians. Only people who remain on AD will be the specialists who will deploy over and over again (surgeons, anesthesiologists, EM, GMOs...)

The remaining AD who are not deployed will be treated to a healthy dose of cost reduction measures....meaning, no more easy days that used to be a draw for military medicine. Physicians will be seeing more and more patients per day...meaning you will be working just hard as your civilian counterparts.

Make sure to ask your recruiter about PBD 712 before you sign.

so where can we view this for ourselves? i googled it and came up with nil.

when are you getting out of the navy? this probably won't effect you too much, if at all. who knows, maybe this plan, if ture, will improve things by increasing some volume-- one of your main complaints about GME in the military. :)

i would also imagine this will take some time to implement. nothing the government does is fast, expecially changes this sweeping.

i guess i'll cross that bridge when i get to it. the sky's not falling quite yet, lol :)

I have heard off the plan, but didn't know what the name was. It's part of the Secretary of Defense's cost reduction plan. I agree that the result will be to scare the remaining docs away from the military.

Ed

Originally posted by edmadison
I have heard off the plan, but didn't know what the name was. It's part of the Secretary of Defense's cost reduction plan. I agree that the result will be to scare the remaining docs away from the military.

Ed

Cutting costs from a department dedicated to the health of the soldiers...Who said that there is no military intelligence!:(

At least they may give more deferrals

Couple of things. I'm not in the Navy, but I am getting out soon, so PBD 712 won't affect me.

This initiative was slated for fiscal year 2006 of 2007, but the SecDef moved it up. It is slated for implementation by 2005. It will most likely affect all current medical students.

Not a lot on the web. You need to ask your GME leaders about this. It will most likely mean less GME.....no more need to train FP, peds, and the likes.

It is not supposed to cut healthcare benefits, just AD non-deploying military physicians, and replace them with civilian contractors, and then make those who remain on AD see more patients per day.

This initiative is aimed at the military as a whole.....the medical department is just a small part of the entire plan.

I would also imagine this will take some time to implement. nothing the government does is fast, expecially changes this sweeping.


I am the spouse of a military physician who is a year and a half from completing his four year HPSP committment. :clap: He also did a four year military residency.

Our experience has been that if there is no funding, the military is capable of changing things VERY quickly.......it is just the paperwork that takes awhile to catch up.

Trust me......at smaller bases, things are already pretty close to the bone and the docs are working pretty damn hard. Things will get worse as military medicine as it has been dies a slow and horrible death.

Sally

What this plan entails is basically reducing the non-fighting, non-deployable military force, and replacing them with civilians. What does this mean for the medical community?

It will be slightly different for each service, but bottom line, is that primary care billets will be replaced with a lot of civilians. Only people who remain on AD will be the specialists who will deploy over and over again (surgeons, anesthesiologists, EM, GMOs...)

The remaining AD who are not deployed will be treated to a healthy dose of cost reduction measures....meaning, no more easy days that used to be a draw for military medicine. Physicians will be seeing more and more patients per day...meaning you will be working just hard as your civilian counterparts.


This is not necessarily just a cost-cutting measure. The military (or at least the Army) has decided that it needs to improve its "tooth to tail" ratio, that is, the number of soldiers who actually fight vs those who are "behind the lines" doing support work. Repacing the support staff (administration, mechanics, supply personnel, etc) with civilians is not an unreasonable plan as it frees up more soldiers to do what the military is ostensibly supposed to do: engage in combat.

Now, this doesn't necessarily translate into fewer active duty personnel. They will just be reassigned to combat roles. Also, if you've been keeping up with the news, you've probably heard about the plans for adding an extra 30,000 or so military personnel in the near future. That doesn't sound like "cost reduction" to me.

As for the fate of the medical corps, well, you will still need docs to go to combat zones and be lifesavers. But the military also needs to think long and hard about how it wants to care for nondeployed troops and (and this is a political minefield) the zillions of retirees who are getting healthcare via military facilities.

As someone else has noted, the smaller MTF's are already largely civilian staffed. This trend is likely to continue. I suspect over time that military medicine will shrink down to include just docs who absolutely have to be in combat zones (surgeons, ED, anesthesia, and primary care). Military subspecialists will slowly disappear. And you know what? I don't think that this is necessarily a bad idea. Having been a subspecialist in the Army for about 7 years, I've pretty much come to the conclusion that we're not necessary. Reason: if you are a soldier who truly needs ongoing subspecialty medical care, you in all likelyhood have a medical condition that prevents you from being fully deployable as a warfighter, and you ought to be medically discharged. We really don't need soldiers with hypertrophic cardiomyopathy, diabetes, MS, epilepsy, and other chronic, potentially disabling conditions sitting around. If you really need diagnostic evaluation or acute care, you can be sent out to a civilian doc for that. The main reason to have specialists hanging around in the military is to treat dependents and retirees, and frankly I think that aspect of things should be farmed out to the civilian medical communiity (as I believe it used to be under the old CHAMPUS system). Military docs should deal with keeping the fighting force healthy, period. Anything else is secondary. Also, focusing the medical corps specifically for a deployment/combat role would also end the nonsense of docs being deployed out of their specialty, like for example a pediatrician or ophthalmolgist being sent off to be GMO or battalion surgeon in a combat zone. I, for one, don't think things would be any worse off if military medicine were cut to the bone and significantly reorganized.

Originally posted by R-Me-Doc
As someone else has noted, the smaller MTF's are already largely civilian staffed. This trend is likely to continue. I suspect over time that military medicine will shrink down to include just docs who absolutely have to be in combat zones (surgeons, ED, anesthesia, and primary care). Military subspecialists will slowly disappear. And you know what? I don't think that this is necessarily a bad idea. Having been a subspecialist in the Army for about 7 years, I've pretty much come to the conclusion that we're not necessary. Reason: if you are a soldier who truly needs ongoing subspecialty medical care, you in all likelyhood have a medical condition that prevents you from being fully deployable as a warfighter, and you ought to be medically discharged. We really don't need soldiers with hypertrophic cardiomyopathy, diabetes, MS, epilepsy, and other chronic, potentially disabling conditions sitting around. If you really need diagnostic evaluation or acute care, you can be sent out to a civilian doc for that. The main reason to have specialists hanging around in the military is to treat dependents and retirees, and frankly I think that aspect of things should be farmed out to the civilian medical communiity (as I believe it used to be under the old CHAMPUS system). Military docs should deal with keeping the fighting force healthy, period. Anything else is secondary. Also, focusing the medical corps specifically for a deployment/combat role would also end the nonsense of docs being deployed out of their specialty, like for example a pediatrician or ophthalmolgist being sent off to be GMO or battalion surgeon in a combat zone. I, for one, don't think things would be any worse off if military medicine were cut to the bone and significantly reorganized.


I agree with what you're saying, except for one problem. How is the military going to recruit people for fields like orthopaedics and gen surg if there is not any decent medical infrastructure? I don't think many people would sign an HPSP contract once word got out.

How about this:

1. No more HPSP. :wow: (since year 1 of med school most students really don't know what they'll come out as, there's no point locking them into the military if there's a chance they'll come out wanting to go into some specialty the military doesn't want or need)

2. Instead, you wwould join the military only AFTER completing civilian residency, in return for 100% tuition and loan payback. That way the military can focus on recruiting specialties it really needs and get fully trained people. Alternatively, you could join during civilian residency, and get the tuition payback and maybe a higher govt. subsideized salary during residency to "sweeten the pot" a little.

3. Once you are in the military, you will be assigned to a military treatment clinic if you are in a primary care specialty (you don't really need much "infrastructure" to do FP or IM on mostly healthy people). Or, if you are a surgeon/anesthesiologist etc, you get assigned full time to a local civilian hospital. You handle whatever consults come in from the military base, and in your downtime you "change hats" and cover the civilian side of things. That should keep your skills up quite nicely. Every once in a while you go do some "military specific training" and if we go to war, you get pulled out. It seems to me that everyone benefits from this: The military doesn't have to support expensive fixed hospital facilities, the surgeons don't let their skills atrophy sitting around at a military hospital if there's nothing to do (a not uncommon complaint), and the civilian facilities get a free pair of hands paid by someone else.

Originally posted by R-Me-Doc
How about this:

1. No more HPSP. :wow: (since year 1 of med school most students really don't know what they'll come out as, there's no point locking them into the military if there's a chance they'll come out wanting to go into some specialty the military doesn't want or need)

2. Instead, you wwould join the military only AFTER completing civilian residency, in return for 100% tuition and loan payback. That way the military can focus on recruiting specialties it really needs and get fully trained people. Alternatively, you could join during civilian residency, and get the tuition payback and maybe a higher govt. subsideized salary during residency to "sweeten the pot" a little.

3. Once you are in the military, you will be assigned to a military treatment clinic if you are in a primary care specialty (you don't really need much "infrastructure" to do FP or IM on mostly healthy people). Or, if you are a surgeon/anesthesiologist etc, you get assigned full time to a local civilian hospital. You handle whatever consults come in from the military base, and in your downtime you "change hats" and cover the civilian side of things. That should keep your skills up quite nicely. Every once in a while you go do some "military specific training" and if we go to war, you get pulled out. It seems to me that everyone benefits from this: The military doesn't have to support expensive fixed hospital facilities, the surgeons don't let their skills atrophy sitting around at a military hospital if there's nothing to do (a not uncommon complaint), and the civilian facilities get a free pair of hands paid by someone else.

sounds like a great idea. but this is where militarymd will come in and say how "flag officers" will ruin everything. :D

Originally posted by R-Me-Doc
How about this:

1. No more HPSP. :wow: (since year 1 of med school most students really don't know what they'll come out as, there's no point locking them into the military if there's a chance they'll come out wanting to go into some specialty the military doesn't want or need)

2. Instead, you wwould join the military only AFTER completing civilian residency, in return for 100% tuition and loan payback. That way the military can focus on recruiting specialties it really needs and get fully trained people. Alternatively, you could join during civilian residency, and get the tuition payback and maybe a higher govt. subsideized salary during residency to "sweeten the pot" a little.

3. Once you are in the military, you will be assigned to a military treatment clinic if you are in a primary care specialty (you don't really need much "infrastructure" to do FP or IM on mostly healthy people). Or, if you are a surgeon/anesthesiologist etc, you get assigned full time to a local civilian hospital. You handle whatever consults come in from the military base, and in your downtime you "change hats" and cover the civilian side of things. That should keep your skills up quite nicely. Every once in a while you go do some "military specific training" and if we go to war, you get pulled out. It seems to me that everyone benefits from this: The military doesn't have to support expensive fixed hospital facilities, the surgeons don't let their skills atrophy sitting around at a military hospital if there's nothing to do (a not uncommon complaint), and the civilian facilities get a free pair of hands paid by someone else.


This would work w/ FP or peds probably. But I just don't believe too many orthopaedic surgeons, who start after residency (or one year fellowship) b/w 250-350 (and go up from there) will be signing up with the military after completely residency. Likewise w/ anesthesia or any high paying speciality.

Signing people after they finish med school might work though. The military could set up deals with civilian ortho residencies, to make one spot a designated "military" slot, and the military would pay for their training and pay off the resident's loans. Although there might be a problem due to the fact that the older people get, the more they start thinking about families and will be less likely to sign up for highly deployable specialities in the military, which are exactly the specialties that the military needs.

Also, no civilian institution is going to want many doctors who are likely to get deployed at any given second. Reserves get called up once in a blue moon, but these active duty surgeons would probably get deployed frequently, making an good civilian gig unlikely.

Originally posted by Sledge2005
This would work w/ FP or peds probably. But I just don't believe too many orthopaedic surgeons, who start after residency (or one year fellowship) b/w 250-350 (and go up from there) will be signing up with the military after completely residency. Likewise w/ anesthesia or any high paying speciality.

Signing people after they finish med school might work though. The military could set up deals with civilian ortho residencies, to make one spot a designated "military" slot, and the military would pay for their training and pay off the resident's loans. Although there might be a problem due to the fact that the older people get, the more they start thinking about families and will be less likely to sign up for highly deployable specialities in the military, which are exactly the specialties that the military needs.

Also, no civilian institution is going to want many doctors who are likely to get deployed at any given second. Reserves get called up once in a blue moon, but these active duty surgeons would probably get deployed frequently, making an good civilian gig unlikely.

There is already a program simlar to this; it is called FAP.

Originally posted by JKDMed
There is already a program simlar to this; it is called FAP.

no kidding, but the minority of military docs are products of it

As an active duty resident, I would be thrilled if the PBD 712 really were implemented to outsource non-combat essential medical care to the civilian sector. This would theoretically maintain quality medical personnel to support the troops without having to deal with the hassles of maintaining huge medical centers and GME programs. There is no doubt that GME has suffered greatly due to the downsizing, lower caseloads, and frequent deployment of teaching staff. Therefore, deferring most of GME to the civilian sector, as well as any non-essential medical care, makes a ton of sense to me. As it stands now, there just isn't the caseload to maintain quality GME or to keep the specialists busy as they are stationed at low volume hospitals throughout the DoD.

However, all of this being said, I have no personal experience or understanding of what the PBD 712 is all about. To find out more, I emailed Dr. Harold Koenig, a retired US Navy Admiral and physician who many of you may be familiar with from his excellent articles on the state of military medicine in the US Medicine newsletter. Here is his reply; I think it may help shed more light on this important issue:

"I am going to try and give you some insight into PBD 712, at least from
my perspective. You have my permission to post it to the
studentdoctor.net website.
I have only seen the impact PBD 712 will have on the Navy Medical
Department, not the Army or Air Force. I suspect the impacts are
similar. For the Navy Medical Corps the impact falls disproportionately
on the primary care specialties, Pediatrics, Family Practice and
Internal Medicine. There are impacts also on the Nurse Corps, Medical
Service Corps and Dental Corps.
These cuts are no surprise to me. The US Armed Forces began a drawdown
as we saw the Cold War coming to an end. In 1988, two years before the
Berlin Wall fell the United States had its first round of Base
Realignment And Closure (BRAC) followed by additional rounds in 1991,
1993 and 1995. The purpose of BRAC was to get rid of infrastructure
(bases) that were no longer needed. This was a very controversial
political process and the only way it could be accomplished was to
"de-politicize" it by setting up an independent commission that would
put together a list of bases to close and then submit it to Congress and
the President who could only vote yea or nay on it, they could not make
changes. A lot of excess infrastructure was removed from the DOD
inventory, communities suffered, but most recovered, got access to the
land and are now better off economically than they were before. A few
localities have not yet benefited because of local politics. There is
another round of BRAC authorized for this year with the final decisions
due in May of next year.
Coincident with the BRAC process there was a need to downsize the force,
that means get rid of people, not just in uniform, but civilians as
well. That is as tough as getting rid of bases because good people lose
their jobs. From the time of the first BRAC until the last the number
of people in uniform dropped from over 2.1 million down to about 1.4
million, a one-third reduction in manpower. Similarly proportional cuts
were made in the number of civilian jobs in the Department of Defense.
The medical departments were not spared in this process. Hospitals and
clinics that were on bases that closed were also closed. Along with
their closure went proportional reductions in medical department end
strengths, both uniformed and civilian. All of this caused a lot of
anxiety among health care providers and their patients but most of the
rest of the nation was pleased with the process because the nation was
able to reap a "Peace Dividend."
The drawdown was not proportional everywhere. Some states saw no bases
closed, some saw a lot and suffered economically. But the biggest hits
came overseas. Before the drawdown began and in fact up through 1991,
we had over 300,000 men and women in uniform in Germany alone. We had
eleven hospitals in Germany and a whole lot of clinics. Now we are down
to about three hospitals and less than 100,000 uniformed people in
Germany. Many of those people rotated back to the USA, but their
positions went away. By the way, this process was economically brutal
for the German people living in the communities with large US bases that
closed.
Now the United States is re-accessing its need for overseas bases again.
It looks like we may see a near total pull out of US Forces north of the
Alps in Europe. This is not out of pique over recent disagreements over
Iraq. This is because after over a half Century of presence we really
are not needed there any more. If we aren't needed we shouldn't stay,
imagine how you would feel if there were foreign soldiers based in your
community? Some, but not all of these forces may be moved to other
countries in the region that have emerged out of the former Soviet
Union. Some of these countries need the protection and stability that
the presence of US Forces will provide. Again, we should remain there
only as long as we are needed. We are also looking at possible force
reductions or at least relocations in the Fare East. This again is
because at least some countries in these areas have become more stable
and self-sufficient. We should look at all of this as a victory to be
celebrated, not a failure to be mourned. Of course some people will
suffer unintended consequences, they may lost their jobs and others may
lose convenient access to health care and other services provided on
military bases.
While re-assessing our need for overseas bases we also need to look at
our need for bases here at home. That is what the current round of BRAC
will do. Along with that will come a need to somewhat proportionally
reduce manpower. There is another factor at play here though that
needs to be understood. As the force is reduced in size there is a need
to maintain as much of the fighting strength as possible. The military
refers to this as "Tooth to Tail ratio." I am sure you understand the
meaning of that.
There are a lot of jobs in the military that can be done by people not
in uniform. If those jobs are "civilianized" the "Tooth to Tail ratio"
will improve. That is what PBD 712 is all about.
As PBD 712 plays out keep all of this in mind. This is not about
discrimination against certain medical specialties, or nurses, dentists,
doctors, patients or any of the other myriad professional areas that can
be "civilianized." It is about maintaining America's military strength
in the most efficient and effective way possible.
We are much more fortunate today than we were when all of this drawdown
process began back in the late 1980's. Today we have Tricare in place,
then all we had was the old CHAMPUS benefit and Medicare for those over
65 who lost access to military medical facilities. That is an
improvement that only those of us who were around then can appreciate.
Tricare just doesn't benefit patients, it also benefits health care
providers who prefer to practice in the military environment, even if
they have to do so out of uniform. Military medicine will continue to
need pediatricians, family practitioners, internists and so on to
provide care in its hospitals and clinics. Tricare allows for that with
the resource sharing provisions in the contracts. And finally, don't
forget the reserves. There is an on-going and perhaps increasing need
for health care providers in the reserves, especially the Army Guard and
Reserve.
In summary, I see PBD 712 not as bad news but as part of a long on-going
effort to "right-size" our military forces and preserve its strength at
the lowest cost possible. That is as it should be. There remains an
important role for all of you to play in this."

Harold M. Koenig, MD
Vice Admiral, Medical Corps
U.S. Navy, Retired

Originally posted by Rudy
Here is his reply; I think it may help shed more light on this important issue:


Thank you for the interesting and informative post.

The Admiral, however, doesn't talk about the impact of 712 on the military's GME system. Does this PBD mean that people going through school now will be given many more deferments to civilian residencies in the near future? I have 0 interest in primary care/peds/im/fp. I am primarily concerned with the specialist residencies

Originally posted by Rudy

You have my permission to post it to the
studentdoctor.net website.

Hey, thanks a lot for the information! It's great to hear something coming from such an authority. However, by mentioning that you may post it on SDN (or any public place), I'm afraid that his answer might not have been the same as what he might have said behind closed doors. That's just a theory of course, but he did seem to be giving a very politically correct answer while at the same time not dishing out tons of hard info. It was a interesting read though. I liked the historical perspective a lot.

Originally posted by idq1i
Thank you for the interesting and informative post.

The Admiral, however, doesn't talk about the impact of 712 on the military's GME system. Does this PBD mean that people going through school now will be given many more deferments to civilian residencies in the near future? I have 0 interest in primary care/peds/im/fp. I am primarily concerned with the specialist residencies

Maybe I misunderstood what the Admiral wrote, but it seems that there will be no need for military-trained FP, Peds, and IM guys at all. It appears the military may be looking for specialists and outsourcing the primary care jobs. They want deployable docs who can directly support the line.

Why pay for a family doc when you can source that out and put a surgeon in uniform to deploy with a unit?

Sure sounds that way, doesn't it?

Originally posted by JKDMed
Maybe I misunderstood what the Admiral wrote, but it seems that there will be no need for military-trained FP, Peds, and IM guys at all. It appears the military may be looking for specialists and outsourcing the primary care jobs. They want deployable docs who can directly support the line.

Why pay for a family doc when you can source that out and put a surgeon in uniform to deploy with a unit?

so what happens when they implement this to the people out there in primary care fields with time still left on their obligation? will they jsut send them to the reserves?

Originally posted by Homunculus
so what happens when they implement this to the people out there in primary care fields with time still left on their obligation? will they jsut send them to the reserves?

I would imagine they would just phase the new program in. The worry is what if they start eliminating residency programs. How can you be an R3 effectively if there are no interns in your program to teach and scut?

Ed

They will probably just stop accepting new primary care type people (though I imagine psych will not be included in things that are sourced out).

They want docs who can be deployed, not docs who stay on a base treating the families of military personnel. Though it is kind of ****ty for the primary care guys, I can really see the point of doing this. The uniformed docs should be out there with the troops when the time is needed.

I was hoping to do a surgical specialty anyways, so hopefully this won't affect me.

The real question is how does this affect HPSP? Does the military say, "You cannot do any primary care or IM field". Do they ditch HPSP and start using only FAP? Not likely. It will be interesting to see how they handle this. Maybe they phase out all of the military primary care and IM residencies so HPSPers cannot choose one of these fields. This means you're stuck to a specialty, which could be good or bad. Competition would be fierce, though, and a lot more HPSP students will get civilian deferrments or fail to match at all.

or maybe, like with so many other similar sweeping changes, the bureaucracy will wait them out, make lip service and change nothing.

The below is a statement from VADM Cowan regarding the effects of PBD 712 on Navy Medicine beginning in FY05. Looks like the list of billets undergoing conversion is scheduled for release in May 2004....watching & waiting.

...update on Program Budget Decision (PBD) 712, signed January 2004. This PBD directed that Navy Medicine convert 1,772 military positions (billets) to civilian/contract positions in FY05. Below provides you further information about actions being taken to meet this requirement, as well as future actions that may occur related to non-readiness military manpower.

PBDs are an OSD-directed budgetary action that occurs every year. This particular PBD addresses military-to-civilian conversions for all three Services for the upcoming budget year (FY05). Specifically, the PBD states, ?recent studies indicate that 300,000 military personnel are being used to perform tasks that civilians could perform.? Conversions of these positions would ?alleviate the stress on the operating forces?and reduce workforce costs? so that ?military personnel are used to perform tasks that are military essential?. This thought process is very much in line with Navy?s FY04 human resource philosophy which includes maximizing civilian and contract personnel for non-military essential (non-readiness) positions.

This year?s PBD 712 directs 10,070 military-to-civilian conversions in FY05 within the Army, Navy, Marine Corps and Air Force. Naval Medicine?s share is 1,772, broken down in the following manner:

Officer: 536
MC: 162
DC: 103
MSC: 187
NC: 84

Enlisted: 1,236
HM: 1,000
DT: 236

All 1,772 positions are at CONUS MTFs or DTFs. OCONUS or operational commands are unaffected.

The final determination of which billets will be converted has NOT occurred yet. I have made it clear to our leadership that BUMED will provide a finalized list by May 04. This time delay is required to ensure we make the appropriate business decisions. Because we have not finalized the list of billets that will be converted, I cannot send out a full listing at this time.

The draft list of the 1,772 billets under consideration was identified from a larger list of approximately 5,400 over THCSRR billets that BUMED has been studying. Our manpower experts in M1 have the lead, working closely with representatives from the Corps Chiefs/Director?s Offices, M3M, M8 and the Center for Naval Analysis.
Factors to determine the final 1,772 positions include readiness impact based on emerging threats, community manning levels, cost of conversion, skill availability in market place, and many others, including your input. I ask each of you to be available if my staff or CNA calls you directly to discuss any issue surrounding this critical topic.

The money to buy the civilian conversions has been provided and will be available to us starting July 2005 (funding for the military billet being converted will cease in June 2005). Once the final military conversions have been identified and it is determined that additional funding is required I am prepared to go forward with an unfunded request.

In order to make these conversions as seamless as possible the Bureau of Personnel (BUPERS) and BUMED manpower analysts and community managers are identifying methods to ensure we do not endanger any one officer or enlisted community. BUMED has also discussed the conversion with the detailers (BUPERS 4415) and it does not appear that orders will have to be written for a person who occupies a converted billet even though their PRD may be past FY05.

As the force structure of our military changes, Naval Medicine must transform to meet the changing needs of our Navy/Marine Corps team. These changes will present challenges that I know will make us a more productive, efficient medical force in the future.

Thanks for the info. I wonder how the numbers will break down for the Air Force.

For those of you either in HPSP, military residency, or active duty, how would you advise a current Army HPSP applicant such as myself? With all the changes being driven by PBD 712, I am starting to think that it's no longer worth it to commit myself to at least 4 years of active duty at this early point in my career. Any advice??

My biggest concerns are the possible limitations in speciality and the unknown impact of PBD 712 on military GME. I had my mind made up to do HPSP until I started hearing about PBD 712, but now I am not so sure...

caddis23:

Although I've been pleased with my time in the military & the scholarship I received - I can honestly say that if I were in your shoes, I would probably not sign a contract for an HPSP scholarship at this time due to the potential changes coming with PBD 712.

Can someone go over what specialities they think will be affected? I am waiting to hear about my AF and Army HPSP application so I agree this is a big deal! Someone mentioned surgeons, anesthesiologists, EM docs as still being needed. Does this mean I would have a better chance of getting one of those specialities (although deploying much more frequently)? And since I have signed a contract to work for 4 yrs after residency, although I could be forced into a speciality I don't want, my job can't be lost to a civilian. Am I correct then in thinking that the lost billets are going to affect primarily those who plan to remain in military medicine? (assuming I am in a speciality I want and am not "affected" by speciality limitations) Also...do you think PBD 712 will have any impact on increasing people called up from the reserves? Thanks for your help.

Scott-

Maybe I'm missing the bigger picture here. I think now is the perfect time to take a HPSP scholarship because if this works out to mean less IM and FP billets you would have to complete a residency in a specialty (FTIS or FTOS) which many people who take the scholarship are afraid of NOT being able to get.

Seocondly, I saw similar situations, twice, during my time as an aviator. In the early 90's, right after Desert Storm, they were separating pilots after their first tour who didn't augment, complete with exit bonuses. Four or five years later they started offering sizable retention bonuses for anyone, and I do mean anyone, who would stay. I myself took a two-year bonus to finish my tour in Key West and then go to a TAR squadron in the northeast.

I could see this happening...at the end of medical school, due to the shortage of FP, IM, OB/GYN, etc residency spots for HPSP'ers (recall USUHS folks get 'em first) they give out increased numbers of deferments, full or 1-year and/or offer you a reserve commission and let you do FAP if you want. Frankly they'd probably just as soon be free of you altogether but would do someting like FAP to save a little face.

Like I said maybe I'm missing the bigger picture here, but unless you had your heart set on doing FP or IM and doing your training in the military, I don't see how this is a bad deal. I would guess your contract will still be completed (ie, your tuitiion paid) but your future in the military is questionable. Given the normal attrition, I would also think anyone who really WANTS to pay back their HPSP on active duty would be able to.

Maybe I'll fire off an email to OH and see what they say about it.

Spang

Spang,

What you're saying may be true - or it may turn out exactly opposite...that's the thing right now, no one really knows how this is going to shake things up.

I can't speak for the Army or AF situations, but as for the Navy - they are going to be converting 162 Medical Corps billets to civilian contracts in the next fiscal year. They are going to be the non-operational, CONUS billets. While they've not released the billets yet, I anticipate that this will hit both primary care as well as some of the non-operational subspecialties. How this will affect GME & future HPSP students is all speculation...will it result in more rollovers into GMO tours for those not choosing the "operational specific" specialties such as surgery, ortho, ER, etc; or will it still allow folks to go finish primary care residencies & then stick them in traditionally GMO-filled operational billets; or they could roll all of these non-operational folks into jobs with the Dept of Health & Human Services (it's a possibility within the HPSP contract) to finish out their obligations....again it's anyone's guess.

It goes back to one of the common theme's of this military forum - if your goal is to become a military physician, by all means pursue the HPSP scholarship but don't do it for any other reason, financial or otherwise. There have never been any guarantees in military medicine & this has just served to shake-up whatever basic assumptions could have previously been made about GME & billet availability.

I'm justing waiting to see what happens, the same as everyone else.

# of days left in active duty = 72 & counting....

Sorry to drag up an old thread, but when I asked my recruiter about PBD 712 she claimed to have no idea what I was talking about. Is it possible that recruiters are that poorly informed (which is surprising considering how important it is for students to know before taking scholarships), or is it not as big a deal as it seems, or was she trying to dodge?

IM at Balboa lost 5 billets. Interestingly, 4 of these had not been filled in years, so the net effect there was essentially -1 staff physician.

The recruiter probably has no idea about this (which is only slightly less bad than actively lying). Recruiters do not have your best interests at heart and its not really in their interest to stay informed about this sort of stuff. It's as simple as that.

There are 6 sailors on my ship who were promised HM "A" school after a 2 year sea duty as a deck seaman. They all were assurred that, while here, they would spend the bulk of their time in the medical department. Well, they are taking up Deck billets and their department is not terribly inclined to lose them. So, they chip a lot of paint.

zoomass rower:

It's most likely she really didn't know. I emailed the people who administer the HPSP program and they didn't recognize the program by name, but when I explained they knew a little about it. It's the old "buyer beware" thing and the more you know the better off you are. Never, never take anything anyone in the military says as fact until you see the ALLNAV or NAVADMIN or instruction governing that program. Often the misinformation is just bad gouge, but even I will admit that recruiters may color the truth from time to time. Recruiters, and to a much greater extent, detailers, have a tough job pounding square pegs into round holes at times and if you think they don't cheat a little you'd be kidding yourself.

All that said, I think there's almost no way to forecast whether these developments (PBD 712) will be good for Navy medicine or bad, and definitely impossible to see into the future and guess whether it'll be good or bad for an individual doc. My perspective is a little different because I have 13 years active duty already, so after GME1 and GMO I'll only have 4 years to go until 20 so trudging through anything for that short of a period seems easy compared to the first 13 years I did (which weren't all that bad, truthfully).

Way more of an answer than you needed, but there you go.

Spang

PS: I heard there were something like 4 fewer Navy HPSP spots this year, but the person who told me that couldn't say if it was a direct result of PBD 712.

Bump...........

Scott-

Maybe I'm missing the bigger picture here. I think now is the perfect time to take a HPSP scholarship because if this works out to mean less IM and FP billets you would have to complete a residency in a specialty (FTIS or FTOS) which many people who take the scholarship are afraid of NOT being able to get.

Seocondly, I saw similar situations, twice, during my time as an aviator. In the early 90's, right after Desert Storm, they were separating pilots after their first tour who didn't augment, complete with exit bonuses. Four or five years later they started offering sizable retention bonuses for anyone, and I do mean anyone, who would stay. I myself took a two-year bonus to finish my tour in Key West and then go to a TAR squadron in the northeast.

I could see this happening...at the end of medical school, due to the shortage of FP, IM, OB/GYN, etc residency spots for HPSP'ers (recall USUHS folks get 'em first) they give out increased numbers of deferments, full or 1-year and/or offer you a reserve commission and let you do FAP if you want. Frankly they'd probably just as soon be free of you altogether but would do someting like FAP to save a little face.

Like I said maybe I'm missing the bigger picture here, but unless you had your heart set on doing FP or IM and doing your training in the military, I don't see how this is a bad deal. I would guess your contract will still be completed (ie, your tuitiion paid) but your future in the military is questionable. Given the normal attrition, I would also think anyone who really WANTS to pay back their HPSP on active duty would be able to.

Maybe I'll fire off an email to OH and see what they say about it.

Spang
Spang:

Didja ever serve with JIATF-East? I did a summer ADSW there in '97....

Small world...

I didn't serve with JIATF-East but some of my good buddies worked there and we transported alot of their guys to Miami for commercial flights to South America. I've seen their situation room where they track bad guys. Good stuff!

Spang

I didn't serve with JIATF-East but some of my good buddies worked there and we transported alot of their guys to Miami for commercial flights to South America. I've seen their situation room where they track bad guys. Good stuff!

Spang
Yeah, definitely good stuff! Great duty station, that one. Makes you feel like you're getting one over on Uncle Sugar.

Hope you had the chance to take advantage of all that KW had to offer! :thumbup:

thought this is a worthy thread to bump.

Anyway, what do you all think the effect of PBD 712 will be on USUHS. If 712's goal is as stated, will the military need to continue to fund its own medical school. Will enrolment decrease? I cant imagine any medical school operating where all its students would have to become specialists. any ideas?

Everyone should read Dr. Koenig's response - it gives both the historical perspective as well and the tentative plan. The PBD-712 has indeed been moved up, and does disproporionately hit the primary care specialties. However, many of the "downsized" billets will be through natural attrition and retirements. Remember that mandatory retirement is after 30 years as an officer, so people like myself with be naturally downsized shortly. The GME programs in the three services are mostly excellent, but some are being staffed at levels that the RRC (national governing body for all residencies, both civilian and military) feels may be at the lower limit of acceptability. The three services will look at their programs, determine how many physicians need to be trained in service and how many can be trained in civilian deferments. So, yes, there may be more civilian deferments available in the coming years. But some communities are grossly overstaffed - i.e., many more specialists than needed. As the salary differential decreases between the civilian and military sector, the proportion of specialists who stay in increases. The salary differential for my subspecialty is about $250,000. This is not that different from Anesthesiology, Orthopedic Surgery, and Neurosurgery. But pediatricians and family practice docs don't make that much money usually on the outside, plus everyone in private practice has to pay malpractice insurance, too. Every doctor in my subspecialty has indeed, gotten out as soon as their obligation was up. That is not to say that they were not dedicated, hardworking, compassionate talented physicians and surgeons. They just got out when they could, and are all making a gazillion bucks and are very happy. Physicians who enter active duty after a full civilian deferment will only owe the length of the HPSP contract, so mostly 3-4 years. All physicians are highly valued and are part of the whole health care team that provides high quality medical care to servicemembers, retirees, and their families. However, it is easier to make the decision to get out (i.e., not incur that huge retirement obligation from say, age 45 onward) when you have 3-4 years of creditable service vs. 9 (internship + 4 year residency + four year payback) or 12 (internship + 4 year residency + 7 year payback for USU).
With regard to cutting bases to the bare bones - there is a lot of redundancy in services, and the three branches are looking at where they really need doctors, vs. not. For example, when they closed Long Beach, the community absorbed both the active duty and dependent care without batting an eyelash. Why some places closed and others didn't is also politically driven to some extent. And if you have ever actually talked to a congressperson or senator, it is pretty scary that they vote on your tax dollars, too.
Bottom line, we have plenty of work to keep everyone gainfully employed. Your best bet is to make sure you are in touch with the GME offices from whatever branch of the service you are in in order to be as proactive as possible in making your selections. The Air Force has always had more full civilian deferments, and the care provided at AF hospitals achieves the same high standards as the Navy and Army, so there is unlikely to be a perceivable difference in care by changing the balance of civilian deferred and inservice trained providers.