DOD Inspector General report, November 2023, on access to care

[Monty Python]

What a mismanaged circus affecting access to care.

https://media.defense.gov/2023/Nov/30/2003349496/-1/-1/1/DODIG-2024-033_REDACTED.PDF

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[armytrainingsir]

Nothing that yet another layer of bureaucrats and meetings can’t fix!

 

[Gastrapathy]

I wonder how much taxpayers paid for them to recommend a survey and recommend that the DoD bring their health care networks into compliance with their access standards. Great advice.

 

[Brouillet2017]

A "leopards ate my face" moment if there ever was one....

 

[TheEarDoc]

What a mismanaged circus affecting access to care.

https://media.defense.gov/2023/Nov/30/2003349496/-1/-1/1/DODIG-2024-033_REDACTED.PDF

Wait a minute! I thought DHA and purple medicine was going to correct all these issues!

 

[Chonal Atresia]

Dumpster fire…just when you think military medicine can’t become any more incompetent than it already is.

Monkeys on a flagpole…..

 

[DrMetal]

To be honest, I don't think we have an access to care problem, at least not for our active duty. I've never had problems getting an AD member care when they really needed it.

Now, we have a lot of broken and needy soldiers/sailors who think having to wait 10 days to see a mental health provider is unacceptable (meanwhile the wait in the civilian world is 2-3 months). We also have a plethora of psychosomatic situations, and we're just too scared to tell people how healthy they really are.

For our dependents and retirees: we could do a lot better. It's unfortunate most are deferred out to the network. They make for great volume and acuity.

 

[militaryPHYS]

Mom and Dad are fighting and I’m just over here doing my job.

Seems like this also a way for DOD to make it known they are doing their part to advocate for the mental health of their people even if DHA is falling short of expectations.

 

[pawprint]

Access to care IS horrible. I can’t get any of my patients in to see any subspecialists for at least 4 weeks. One time I had an active thyroid cancer patient PCS to my clinic (the operational duty screener nurse practitioner lied and said the patient was in perfect health, and her previous endocrinologist had deployed on a hospital ship without transferring her care to anyone), and I couldn’t get an endocrinologist or ENT to see her 8 weeks…which is totally substandard for care.

I could go on and on with other examples, both my active duty folks and their spouses have abysmal referral wait times. Meanwhile I’ll try and manage their care with my one year of training as a pediatric intern and 8 weeks of flight medicine training.

 

[armytrainingsir]

A "leopards ate my face" moment if there ever was one....

Is that like ‘a dingo ate my baby’?

 

[militaryPHYS]

Access to care IS horrible. I can’t get any of my patients in to see any subspecialists for at least 4 weeks. One time I had an active thyroid cancer patient PCS to my clinic (the operational duty screener nurse practitioner lied and said the patient was in perfect health, and her previous endocrinologist had deployed on a hospital ship without transferring her care to anyone), and I couldn’t get an endocrinologist or ENT to see her 8 weeks…which is totally substandard for care.

I could go on and on with other examples, both my active duty folks and their spouses have abysmal referral wait times. Meanwhile I’ll try and manage their care with my one year of training as a pediatric intern and 8 weeks of flight medicine training.

You are well trained and should be confident in your ability to manage primary care issues at an active duty clinic.

Based on the patient's previous notes and your assessment, if the patient requires faster access then it is very appropriate to call endocrinology or ENT directly. Any specialist/sub-specialist appreciates a phone call if there is a patient who truly needs to be seen and is caught in the referral backlog. Call in a respectful way, ask if the patient needs to be seen sooner and let them make the decision as the subspecialist. If there are any issues with this process involve your leadership.

Right now there are abysmal wait times in all sectors of U.S. Healthcare. My father lives in a major city and has new and significant neurocognitive decline. His wait time to see a neuropsych is 6 months and PCP is not doing anything now to actually begin cognitive, behavioral, medical or social treatments.

Major issues with Tricare and DHA, no doubt. The U.S. healthcare system in general is in decline due to attrition as a result of over emphasis on EMR/documentation, reactive medicine that reimburses well plus other insurance BS, and other bureaucratic red tape.

Focus on what you can control, don't feel pressured to practice outside of your training, voice concerns when standard of care is being breached. Always have COA's ready for the problems that you identify in the system.

 

[DrMetal]

Access to care IS horrible. I can’t get any of my patients in to see any subspecialists for at least 4 weeks.

That's pretty good, believe it or not. Most subspecs in the civilian world have a 2-3 month que. (For real cancer, people tend to move more quickly, but you have to prove it's cancer. I get all the labs, rads, IR biopsies done. Once we really know it's cancer, don't have much trouble getting people seen.)

Right now there are abysmal wait times in all sectors of U.S. Healthcare.

Quite true. It's our own fault. We've flooded the entire medical system with so much "nothing-burger" medicine, that it's now impossible to get people seen when they really need it. Not every hypothyroid needs and an Endocrinologist, not every mild-cognitive-impairment needs a neurologist. But we (primary care types) have become so scared to take care of anything ourselves, plus the plethora of mid-levels now involved, has all made for great Consultology.

 

[militaryPHYS]

But we (primary care types) have become so scared to take care of anything ourselves, plus the plethora of mid-levels now involved, has all made for great Consultology.

Well I also think its because PCP's are now expected to see umpteen patients per half day and there isn't enough time to do the right thing for every single patient because the breadth of issues is so large.

Patients don't just need the billable treatment we have to offer. They also need us as a trusted community member to listen to them so that they can be heard, understood and actually cared for beyond what codes well.

 

[Atlas Shrugged]

More surveys, great. Higher likes to talk about accountability at the servicemember level, yet there is no accountability for higher.

 

[Atlas Shrugged]

Did y’all see the response from the deputy secretary of defense? Apparently DHA is going to assume command. Which as a body that is supposed to civilianize things seems strange.

I assume the services will make all physicians MAP, EMF-M, and whatever the air force calls it.

 

[MedicalCorpse]

I assume the services will make all physicians MAP, EMF-M, and whatever the air force calls it.

Based on the Vietnam War technology I experienced in the California desert during MOBEXes around the year 2000,
the most accurate Air Force terminology would be: Antiquated Medical Facility: Yurt On Yurt Off (AMF:YOYO).

...similar to the Navy's Roll On, Roll Off (RORO), without any of the latter's functionality.

 

[militaryPHYS]

Did y’all see the response from the deputy secretary of defense? Apparently DHA is going to assume command. Which as a body that is supposed to civilianize things seems strange.

I assume the services will make all physicians MAP, EMF-M, and whatever the air force calls it.

Where did you see this? Can't find it