Effects of PBD 712 starting to happen

[Rudy]

Within the past few days I have heard of a few more examples of the downsizing of military medicine:

1) Peds, Int med and OB-GYN residencies at Travis AFB will be closing to new applicants this year for the first time since opening in the early 1970s. Apparently they will be allowing current residents to finish, but no new residents will arrive.

2) The Navy has decided to start outsourcing Pediatrics at all CONUS locations. This sounds like it will be a gradual process, but according to a friend of mine who recently rotated at NNMC Bethesda, they have already started reducing the number of peds residency slots.

I think these changes actually make sense and are in the best interest of the military given the current war time needs. It is becoming more and more clear that meeting war-time needs and maintaining full-service, highly specialized GME programs are two tasks that are difficult to sometimes impossible. It looks like the military is trying to evaluate how much longer it can justify staying in the business of GME--so I would expect further changes to continue to happen.

For those who are considering joining the military to obtain medical training, you need to realize that this is a major time of transition and in military medicine right now, and it is hard to predict how other programs may be affected by further downsizing.

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[umass rower]

This is important information for people taking HPSP scholarships who (like me) were told "Oh yeah, there are tons of Peds/IM/OB-GYN spots available in the Air Force (or whatever other branch)" A friend of mine was lured in by this, and I feel awful for her if she finishes med school and discovers that she can't get into Peds until she gets out of the military.

 

[Rudy]

EXACTLY. This is a really important issue. Most of the pre-med/med students focus primarily on the financial side of whether to join the military, but really don't have exposure to some of the major changes that are coming down the pipeline in terms of training opportunities and quality of practice in the military. The caseload for AF medicine is really tapering off and I think because of lack of case volume/diversity as well as an increasing emphasis on operational medicine will lead to further downsizing/closure of othe not-so-military essential specialties. This may not seem so important to some people now, but when it's time to select the career you will practice for 30-40 years, it will be huge. People need to be aware of this.

 

[batzmaru]

i'm assuming this new PBD 712 affects all the medical field, including dental?
would this mean less spots open for dental specialty residencies in the future? im just curious...

 

[idq1i]

So does this mean that the specialized GME people will be deferred en masse to the civilian side? (I hope)

Or...........does it mean that the military will go to an all-GMO force

 

[militarymd]

bump

 

[cmeshy]

So does this mean that the specialized GME people will be deferred en masse to the civilian side? (I hope)

Or...........does it mean that the military will go to an all-GMO force

I've been doing considerable googling of this subject and keep finding many letters and orders of such stating that GMO is on its way out. These especially come from Army orders, not sure about the Navy yet, and apparently most in the Air Force get what they want without doing GMO. So with the loss of GME positions, will that mean most HPSP and USHUS students will go civilian for GME? I think it makes since, just hope this is the case. They can save that money and keep it to keep facilities in better shape. If they state they will not make a student go into a field they don't wish and if they close GMO, I guess that would only leave civy education for residency.

Ahhhh, the uncertainty...drives me nuts. I really want to take this (HPSP) scholarship for many reasons, but the future of not doing GME that I have worked hard for sucks. plain sucks.

I read something along the lines too that stated Tricare is regulating that it wants at a min. 3 PGY trained only physicians for its force. So, it does really look like changes for the better are being made. In addition, I read that I believe next year, or very soon, budgets have been authorized to nearly double the ICP pay for physicians. Too many good guys leaving have stated that a near double in salary is too attractive to give up...can't blame them.

From defenselink.com:
Over the next three to four years, we will phase out our use of general medical officer physicians. The GMO designation is given to providers who are recent medical school graduates with only one year of postgraduate training. Historically we have used these physicians to fill medical requirements in line units and positions in adult care outpatient clinics within our medical treatment facilities. Medical training today assumes a requirement for three years of postgraduate medical education to produce a fully trained physician. Physicians with less training will not be able to assume the comprehensive duties of a primary care manager under our TRICARE program, especially for areas of increased attention such as women's health. A plan to limit future active duty accessions to physicians with three years of postgraduate training will be developed and implemented.
http://www.defenselink.mil/speeches/1997/s19971106-martin.html

decent article that seems to demonstrate that the problems often discussed here are identified and HOPEFULLY will be addressed.
Here's to the future...

 

[militarymd]

that's the probelm....UNCERTAINTY.....

 

[island doc]

I've been doing considerable googling of this subject and keep finding many letters and orders of such stating that GMO is on its way out. These especially come from Army orders, not sure about the Navy yet, and apparently most in the Air Force get what they want without doing GMO. So with the loss of GME positions, will that mean most HPSP and USHUS students will go civilian for GME? I think it makes since, just hope this is the case. They can save that money and keep it to keep facilities in better shape. If they state they will not make a student go into a field they don't wish and if they close GMO, I guess that would only leave civy education for residency.

Ahhhh, the uncertainty...drives me nuts. I really want to take this (HPSP) scholarship for many reasons, but the future of not doing GME that I have worked hard for sucks. plain sucks.

I read something along the lines too that stated Tricare is regulating that it wants at a min. 3 PGY trained only physicians for its force. So, it does really look like changes for the better are being made. In addition, I read that I believe next year, or very soon, budgets have been authorized to nearly double the ICP pay for physicians. Too many good guys leaving have stated that a near double in salary is too attractive to give up...can't blame them.

From defenselink.com:
Over the next three to four years, we will phase out our use of general medical officer physicians. The GMO designation is given to providers who are recent medical school graduates with only one year of postgraduate training. Historically we have used these physicians to fill medical requirements in line units and positions in adult care outpatient clinics within our medical treatment facilities. Medical training today assumes a requirement for three years of postgraduate medical education to produce a fully trained physician. Physicians with less training will not be able to assume the comprehensive duties of a primary care manager under our TRICARE program, especially for areas of increased attention such as women's health. A plan to limit future active duty accessions to physicians with three years of postgraduate training will be developed and implemented.
http://www.defenselink.mil/speeches/1997/s19971106-martin.html

decent article that seems to demonstrate that the problems often discussed here are identified and HOPEFULLY will be addressed.
Here's to the future...

That is an OLD statement on GMO accessions from almost a decade ago from before I separated. I ask you, have GMO's been brought into service since then, of course they have. More of Uncle Sam's lies...

 

[orbitsurgMD]

That is an OLD statement on GMO accessions from almost a decade ago from before I separated. I ask you, have GMO's been brought into service since then, of course they have. More of Uncle Sam's lies...

Tricare dictating terms. That is almost as believable as saying Medicaid is dictating terms. When you are a bottom-of-the barrel insurer, as Tricare unfortunately is, you are lucky to have participating providers at all. Funny, the military services never tell you that your payoff in retirement and for your family is going to be enrollment in an insurance plan most civilian providers don't really want.

Tricare is a disgrace. It is pimping patriotism, expecting participation from medical service providers based not on fair compensation for services to people who have earned the right to expect proper coverage, just like any federal employee ought to be able to expect, but instead on the cheap trade of guilt and a shirked moral obligation.