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Military looking for a few good medics
... and surgeons, and RNs, and radiologists, too
By Michael Moran
Senior correspondent
MSNBC
Updated: 6:09 a.m. CT June 10, 2005
NEWARK, N.J. Sirens wailing, Ed Wheats ambulance races through the streets of Newark en route to yet another GSW. In Wheat's world, that's shorthand for gun shot wound. Newark is a city so rough that no one but the state government is willing to take responsibility for emergency medical care. Wheats crew is often the first on the scene of traumatic accidents, stabbings and gun battles.
This time, the initial report is wrong not a gun shot victim, just a 300-pound diabetic, former professional boxer whose hypoglycemic state has him flailing at those who have come to his aid. Wheat, a 64 250 pounds former military policeman, is the perfect candidate to step in and subdue the man. With several police and firefighters, he moves in and takes a hard punch in the eye before the man is loaded into the ambulance for treatment.
Its like that some days, Wheat says, showing off a burgeoning shiner. It can be quiet sometimes, but a lot of times its run and gun, and youre fighting to stay focused on your job, almost robotic, instead of thinking about what could happen around you.
Coolness under pressure and his experience with gun and knife wounds makes the 34-year-old the perfect candidate for another job, one the Army and Marine Corps are more and more desperate to fill these days. A few months ago, Wheat and several of his colleagues here were approached by a Navy recruiter who promised a tax-free $120,000 bonus if they agreed to sign on as medical consultants with a Marine Corps unit in Iraq.
I knew what they were asking, and dont get me wrong, I was tempted, says Wheat. Thats a lot of money, and I really want to help. But I worried that I wouldnt be accepted by the Marines, as an outsider, and I wont kid you I thought about getting killed or injured. And I decided. Hey, Im already doing a job thats dangerous that no one else wants right here. So I said no.
Luring trained veterans like Ed Wheat back into the medical corps is a full-time headache for the military, which even in peace time is compelled to offer bonuses and perks that would compare with those available in the private sector. These days, with conflicts in Iraq and Afghanistan and the military attempting to add more than 40,000 new soldiers over the next few years, the challenge is more acute than ever.
Whats happening with our combat medics is not so much a recruiting problem as it is keeping up with the Armys expansion, says Lt. Gen. Kevin Kiley, the Armys surgeon general. Were standing up entirely new brigades, and that has added to requirements, so were having to hustle to continue to recruit highly qualified men and women who can make it through courses and get into the field.
More acute for specialties
The decline in general Army recruiting in recent months has been precipitous. On Wednesday, for instance, the Army said that it had missed its recruitment goal for May by more than 25 percent that after lowering its monthly target. It was the fourth month in a row that recruitment fell short. Perhaps more importantly, unlike February and March, which are traditionally slow periods for recruiters, May is usually a busy month as students begin to graduate or anticipate graduation from high school.
While media reports have focused on the problems the Army and Marine Corps are having with recruitment, the retention of highly trained specialists is as serious, if not more so, for the long-term ability of the military to sustain operations around the globe. Kiley notes that some 36,000 medical staff doctors, nurses, technicians have deployed to southwest Asia from the Army alone in the past four years. That is not only time away from home, but in some cases an interruption of their training as internists or medical students.
The bonuses offered to Wheat and others to work as private consultants are part of a series of strategies designed to bring in highly trained people and to hold on to those already in the service.
In my experience, in the Army since 1976, it has never been easy to hold on to people who can command high salaries in the outside world, says Kiley. But today were also feeding into the larger issue of recruiting for the Army altogether, and were having some issues of getting our total end strengths up to the maximums. And our ability to offer bonuses is key.
For instance, the Army is currently offering a $20,000 bonus to those who agree to re-enlist after their first four year tour is up. But that amount can grow depending on the skills involved and the militarys need for them.
Paging Dr. Dogface
Some of these specialties are perennially difficult to keep. For the most highly skilled cardio-thoracic surgeons, neurological specialist, orthopedic surgeons - bonuses can in some cases be up to $70,000 a year. As Wheat attests, for those who prefer to work as private consultants on the front lines in Iraq, the amount can be much higher.
For the most part, the militarys medical system trains its own doctors, either through ROTC-like scholarship programs, which trade medical school tuition and some expenses for a seven year commitment to the military, or more directly by educating them at the Uniformed Services Universities of the Health Sciences just north of Washington.
Weve been in a sustained deployment now and it has its impact on recruiting and retention, says Virginia Stephanakis, an Army Medical Command spokesperson. Its something were keeping an eye on. But the long commitment after training helps ensure we always have enough people to fight a war and to take care of military family medical needs.
Kiley and other military medical commanders recently appeared before Congress to urge them to increase the flexibility of the current bonus system. Kiley says if he had the flexibility to offer special packages when they were needed to certain specialties, Id fill every slot, I believe. As it is under the current system, I have 4,347 physicians authorized, but only 4,220 on duty.
Bonuses under the current system are set year-by-year by Congress, with little discretion exercised by military medical commanders.
For instance, this year all obstetricians may get $34,000, but that could drop next year to $29,000, Kiley says. A radiologist could get as high as $50,000. And others further down the list could be offered a multiple specialty bonus meaning if you sign on for two years you get $20,000 over that period.
Steve Kosiak, an analyst with the Center for Strategic and Budgetary Assessments in Washington, notes that bonuses currently make up five percent of the total amount the Pentagon spends on military pay. Most of that is in across the board bonuses, like the $20,000 being offered for reenlistment, he says. If it were structured to target specialists better, it could be a more effective program.
Where are the nurses?
Other specialties in the medical and other fields also are experiencing serious shortfalls. These include information and internet specialists, as well as many mid-level officers who appear to be concluding that plotting a military career during wartime is not as attractive as it may have been during the 1990s.
Others, like registered nurses, who rank as officers in the military, and non-commissioned physicians assistants and certain engineering positions, reflect shortages that extend into the civilian economy, as well.
We are having some problems retaining nurses, Gen. Kiley says. They are in great demand in the civilian sector. And were also having some trouble with physicians assistants, too. Its not just a question of Iraq, its a question that there arent enough slots open in universities military or civilian to fill current demand.
Unfortunately, the way the militarys pay and retirement and promotions system is structured creates a distortion, says Cindy Williams, an MIT military analyst who for years specialized in personnel issues for the Congressional Budget Office. They wind up keeping too many of the wrong people cooks and clerks and unskilled laborers where the salaries and benefits in the civilian economy would not be so different and not enough of the right people who can make far more by leaving.
The problem with that, Williams says, is that serving 14 to 20 years as a medical specialist probably means that at the end of your career you are a stellar medical specialist. Where as, say, someone who has been cooking in a mess hall for 20 years is likely to be only marginally better, if at all.
Kiley recognizes the problem, but says he has to live in the real world if he is to mitigate the consequences.
You ask the doctors who are leaving where theyre going, and it is stunning, mind-boggling what the cardiologists, radiologists and orthopedic surgeons are getting, Kiley says. In a sustained way, we cant keep up. We have to rely, at least in part, on patriotism and a sense of duty, and the obligation that some of these doctors and nurses and other people owe the military because we trained them.
URL: http://www.msnbc.msn.com/id/8143733/
... and surgeons, and RNs, and radiologists, too
By Michael Moran
Senior correspondent
MSNBC
Updated: 6:09 a.m. CT June 10, 2005
NEWARK, N.J. Sirens wailing, Ed Wheats ambulance races through the streets of Newark en route to yet another GSW. In Wheat's world, that's shorthand for gun shot wound. Newark is a city so rough that no one but the state government is willing to take responsibility for emergency medical care. Wheats crew is often the first on the scene of traumatic accidents, stabbings and gun battles.
This time, the initial report is wrong not a gun shot victim, just a 300-pound diabetic, former professional boxer whose hypoglycemic state has him flailing at those who have come to his aid. Wheat, a 64 250 pounds former military policeman, is the perfect candidate to step in and subdue the man. With several police and firefighters, he moves in and takes a hard punch in the eye before the man is loaded into the ambulance for treatment.
Its like that some days, Wheat says, showing off a burgeoning shiner. It can be quiet sometimes, but a lot of times its run and gun, and youre fighting to stay focused on your job, almost robotic, instead of thinking about what could happen around you.
Coolness under pressure and his experience with gun and knife wounds makes the 34-year-old the perfect candidate for another job, one the Army and Marine Corps are more and more desperate to fill these days. A few months ago, Wheat and several of his colleagues here were approached by a Navy recruiter who promised a tax-free $120,000 bonus if they agreed to sign on as medical consultants with a Marine Corps unit in Iraq.
I knew what they were asking, and dont get me wrong, I was tempted, says Wheat. Thats a lot of money, and I really want to help. But I worried that I wouldnt be accepted by the Marines, as an outsider, and I wont kid you I thought about getting killed or injured. And I decided. Hey, Im already doing a job thats dangerous that no one else wants right here. So I said no.
Luring trained veterans like Ed Wheat back into the medical corps is a full-time headache for the military, which even in peace time is compelled to offer bonuses and perks that would compare with those available in the private sector. These days, with conflicts in Iraq and Afghanistan and the military attempting to add more than 40,000 new soldiers over the next few years, the challenge is more acute than ever.
Whats happening with our combat medics is not so much a recruiting problem as it is keeping up with the Armys expansion, says Lt. Gen. Kevin Kiley, the Armys surgeon general. Were standing up entirely new brigades, and that has added to requirements, so were having to hustle to continue to recruit highly qualified men and women who can make it through courses and get into the field.
More acute for specialties
The decline in general Army recruiting in recent months has been precipitous. On Wednesday, for instance, the Army said that it had missed its recruitment goal for May by more than 25 percent that after lowering its monthly target. It was the fourth month in a row that recruitment fell short. Perhaps more importantly, unlike February and March, which are traditionally slow periods for recruiters, May is usually a busy month as students begin to graduate or anticipate graduation from high school.
While media reports have focused on the problems the Army and Marine Corps are having with recruitment, the retention of highly trained specialists is as serious, if not more so, for the long-term ability of the military to sustain operations around the globe. Kiley notes that some 36,000 medical staff doctors, nurses, technicians have deployed to southwest Asia from the Army alone in the past four years. That is not only time away from home, but in some cases an interruption of their training as internists or medical students.
The bonuses offered to Wheat and others to work as private consultants are part of a series of strategies designed to bring in highly trained people and to hold on to those already in the service.
In my experience, in the Army since 1976, it has never been easy to hold on to people who can command high salaries in the outside world, says Kiley. But today were also feeding into the larger issue of recruiting for the Army altogether, and were having some issues of getting our total end strengths up to the maximums. And our ability to offer bonuses is key.
For instance, the Army is currently offering a $20,000 bonus to those who agree to re-enlist after their first four year tour is up. But that amount can grow depending on the skills involved and the militarys need for them.
Paging Dr. Dogface
Some of these specialties are perennially difficult to keep. For the most highly skilled cardio-thoracic surgeons, neurological specialist, orthopedic surgeons - bonuses can in some cases be up to $70,000 a year. As Wheat attests, for those who prefer to work as private consultants on the front lines in Iraq, the amount can be much higher.
For the most part, the militarys medical system trains its own doctors, either through ROTC-like scholarship programs, which trade medical school tuition and some expenses for a seven year commitment to the military, or more directly by educating them at the Uniformed Services Universities of the Health Sciences just north of Washington.
Weve been in a sustained deployment now and it has its impact on recruiting and retention, says Virginia Stephanakis, an Army Medical Command spokesperson. Its something were keeping an eye on. But the long commitment after training helps ensure we always have enough people to fight a war and to take care of military family medical needs.
Kiley and other military medical commanders recently appeared before Congress to urge them to increase the flexibility of the current bonus system. Kiley says if he had the flexibility to offer special packages when they were needed to certain specialties, Id fill every slot, I believe. As it is under the current system, I have 4,347 physicians authorized, but only 4,220 on duty.
Bonuses under the current system are set year-by-year by Congress, with little discretion exercised by military medical commanders.
For instance, this year all obstetricians may get $34,000, but that could drop next year to $29,000, Kiley says. A radiologist could get as high as $50,000. And others further down the list could be offered a multiple specialty bonus meaning if you sign on for two years you get $20,000 over that period.
Steve Kosiak, an analyst with the Center for Strategic and Budgetary Assessments in Washington, notes that bonuses currently make up five percent of the total amount the Pentagon spends on military pay. Most of that is in across the board bonuses, like the $20,000 being offered for reenlistment, he says. If it were structured to target specialists better, it could be a more effective program.
Where are the nurses?
Other specialties in the medical and other fields also are experiencing serious shortfalls. These include information and internet specialists, as well as many mid-level officers who appear to be concluding that plotting a military career during wartime is not as attractive as it may have been during the 1990s.
Others, like registered nurses, who rank as officers in the military, and non-commissioned physicians assistants and certain engineering positions, reflect shortages that extend into the civilian economy, as well.
We are having some problems retaining nurses, Gen. Kiley says. They are in great demand in the civilian sector. And were also having some trouble with physicians assistants, too. Its not just a question of Iraq, its a question that there arent enough slots open in universities military or civilian to fill current demand.
Unfortunately, the way the militarys pay and retirement and promotions system is structured creates a distortion, says Cindy Williams, an MIT military analyst who for years specialized in personnel issues for the Congressional Budget Office. They wind up keeping too many of the wrong people cooks and clerks and unskilled laborers where the salaries and benefits in the civilian economy would not be so different and not enough of the right people who can make far more by leaving.
The problem with that, Williams says, is that serving 14 to 20 years as a medical specialist probably means that at the end of your career you are a stellar medical specialist. Where as, say, someone who has been cooking in a mess hall for 20 years is likely to be only marginally better, if at all.
Kiley recognizes the problem, but says he has to live in the real world if he is to mitigate the consequences.
You ask the doctors who are leaving where theyre going, and it is stunning, mind-boggling what the cardiologists, radiologists and orthopedic surgeons are getting, Kiley says. In a sustained way, we cant keep up. We have to rely, at least in part, on patriotism and a sense of duty, and the obligation that some of these doctors and nurses and other people owe the military because we trained them.
URL: http://www.msnbc.msn.com/id/8143733/
And no I've never made claim to being an expert in small practice economics.
