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http://m.kitsapsun.com/news/1998/Mar/05/tom-philpott-order-some-doctors-need-more/
TOM PHILPOTT: Order: Some doctors need more training
Tom Philpott Thursday, March 5, 1998
The Defense Department has ordered the services to stop recruiting under-trained doctors and sending them to isolated billets where their performance can't be checked.
The physicians in question are called General Medical Officers. Roughly 1,500 GMOs now are on active duty, mostly in the Navy and Air Force. They serve primarily on ships, with Fleet Marine Force units or as flight surgeons.
GMOs are medical school graduates who spend only a year as interns before being shipped to an operational billet.
Defense officials have given the services four years to stop recruiting GMOs. Those already in service can stay for full careers, but some might see their assignment choices narrowed as the services tighten standards on patient care.
Most GMOs will be given a chance to complete two or three more years of graduate medical education to become fully qualified specialists in areas such as family practice, pediatrics, internal medicine, emergency medicine and occupational medicine.
Dr. Edward Martin, acting assistant secretary of defense for health affairs, said the military can no longer risk having undertrained doctors provide unsupervised care.
""The judgment is that (the GMO program) might have worked 10 or 20 years ago, but today they're not adequately trained to provide care, particularly to isolated duty,"" Martin said.
Service officials have worried for years about GMOs qualifications but have been slow to act. The Navy, asked by Defense recently to develop a four-year phaseout plan, provided a 10-year plan instead, said a Defense official.
Phaseout of GMOs is among 13 initiatives Martin recently unveiled to improve the quality of military medicine. It's controversial, in part, because it isn't sparked by high-profile malpractice cases. Martin told his staff he doesn't want the department to wait until tragedy strikes.
""We all know, conceptually, these people should be better trained, so let's do it,"" said a Defense official.
It is a particularly thorny issue for the Navy, Martin conceded, given the ""sizable number of doctors involved.""
The Army has only a few hundred GMOs. The Air Force has 450. That's 14 percent of its current total. But a quarter of all Navy physicians -- 750 -- are GMOs. That's a training gap that will be expensive to close.
The Navy invested heavily in GMOs because it's a forward-deployed force. Not long ago, it made sense to send young doctors, a year out of medical school, to care for a young, healthy population. Fully-trained specialists went to hospitals to sharpen their skills.
GMOs also made fiscal sense. ""The Navy didn't have to invest in specialty training for these people until they were mature enough to know this is the life they really wanted,"" an official said.
After an operational tour, GMOs can complete their residency program to become medical board eligible.
But over the years, graduate medical training has changed. A one-year internship is more classroom work now than the practical, hands-on experience that helped to prepare GMOs for isolated duty, an official explained.
Also, more is expected of doctors today wherever they are assigned. For example, many GMOs lack training in female health issues. Yet more and more women are being assigned to deploying units.
The military's move away from GMOs is part of a nationwide trend. Eleven states now require doctors to have more than a year of graduate medical education to be licensed.
The Navy now plans an aggressive recruiting effort of civilian doctors already in residency training. GMOs already are being replaced at units with a ""broad spectrum"" of patients. That includes aircraft carriers and amphibious ships, officials said.
Dr. James A. Zimble is president of the Uniformed Services University of the Health Sciences in Bethesda, Md., where many service doctors get their training. He warns that replacing GMOs with fully-trained specialists must be incremental. A former Navy surgeon general, Zimble said he isn't sure all GMOs should be phased out.
""We have to be sure in key locations that we do have the appropriate training,"" Zimble said. ""But perhaps a better solution would be increased use of teleconsultation and other aspects of telemedicine to reinforce the GMO.""
Air Force reforms are well under way. The service stopped recruiting GMOs last fall. It now is considering ""making residency training and board eligibility a condition of employment,"" said a spokeswomen for Air Force medicine. This change would apply to persons entering medical training on or after Oct. 1, 1999. Current GMOs would be ""grandfathered,"" she said.
Doctors who enter service after that date and fail to enter specialty training ""would only stay for their initial tour,"" she said. ""A career would not be an option.""
The Air Force also has begun assigning all GMOs in units with residency-trained physicians so they have someone to consult when questions arise.
With Martin set to retire, he worries that momentum for GMO reform will stall when he leaves. To prevent that from happening, a Defense official said, Martin recently invited Congress to write restrictions on GMOs into law.
TOM PHILPOTT: Order: Some doctors need more training
Tom Philpott Thursday, March 5, 1998
The Defense Department has ordered the services to stop recruiting under-trained doctors and sending them to isolated billets where their performance can't be checked.
The physicians in question are called General Medical Officers. Roughly 1,500 GMOs now are on active duty, mostly in the Navy and Air Force. They serve primarily on ships, with Fleet Marine Force units or as flight surgeons.
GMOs are medical school graduates who spend only a year as interns before being shipped to an operational billet.
Defense officials have given the services four years to stop recruiting GMOs. Those already in service can stay for full careers, but some might see their assignment choices narrowed as the services tighten standards on patient care.
Most GMOs will be given a chance to complete two or three more years of graduate medical education to become fully qualified specialists in areas such as family practice, pediatrics, internal medicine, emergency medicine and occupational medicine.
Dr. Edward Martin, acting assistant secretary of defense for health affairs, said the military can no longer risk having undertrained doctors provide unsupervised care.
""The judgment is that (the GMO program) might have worked 10 or 20 years ago, but today they're not adequately trained to provide care, particularly to isolated duty,"" Martin said.
Service officials have worried for years about GMOs qualifications but have been slow to act. The Navy, asked by Defense recently to develop a four-year phaseout plan, provided a 10-year plan instead, said a Defense official.
Phaseout of GMOs is among 13 initiatives Martin recently unveiled to improve the quality of military medicine. It's controversial, in part, because it isn't sparked by high-profile malpractice cases. Martin told his staff he doesn't want the department to wait until tragedy strikes.
""We all know, conceptually, these people should be better trained, so let's do it,"" said a Defense official.
It is a particularly thorny issue for the Navy, Martin conceded, given the ""sizable number of doctors involved.""
The Army has only a few hundred GMOs. The Air Force has 450. That's 14 percent of its current total. But a quarter of all Navy physicians -- 750 -- are GMOs. That's a training gap that will be expensive to close.
The Navy invested heavily in GMOs because it's a forward-deployed force. Not long ago, it made sense to send young doctors, a year out of medical school, to care for a young, healthy population. Fully-trained specialists went to hospitals to sharpen their skills.
GMOs also made fiscal sense. ""The Navy didn't have to invest in specialty training for these people until they were mature enough to know this is the life they really wanted,"" an official said.
After an operational tour, GMOs can complete their residency program to become medical board eligible.
But over the years, graduate medical training has changed. A one-year internship is more classroom work now than the practical, hands-on experience that helped to prepare GMOs for isolated duty, an official explained.
Also, more is expected of doctors today wherever they are assigned. For example, many GMOs lack training in female health issues. Yet more and more women are being assigned to deploying units.
The military's move away from GMOs is part of a nationwide trend. Eleven states now require doctors to have more than a year of graduate medical education to be licensed.
The Navy now plans an aggressive recruiting effort of civilian doctors already in residency training. GMOs already are being replaced at units with a ""broad spectrum"" of patients. That includes aircraft carriers and amphibious ships, officials said.
Dr. James A. Zimble is president of the Uniformed Services University of the Health Sciences in Bethesda, Md., where many service doctors get their training. He warns that replacing GMOs with fully-trained specialists must be incremental. A former Navy surgeon general, Zimble said he isn't sure all GMOs should be phased out.
""We have to be sure in key locations that we do have the appropriate training,"" Zimble said. ""But perhaps a better solution would be increased use of teleconsultation and other aspects of telemedicine to reinforce the GMO.""
Air Force reforms are well under way. The service stopped recruiting GMOs last fall. It now is considering ""making residency training and board eligibility a condition of employment,"" said a spokeswomen for Air Force medicine. This change would apply to persons entering medical training on or after Oct. 1, 1999. Current GMOs would be ""grandfathered,"" she said.
Doctors who enter service after that date and fail to enter specialty training ""would only stay for their initial tour,"" she said. ""A career would not be an option.""
The Air Force also has begun assigning all GMOs in units with residency-trained physicians so they have someone to consult when questions arise.
With Martin set to retire, he worries that momentum for GMO reform will stall when he leaves. To prevent that from happening, a Defense official said, Martin recently invited Congress to write restrictions on GMOs into law.
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