This memo means absolutely nothing. The services won’t follow it, they are forging their own path and it is tough to reverse course when MC manning is 70%. They dumped the infrastructure on the DHA and have pulled most of their remaining active workforce and told them that MTF duty and patient care isn’t important.
You ask the GS or contractors to do more, they quit or change jobs- or threaten to in the setting of the current severe manpower crunch - effectively ending the discussion. It just doesn’t happen. You have very little flexibility to convince career GS to do more than they want to. Military just transfer out or seek platform jobs which decreases overall FTE dedicated to patient care. The Navy does not have a deep bench to replace transferring clinicians due to training cuts in many specialties. They aren’t rewarded for patient care so they don’t see it as a priority. Once available FTE drops for a time and patients are kicked to the network, they are hard to get back.
DHA and their market leadership has no true idea what’s going on at the market level with availability of care or compensation, and no money to hire anything other than new online-trained NPs who send referrals for all problems- increasing cost of care due to unnecessary network specialty consults. Certainly no specialists are going to be hired directly for MTFs at DHA rates, and they have no true power to tell the services what they can do with their specialists- which frequently takes them out of patient care for menial tasks/operational reasons.
The old “see way fewer patients for a little less money” deal that they would offer 20 year ret O6 has gone away. These clinicians were important for facility stability. Now it is “see equivalent patients with no support staff for way less money.” No thanks - the few people that we retain to 20 years are not taking that deal. And by the way most of those people haven’t practiced at a high level for a while because they have been doing admin and operational jobs- they don’t want to go back to grinding clinic 1.0 FTE.
The MTF is a failed model and it’s winding down just by natural forces. The DHA is not agile enough to compete for people even with the VA. The DHA makes the VA look like Google or Apple when it comes to innovation and management, and it’s a mess too. But if you want to do federal/socialized medicine, it’s a better deal.
It is very difficult to bring back care to the MTF in the current environment and we don’t have the people or money to do it, plain and simple. Once these patients are gone they are gone, you can force some back but it’s only good until the next hospital ship deployment. It won’t end all at once but it is in a long declining sine wave that’s headed for 0.
We need to pull off the bandaid and end the MTF model. Either combine with the VA, or separate platforms from MTFs and have people work in the community. These are hard things but likely no harder than rebuilding the MTF system in a cost effective way.
/s
