2024 House proposed NDAA

[SirGecko]

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https://www.govinfo.gov/content/pkg/BILLS-118hr8070ih/pdf/BILLS-118hr8070ih.pdf

So the house advanced their bill out of committee and under the “access to medical care” section it includes a provision to mandate a survey on retention. Nothing to address retention, just a survey to ask people why they stay or don’t stay. I know there are several specialties in the 60ish percent manned or lower. I’m not saying they shouldn’t try to figure out the drivers for retention but I can think of a pretty big obvious one they could change if they actually wanted to affect retention... increase incentive pay to the levels they previously authorized. They’ve known from studies they have been underpaying us for years and still can’t figure that one out.

 

[armytrainingsir]

I am pretty confident they don’t care even one little bit about retention. Senior 03s and 04s are the sweet spot for military physicians; motivated to do whatever it takes to keep their skills up and out. No pension costs to worry about. As long as the HPSP pipeline stays full, no worries. And it is much cheaper to toss an extra 20k once to a first year medical student than to make a surgeon’s pay competitive for a career.

 

[Correlate Clinically]

I'd agree with armytraining. They've done similar surveys before. Nothing has changed. The answers are pretty obvious and I don't think it's a mystery.

Sometimes the survey questions are hilariously loaded/skewed. "Which of the following would make you more likely to stay on Active Duty? 1) bludgeoned daily with a dead goose 2) homestead assignment at <insert absolutely awful base location> 3) forced to walk on thumbtacks, barefoot, while singing a Dubstep version of the service medley song or 4) opportunity for more administrative duties."

Then they come back and say "See, no one said anything about needing more specialty pay or maintaining skills. But, we hear you, we're going to see if there's a way we can create more MC billets at <insert absolutely awful base location>!"

I agree that there really is not much incentive to care about retention so long as the training pipelines are full.

The military really only makes significant changes when there is a crisis. There probably won't be major changes to improve retention until there is a true retention/recruitment crisis. And arguably it has to be one that results in bad PR so it's a public crisis. Otherwise there's just not enough incentive on side of the policy makers to expend the political capital and resources to take action. The people making those calls are also balancing everyone's needs. Until Medical Corps issues are so bad they jump to the top of the triage pile, we're probably not going to see much movement.

 

[pgg]

Another survey? Wow! Is it Thursday again already?


They'll conduct yet another survey in which people respond with concerns about pay and case load, and then they'll publish some nonsense about how what military doctors really need is more "mentorship" and "leadership experience" ...

Maybe a couple of medical corps flag officers will kick off a 2024 Reunion World Tour and conduct town hall meetings at various commands to tout some convoluted comparison math in which they claim commissary benefits and tax-free BAH makes up for specialists earning 5th or 10th percentile MGMA paychecks, while case load concerns will be earnestly addressed with the same wind about civilian partnerships and ERSAs that they've been huffing about for the last 20 years.


In the end, the line is getting approximately what they need - a medical corps that keeps the AD population generally healthy and deployable, and that can boast 98% survival rates for combat wounds. From the line's perspective, there is no problem and therefore no reason to buy fewer ships, planes, trucks, missiles, or anything else they need to go kill people and break things.

 

[Correlate Clinically]

Anyone who has been in for any significant length of time is probably pretty frustrated, and that goes for all three branches.

This is key to understanding why a lot of things are the way they are: "In the end, the line is getting approximately what they need..."

When the AF screws up planning (again) and runs dangerously short of pilots, they eventually do things (sometimes effective, sometimes not so much) to retain or train more pilots.

Until the situation is so bad that Commanders have problems getting what they need and there are newspaper articles about either poor care or lack of access, from the perspective of whatever GO/flag officer is looking there really is no apparent problem. The only feedback to the top is "we don't have any doctors and can't go do what we need to."

When they rack and stack the problems of the day, it looks like base housing, that proposal for another CBT as a reaction to whatever idiot did something dumb in public, or a new $1B boat or plane is a much higher priority.

If you are only in the position for 2 years, every decision is a case of "what is a risk to me now." A demoralized medical corps that continues to keep everyone relatively health and alive is a "tomorrow problem".

While some of the high level priorities are misplaced, fundamentally it's not like they are irrational or deliberately trying to dismantle the military health system (at least, I hope not). It's just that within their 2 year horizon, other things look like they are more important.

Eventually tomorrow will come and the hollowed out medical services will be a much bigger problem than it needs to be. Fixing it, if they even try, will take much longer and cost much, much more than it would if the system had been maintained.

It is what it is.

 

[narcusprince]

As someone who has served active duty. I can tell you the salary issue is a non starter. My first year out I made 400k second year 1 million. The sad part is I had more vacation then when I was AD. 30 days versus 6 weeks versus 13 weeks currently. I do think a good arguing is all the perks of private practice. I don’t pay for any meals at my hospital and neither does my staff. In addition physicians parking no searching a over packed parking garage. A physicians lounge with all the refreshments I need. Also easier lifestyle many days I am at the gym by 1-2 pm, easy EMR to look up my patients. I am also in much better shape physically outside the military versus inside. The military really should incorporate gym hours into your workday.