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If I wanted to join the Army, I would have joined the Army. I signed up for the Air Force precisely because I wanted to avoid these kinds of situations.
AVOID MILITARY MEDICINE if possible
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If I wanted to join the Army, I would have joined the Army. I signed up for the Air Force precisely because I wanted to avoid these kinds of situations.
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Really? I went to medical school precisely because I wanted to avoid these kinds of situations. 😀
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This is an interesting comment. An AF FP Col I knew a few years back said that FP job satisfaction in the AF was much lower than the other services and he felt that part of the reason was that people chose the airforce because it was the "least military" service and that wasn't as true as people thought. Obviously this isn't close to the only reason AF folks are dissatisfied, but this kind of comment seems to bear that out to some degree.
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[
I suspect there is at least some "truth" in that assessment.
In general, "expectations" play a large role in "satisfaction". For example. If you and I get deployed to IRAQ, and we are "expecting/told" it will be a 6 month deployment, and with 2 weeks to go we find out we will be extended another 5 months...you and I will be "dissatisfied". Yet, if you and I were deployed to IRAQ, and told it will be for 1 year, and with 2 months to go, we get word that we are going home 1 month early, we will likely be elated.
Now in both instances, we got deployed for 11 months, but our "take" on how the military "does business" will be very different in the 2 scenarios.
Experiences/life experiences also play a role. For example, some Family docs I work with in civilian medical care have some problems with the current status of "things". But for me, because I have USAF Primary Care "expereince", no matter how "bad" things can get in the civilian world, things are LIGHT YEARS better than USAF Primary care. There are challenges in civilian med as well as milmed, but civilian med is a "sinus headache" that resolves with an excedrine. Primary care Milmed is "the worst headache of your life" and if anyone should care to "MRI the brain of milmed" they would find a rotting malignancy that needs to be excised asap.
Now I was also prior enlisted, and knew very well about military "rules", "hurry up and wait" and all the stuff that comes somewhat uniquely with a military career. But not in my wildest dreams did I ever imagine that my time as a USAF FP would expose me to the a healthcare system operating on "fumes" like I saw at my base, and is unfortunately found throughout the military primary care system.
[/QUOTE]
I suspect there is at least some "truth" in that assessment.
In general, "expectations" play a large role in "satisfaction". For example. If you and I get deployed to IRAQ, and we are "expecting/told" it will be a 6 month deployment, and with 2 weeks to go we find out we will be extended another 5 months...you and I will be "dissatisfied". Yet, if you and I were deployed to IRAQ, and told it will be for 1 year, and with 2 months to go, we get word that we are going home 1 month early, we will likely be elated.
Now in both instances, we got deployed for 11 months, but our "take" on how the military "does business" will be very different in the 2 scenarios.
Experiences/life experiences also play a role. For example, some Family docs I work with in civilian medical care have some problems with the current status of "things". But for me, because I have USAF Primary Care "expereince", no matter how "bad" things can get in the civilian world, things are LIGHT YEARS better than USAF Primary care. There are challenges in civilian med as well as milmed, but civilian med is a "sinus headache" that resolves with an excedrine. Primary care Milmed is "the worst headache of your life" and if anyone should care to "MRI the brain of milmed" they would find a rotting malignancy that needs to be excised asap.
Now I was also prior enlisted, and knew very well about military "rules", "hurry up and wait" and all the stuff that comes somewhat uniquely with a military career. But not in my wildest dreams did I ever imagine that my time as a USAF FP would expose me to the a healthcare system operating on "fumes" like I saw at my base, and is unfortunately found throughout the military primary care system.
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I wonder what docs out there expected to be in a "typing billet".
interesting news clip from today.
http://news.yahoo.com/s/ap/20070424/ap_on_go_ca_st_pe/air_force_woes
WASHINGTON - The Air Force's top general expressed frustration on Tuesday with the reassignment of troops under his command to ground jobs for which they were not trained, ranging from guarding prisoners to driving trucks and typing. (what about GMOs running ERs, or brand new PAs running FP clinics?)
Gen. Michael Moseley, the Air Force chief of staff, said that over 20,000 airmen have been assigned worldwide into roles outside their specialties.
With President Bush and Congress in a standoff over Iraq spending, the Pentagon is shifting money among services and accounts, including drawing down funds earmarked for other later purposes.
"Somebody's going to have to pay us back," Moseley said. "I don't have to want to have concerns about getting that money back." (wheres the money? is what milmed is all about nowadays)
In a breakfast session with a group of reporters, Moseley said he was trying to be realistic. "We live in a joint world. We live in a military that's at war. And we live in a situation where, if we can contribute, then sign me up for it."
Still, the Air Force general added, "I'm less supportive of things outside our competency."
He said people were being assigned to jobs they weren't trained for. He cited Air Force airmen being used to guard prisoners and to serve as drivers and cited one instance in which an Air Force surgeon was assigned typing chores after three days at her new post.
"We got her back," Moseley said.
Others are being assigned to help the Army provide security in Iraq and Afghanistan.
Moseley said he didn't mind the use of airmen as drivers as much as some of the other new duties usually performed by the Army, such as guarding prisoners.
"Not only do we not have a prison, but very rarely do we have anybody in prison," he joked.
"So, to take our people and train them to be a detainee-guarding entity requires `x' amount of time away from their normal job," said Moseley.
"Those are the things that are very frustrating," he said.
He said the swap-outs come at a time when the Air Force's budget is burdened, when there is little money for new aircraft and when maintaining an aging fleet of older planes, some of them going back to the 1950s and 1960s, is getting increasingly expensive.
"Operational and maintenance costs have gone up 180 percent over the past 10 years, operating these old aircraft," he said.
As part of Bush's troop buildup in order to try to secure Baghdad and nearby hot spots, there are currently about 146,000 U.S. troops in Iraq.
Of these, about 9,500 are Air Force. An additional 1,100 airmen are in Afghanistan, according to the Air Force. Roughly 24,100 Air Force personnel are stationed throughout the broader region.
With much of the action in Iraq now focused on neighborhood-to-neighborhood efforts to contain violence, there has been less attention on the roles of the Air Force and the Navy.
Moseley said the Air Force still has vital responsibilities in Iraq, including striking targets, surveillance and search and rescue missions.
The Pentagon says it has enough money to pay for the Iraq war through June. The Army is taking "prudent measures" aimed at ensuring that delays in the bill financing the war do not harm troop readiness, such as moving money from other accounts, according to instructions sent to Army commanders and budget officials April 14.
The Defense Department also said it plans to ask Congress to approve the temporary reprogramming of $1.6 billion from Navy and Air Force pay accounts to the Army's operating account.
The $70 billion that Congress provided in September for military operations in Iraq and Afghanistan has mostly run out, and the Army has told department officials to slow the purchase of nonessential repair parts and other supplies, restrict the use of government charge cards and limit travel.
On another subject, Moseley said he had ordered a review of vulnerabilities of U.S. military satellites, partially in response to China's anti-missile test in January, in which it used a missile to destroy one of its own old weather satellites. He said he found China's move alarming.
China's motives remain unclear, but demonstrating that it can shoot down one of its own satellites also suggests it could knock another nation's satellites out of the sky if it chose, which Moseley said would be widely seen as an act of war.
[/QUOTE]
I wonder what docs out there expected to be in a "typing billet".
interesting news clip from today.
http://news.yahoo.com/s/ap/20070424/ap_on_go_ca_st_pe/air_force_woes
WASHINGTON - The Air Force's top general expressed frustration on Tuesday with the reassignment of troops under his command to ground jobs for which they were not trained, ranging from guarding prisoners to driving trucks and typing. (what about GMOs running ERs, or brand new PAs running FP clinics?)
Gen. Michael Moseley, the Air Force chief of staff, said that over 20,000 airmen have been assigned worldwide into roles outside their specialties.
With President Bush and Congress in a standoff over Iraq spending, the Pentagon is shifting money among services and accounts, including drawing down funds earmarked for other later purposes.
"Somebody's going to have to pay us back," Moseley said. "I don't have to want to have concerns about getting that money back." (wheres the money? is what milmed is all about nowadays)
In a breakfast session with a group of reporters, Moseley said he was trying to be realistic. "We live in a joint world. We live in a military that's at war. And we live in a situation where, if we can contribute, then sign me up for it."
Still, the Air Force general added, "I'm less supportive of things outside our competency."
He said people were being assigned to jobs they weren't trained for. He cited Air Force airmen being used to guard prisoners and to serve as drivers and cited one instance in which an Air Force surgeon was assigned typing chores after three days at her new post.
"We got her back," Moseley said.
Others are being assigned to help the Army provide security in Iraq and Afghanistan.
Moseley said he didn't mind the use of airmen as drivers as much as some of the other new duties usually performed by the Army, such as guarding prisoners.
"Not only do we not have a prison, but very rarely do we have anybody in prison," he joked.
"So, to take our people and train them to be a detainee-guarding entity requires `x' amount of time away from their normal job," said Moseley.
"Those are the things that are very frustrating," he said.
He said the swap-outs come at a time when the Air Force's budget is burdened, when there is little money for new aircraft and when maintaining an aging fleet of older planes, some of them going back to the 1950s and 1960s, is getting increasingly expensive.
"Operational and maintenance costs have gone up 180 percent over the past 10 years, operating these old aircraft," he said.
As part of Bush's troop buildup in order to try to secure Baghdad and nearby hot spots, there are currently about 146,000 U.S. troops in Iraq.
Of these, about 9,500 are Air Force. An additional 1,100 airmen are in Afghanistan, according to the Air Force. Roughly 24,100 Air Force personnel are stationed throughout the broader region.
With much of the action in Iraq now focused on neighborhood-to-neighborhood efforts to contain violence, there has been less attention on the roles of the Air Force and the Navy.
Moseley said the Air Force still has vital responsibilities in Iraq, including striking targets, surveillance and search and rescue missions.
The Pentagon says it has enough money to pay for the Iraq war through June. The Army is taking "prudent measures" aimed at ensuring that delays in the bill financing the war do not harm troop readiness, such as moving money from other accounts, according to instructions sent to Army commanders and budget officials April 14.
The Defense Department also said it plans to ask Congress to approve the temporary reprogramming of $1.6 billion from Navy and Air Force pay accounts to the Army's operating account.
The $70 billion that Congress provided in September for military operations in Iraq and Afghanistan has mostly run out, and the Army has told department officials to slow the purchase of nonessential repair parts and other supplies, restrict the use of government charge cards and limit travel.
On another subject, Moseley said he had ordered a review of vulnerabilities of U.S. military satellites, partially in response to China's anti-missile test in January, in which it used a missile to destroy one of its own old weather satellites. He said he found China's move alarming.
China's motives remain unclear, but demonstrating that it can shoot down one of its own satellites also suggests it could knock another nation's satellites out of the sky if it chose, which Moseley said would be widely seen as an act of war.
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I knew GMO tours were bad---but typing?!?
the military certainly exceeds in producing EX-milmed physicians😍
I often read that something like 85-90% of USUHS students actually
stay in the military until retirement. It goes to show that most people
that are doing HPSP might be joining the military for the wrong
reasons.
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Somehow, I'm not surprised.
A surgeon's claim-to-fame is that they operate... it's also the one thing that only the surgeon can do. It makes sense (in a profit and efficiency-driven system) to offload non-surgeon-specific tasks to other people. The military views this differently, as it's a zero-sum game for them.
In civilian medical practice, an orthopedic surgeon operates as much as possible. Somebody else turns over the room, somebody else applies the splint, somebody else types out the op-report that he/she dictates. A PA might even write the post-op note, and fill out the patient's prescriptions (which the surgeon then signs).
This distribution of labor isn't just to kiss the surgeon's a$$, or suck up to him/her... it serves another purpose: it allows the surgeon to see and care for the maximum number of patients per unit time. The more patients a surgeon can see efficiently, the more money that practice generates, and the more everybody stands to get paid. The military views the surgeon as a drain on the hospital budget (instead of the reason for it), and acts accordingly.
Viewed through that prism, milmed's actions are perfectly logical.
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that is a good question. I do not know the exact % of USUHS that make a career out of it, but I have heard it was high (and it is certainly much higher than HPSP retention which is likely near zero). Things to consider in the comparison:
At my last base, my closest friend/doc/FP was a USAHS grad. We both were "frustrated to the max" with what was going on milmed wise. We had daily conversations on this. We both planned on a career in milmed (I am prior enlisted). He ended up staying on because (I believe) #1 he went admin to get out of the clinic "mess", #2 he was more nervous about a jump to the civilian side (his only experience was the milmed side), and for him, a career in milmed was his lifes ambition (mine was to serve people as their doc (much preferably a milmed doc, his was to be a milmed doc, no matter what).He was really tornup with the decision making progress.
1) USUHS docs have already committed a large "chunk" of their life towards retirment when they 1st get the chance to consider separating. I suspect many "hang in there" to retirment.
2) Docs who stay are usually quickly moved into the admin ranks. Now admin in milmed has its own headaches I am sure, but not to the extent of what the docs in the clinics see. So all these USUHS docs who stay until retirement may many times not be doing "actual pt care" doc activities.
3) expectations are different between USUHS students and HPSP students, probably.
4) I believe that milmed places the biggest "stress" of pt care on docs in their 1st tour, and that is when the doc is least equipped to manage that "stress". By the time the "new doc" has begun to understand, and be able to function more efficiently within the system, they many times are already planning for a change to a civilian career.What the current state of milmed has done is effectively 'Lose" generations of HPSP docs.
It is one thing to try and function as a doc in a BROKEN healthcare system when you are a "seasoned" physician. It is another to place "newbie docs" in that same BROKEN system.
disillusionment is also a problem. Call me naive, but when I went through Officer school, all the Core Value stuff was very much a part of what drew me to milmed. Then when you get to the "real" milmed, and you see that Core Values are very much "lip service" to those "running the show, much of the luster of a milmed career is removed. Core values have been replaced with metrics, promotion and status quo. And milmed is designed for that with those officers in alignment with the SGs failed plans the ones who stay and get promoted.
Look at the last Army SG (Gen Kiley) who was the Commmander at Walter Reed for years and his superiors made him the Surgeon General. Then the Scandal hits and "poof"; the same guy that was supposedly the best of the best is gone. Now how does that happen? Because what he was likely "best of the best at" was playing politics. Those people don't make waves and let the supeiors know that things are bad if they want promotions.
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Having "been there, done that," I can tell you with all honesty that your statement is incorrect, at least for the "middle management" levels of military admin medicine. While I was a full-time R-Me clinician, dealing with the usual frustrations of practicing in mil-med, I long suspected that the "bean counters" had it easy. And maybe they did, back in the "old days" when I first started out. Then, as a certain famous TV chef puts, it, BAM! -- I came to work one day and was put in a mid-level admin slot. And let me tell you, from day one I wished for nothing more than to go back to my clinic and be a "real" doctor again.
Now, this may not be true of all admin docs -- I never aspired to an admin slot, it was just sort of thrust on me. Someone with a more "managerial" career path in mind might have loved it. But I can say for sure that it could best be described as "clinic headaches x 1000." Why? Because instead of just having to deal with all the day-to-day bullcrap in my own little clinic world, I now had to deal with ALL the bullcrap from ALL the providers in ALL the clinics -- including problems I never even imagined existed. You are basically squeezed between trying to fix he clinical problems below you as best you can and being restricted by a ton of bureaucratic, regulatory, economic and politcal considerations above you. The biggest problem was personell: nowadays with deployments, lousy retention, and poor salary schedules for civilian docs it's incredibly hard to get good people on board. Add to that budget issues, interpersonal squabbles between people, infighting among your superiors who all have their own personal agendas, patient complaints, etc etc etc. Believe me, mid-level admin people (department and clinic chiefs, DCCS, etc) see EVERY ONE of your headaches, magnified by the scale of the entire facility you work at . . . not all of them are brain-dead butt-kissers -- some truly do try to improve things, but it sure ain't easy, and I can certainly see how it leads to early burnout.
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I agree with your assessment. The big difference (my opinion) between "admin" stress and "physician" stress, is what hangs in the balance. The "clinic" doc has the RESPONSIBILITY for the outcome/care of the patient. In my clinic we had;
1) a 20 foot high pile of unfiled paperwork
2) charts available at the time of the pt visit 10-50% of the time
3) clinic manning typically 10-50%
4) unsupervised novice PAs (under my license)
5) 100's of missed labs (abnormals)
6) techs caught 'hiding" stacks of pt results in the "overhead" rather than file them
7) high turnover of support staff (approx 25 changes to my team in 3 years
8) 8 of 9 civilian docs quit/leave during 2 year span
9) 100% civ nurses quit in 3 years
10) Open Access, PGUI, "sick call for civ + military" and other admin "nightmares"
Now all of the above compromises the safe and efficient care of our patients, and when things fall through the cracks, it is the physician who will be held responsible (not middle management). And even when a physician "dodges" the malpractice possibilities, the physician still is the one with most of the worry/concerns about what is going on.
Admin certainly has thier own stressors, but this is comparing apples and oranges. And in the case of milmed, all the fruit is spoiling on the tree😱
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See Me.
As for the high percentage of USU students staying to retirement, those are numbers from the late 1990s, which means that the population of students was in school in the mid 1980s. USU was significantly smaller then and had an even higher percentage of people with substantial prior service (who reached retirement right around or even before the end of their committment). It will be interesting to see the percentages from the more recent past.
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I love that logic... to paraphrase: "it's not that milmed sucks, it's just that you're not looking at it correctly! You have only yourself to blame if you're less than satisfied with your military practice"
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Over 82,000 views of this thread! That has to be some kind of SDN record.
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I remember being at an admiral's call for our hospital command when I heard the flag officer guest-of-honor (and also psychiatrist) give that same argument.
It didn't impress, to say the least. But I became convinced that the only Admiral worth anything was an old T.V. set I saved from the trash when I was a kid.
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I agree with the "psych" aspect of the sentiment; looking on the bright side, being thankful for what you do have is a good idea.
where the problem lies, is when "looking on the brightside" becomes the rationalization of ignoring the problems and going with the status quo.
the problems and broken aspects of milmed didn't just happen, and just looking through the "lens of service" is not far from "just turning a blind eye."
and this is NOT to say that the USAFP president is ignoring the ISSUES; it's just that he can't fix em either.
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Based upon the posts on SDN, I'm not so sure I've seen either of those factors
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speaking of "trump", I dont think the USAF SG is playing with a "full deck"
I didn't think the USAF issued lunch hours for anyone other than Command staff anymore?
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another snapshot of the typical milmed primary care clinic; and they wonder why FPs are leaving.......
http://blog.wired.com/defense/2007/03/like_the_washin.html
Military MD Shortage at Home
Like the Washington Post says in today's story, "It is just not Walter Reed." There are deep, deep problems, throughout the military medical system. And it's going to take a long time to get to the bottom of them.
But here's a glaringly obvious one, to start: there just aren't enough military doctors to go around. So many MDs have been deployed to war zones that coverage back home -- for military family members, retirees, and garrisoned troops -- has been spread awfully thin.
I spoke to one Army doctor the other day - a chief of family practice at a good-sized facility. Let's call him Dr. Jonah. He oversees about a dozen doctors, each with at least 21 patients per day.
Which sounds like a lot - until you consider that he's got a patient base of over 18,000. Which means that diabetics or hypertensives -- who should be seen at least four times annually-- are only seen once a year. "There are women who haven't gotten pap smears in years, who go without mammograms for years," Dr. Jonah says. "The people that the government promised would take care of their health care are not getting nearly the coverage they need," he sighs.
The problem is that Dr. Jonah is the only military doctor at his facility; the rest are overseas. The administration has filled in, by hiring civilian docs -- but only on the cheap. These doctors are getting $50,000-$150,000 less than they would at a civilian hospital. "And you get what you pay for," Dr. Jonah says.
A military medical commission came to his facility not long ago, interviewed everyone in sight, and made some recommendations. Not much has changed, though. Well, except the facility is taking out new ads for doctors, in the local newspaper.
same song and dance, just a different doc name on this sad story.👎
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what a difference a couple years make. It was about 2 years ago I discovered this site. At that time there were only a few docs (active duty) that knew about this site and took the time to tell about what is going on in many milmed sites. there were many responses to this thread defending the "greatness" of milmed initially.
Cut ahead to the present and the recent starter thread below, and you can see that there are no longer just a few people letting the "truth be told" about the status of milmed. While different milmed specialties have different problems (primary care lacks staffing, manning, and has too much admin hassles and too many patients....surgery has too little cases......and med student have little choice in specialty (the needs of the military, and poor planning of the military med leadership)......problems abound, and leadership to fix the problems is lacking.
so for those already committed, hang in there; hope for the best, prepare for the worst.
for those contemplating committing; think twice
for some of those in Command; shame on you👎
http://forums.studentdoctor.net/showthread.php?p=5136699#post5136699
Cut ahead to the present and the recent starter thread below, and you can see that there are no longer just a few people letting the "truth be told" about the status of milmed. While different milmed specialties have different problems (primary care lacks staffing, manning, and has too much admin hassles and too many patients....surgery has too little cases......and med student have little choice in specialty (the needs of the military, and poor planning of the military med leadership)......problems abound, and leadership to fix the problems is lacking.
so for those already committed, hang in there; hope for the best, prepare for the worst.
for those contemplating committing; think twice
for some of those in Command; shame on you👎
http://forums.studentdoctor.net/showthread.php?p=5136699#post5136699
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TRICARE boost to doc paytments in ALASKA
http://www.usmedicine.com/article.cfm?articleID=1510&issueID=97
AHLTA improvemnt in speed
http://www.usmedicine.com/article.cfm?articleID=1512&issueID=97
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Dr. Winkenwerder told an audience of military health care providers at the conference that their concerns about AHLTA have been heard and taken into account. I know that not everyone has had the same successful experience using AHLTA ..."
hysterical
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This is exactly what happens in my clinic. Two PA's working under my GMO license and one non-residency trained civilian MD that could never get a decent job outside of the DoD system. Nothing but the best medical care for the worlds finest 👎
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You're not kidding... those guys always reminded me of the final scene of Monty Python's "The Life of Brian." You know the one... they're all being crucified (one of the most horrible deaths ever concocted), and they're singing "Always look on the bright side of life..."
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funny thing. I had some little turd of an army M.C. type 0-3 constantly trying to bust my balls, who was not my designated S.P. , not even in my chain of command, I even had more time in grade than he did, plus about 17 years time in service over his 2. Maybe you two can do a stateside swap.
I guess the army just isn't that much fun unless you get to have somebody to f**k with.
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oppsss
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The 2 PA's in my clinic are pretty competent. My disagreement is the commands unilateral decision of including them in my license while they practice unsupervised. Do you think this is ethical .legal? I don't think so. BTW, you can have 17 years in the military but you dont have a medical license. When is comes to medical decision making the MD will be the final word.
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That creates another question. From what I understand, the DoD higher ups get to choose where everyone goes for residency. The hospitals are putting their asses on the line for residents that they don't pick.
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Our contract PAs and docs are of two distinct types. Either they suck and are downright dangerous or they are good but don't renew the contract after working in such a s#itty job for so little pay.
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you are right, you are getting screwed. the little ankle biter in my case was always upset that I didn't tolerate shammers and sent their asses back to the motor pool. He wanted to run the place like the student health clinic back on campus.
It would have worked out better if he'd just took the Adderall and concentrated on his own panel instead of mine. Unless a GMO is prior service, he'd do better to find a crusty old E-7 and stick to the guy like super glue.
When you have 17 years in the service, you know considerably more about the nuts and bolts of the system, the warfighters, the mission. That's about 90% of why were're here. It's easy to forget that when you've been indoctonated from the cradle by Hilary, her hubby and the cadre of ass-clowns that we've inherited from that era. The job is to put trigger pullers back on the line, not part of the bennies package as a recruitment and retention tool.
Somehow, BDUs just look freaken stupid with a teddy bear wrapped around your steth. probably a small part of why our enemies aren 't the least bit afraid of us.
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[
this was my experience as well; 8 of 9 civilian docs quit/resigned over a 2 year period. 100% of civilian nurses quit (about 6 of 6)
And realize, that this "civilian experiment" is what the Milmed leadership is relying on to keep the Milmed FP clinics afloat. Read the latest USAFP journal to read more.👎
[/QUOTE]
this was my experience as well; 8 of 9 civilian docs quit/resigned over a 2 year period. 100% of civilian nurses quit (about 6 of 6)
And realize, that this "civilian experiment" is what the Milmed leadership is relying on to keep the Milmed FP clinics afloat. Read the latest USAFP journal to read more.👎
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I resigned my MTF contract, called the IRR branch, went back on AD and asked for Korea to get some peace and quiet.\
Funny thing, when the war started, I had an AD commitment which expired about 4 days short of deployment to a PROFIS slot.... All the IRR,reserves cohort are trapped in a stop loss, while AD was able to resign.
I got out of Iraq by joining the Army
Funny thing, when the war started, I had an AD commitment which expired about 4 days short of deployment to a PROFIS slot.... All the IRR,reserves cohort are trapped in a stop loss, while AD was able to resign.
I got out of Iraq by joining the Army
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FYI on a recent LATimes article talking about how "fear" prevents some people from "speaking out" when they witness "wrongs". While NOT the entire story, this (my opinion) does play a significant role on how milmed got as low as it has, and remains there.
http://www.latimes.com/news/opinion/commentary/la-op-bloche11mar11,0,1266240.story?track=rss
The silence that fueled Walter Reed and Abu Ghraib
The military's culture of fear allows crises to fester before exploding into public view.
By M. Gregg Bloche, M. GREGG BLOCHE is a professor of law at Georgetown University, senior fellow at the Brookings Institution and visiting professor of law at UCLA.
March 11, 2007
WHAT went wrong at Walter Reed Army Medical Center? Congressional hearings and a new commission to study medical care for soldiers and veterans will yield some answers, but in the meantime, a past crisis may provide some clues.
Clinicians correct their mistakes by talking about them, a truth brought home in recent years by multiple studies of medical error in civilian settings. In healthcare, silence is deadly. Military doctors understand this. The culture of armed forces medicine has long encouraged open discussion of clinical and administrative difficulties. Rank has counted for less in such conversations than it typically does in the military. But since 9/11, there's been slippage toward a different ethic one of denial and evasion. Fear has driven this shift fear of the consequences of speaking freely.
In 2004 and 2005, I and a colleague, Jonathan Marks, reported that some military doctors covered up detainee abuse and even helped to plan it at Abu Ghraib, Guantanamo Bay and secret sites elsewhere.
When these stories and others broke, many in military medicine were shocked and ashamed. They tried to talk about what had gone wrong and what the rules should be at such places as Abu Ghraib in the face of pressure to support the Bush administration's few-holds-barred approach to detainees suspected of terrorism. But the Army's top doctor, Lt. Gen. Kevin C. Kiley, and his politically appointed civilian overlord, William Winkenwerder, both of whom now face congressional fire for the squalid treatment of rehabbing soldiers at Walter Reed, made it plain to their troops that they couldn't talk about what went on at Abu Ghraib or Guantanamo.
Shortly after the revelations of prisoner abuse at Abu Ghraib, I was asked by faculty at the military's medical school, the Uniformed Services University of the Health Sciences, to speak at a forum on the ethics of clinical work with detainees. A tentative date in late summer of 2004 was set. I was then told by the event's sponsors that then-Defense Secretary Donald H. Rumsfeld's civilian staff had ordered the session canceled.
Later that year, Maj. Scott Uithol, an Army psychiatrist deployed to Abu Ghraib to help plan interrogations, was to speak at a forensic psychiatry conference on the ethical and other challenges this work posed. The Army Medical Command, headed then as now by Kiley, ordered him not to do so. Kiley ran Walter Reed from 2002 to 2004.
Many other Army doctors gave us similar accounts of being told to keep silent. Several junior officers spoke of threats from above to end their careers and bring criminal charges against anyone who broke with the brass' "don't-ask, don't-tell" approach to mounting evidence of medical complicity in prisoner abuse. A reservist, Maj. David Auch, was scathingly criticized by Pentagon higher-ups when we quoted him in a New York Times article about nightmarish staff and equipment shortages at Abu Ghraib, to the point that a dentist did heart surgery and chest tubes were taken from the dead for reuse.
Kiley and Winkenwerder, who announced that he would resign as assistant secretary of Defense for health affairs a few days after the Washington Post broke the Walter Reed story, ordered reports on detainee healthcare from their subordinates rather than asking for inquiries from outsiders of equal or greater rank. The message was clear: Evidence of misconduct and neglect was to be cloaked demurely, not bared. Kiley's deputy, Maj. Gen. Lester Martinez-Lopez, who wrote the only, even mildly critical, assessment of prisoner treatment, retired within weeks of submitting his findings.
Army doctors have performed heroically in the Iraq war. But many have become disillusioned about supply and personnel shortages and about the silencing of their concerns by higher-ups. There is some anecdotal evidence that recruitment and retention have become problems, aggravated by a sense that those who go along to get along are promoted over more able officers who are more inclined to speak freely.
At Walter Reed, news reports and congressional hearings have made it clear that lower-ranking and noncommissioned officers knew about the conditions under which hundreds of wounded and recovering U.S. soldiers lived until last month. It appears that those near the bottom of the chain of command found the squalor unspeakable, but word of it didn't move upward along the usual channels, and those at the top never "walked the barracks" to preempt trouble.
"There's a need for anyone in a leadership post to walk around, to talk to people, to not rely on subordinates only," a predecessor of Kiley as Army surgeon general, retired Lt. Gen. Ronald Blanck, told me last week. Blanck did not criticize Kiley directly, but he spoke proudly of military medicine's tradition of outspokenness from below.
For efforts by clinicians and administrators to improve the quality of medical care, evasion and denial of mistakes is toxic. The National Academies of Sciences and other bodies have embraced approaches to healthcare quality that stress sharing and vigorous discussion of clinical, bureaucratic and ethical problems. Within military medicine, the climate of fear created from above since 9/11 has made such discussion difficult, if not impossible.
It's urgent that the Walter Reed investigations getting underway address the causes for this climate of fear. Fixing responsibility on a few generals won't be enough (though surely it's time for Kiley to go). We owe America's military health professionals more protection for their independence and willingness to speak out because they deserve it and because their professional judgment is a potent safeguard against clinical, administrative and moral error.
Military medicine will always pose awkward administrative and ethical challenges, arising from tensions between the ideals of professional autonomy and obedience to command and between patient well-being and protecting the nation. Silence, enforced by fear, can submerge these tensions for a time. But when they're not talked about, they can emerge explosively, as they did at Guantanamo, Abu Ghraib and now Walter Reed.
http://www.latimes.com/news/opinion/commentary/la-op-bloche11mar11,0,1266240.story?track=rss
The silence that fueled Walter Reed and Abu Ghraib
The military's culture of fear allows crises to fester before exploding into public view.
By M. Gregg Bloche, M. GREGG BLOCHE is a professor of law at Georgetown University, senior fellow at the Brookings Institution and visiting professor of law at UCLA.
March 11, 2007
WHAT went wrong at Walter Reed Army Medical Center? Congressional hearings and a new commission to study medical care for soldiers and veterans will yield some answers, but in the meantime, a past crisis may provide some clues.
Clinicians correct their mistakes by talking about them, a truth brought home in recent years by multiple studies of medical error in civilian settings. In healthcare, silence is deadly. Military doctors understand this. The culture of armed forces medicine has long encouraged open discussion of clinical and administrative difficulties. Rank has counted for less in such conversations than it typically does in the military. But since 9/11, there's been slippage toward a different ethic one of denial and evasion. Fear has driven this shift fear of the consequences of speaking freely.
In 2004 and 2005, I and a colleague, Jonathan Marks, reported that some military doctors covered up detainee abuse and even helped to plan it at Abu Ghraib, Guantanamo Bay and secret sites elsewhere.
When these stories and others broke, many in military medicine were shocked and ashamed. They tried to talk about what had gone wrong and what the rules should be at such places as Abu Ghraib in the face of pressure to support the Bush administration's few-holds-barred approach to detainees suspected of terrorism. But the Army's top doctor, Lt. Gen. Kevin C. Kiley, and his politically appointed civilian overlord, William Winkenwerder, both of whom now face congressional fire for the squalid treatment of rehabbing soldiers at Walter Reed, made it plain to their troops that they couldn't talk about what went on at Abu Ghraib or Guantanamo.
Shortly after the revelations of prisoner abuse at Abu Ghraib, I was asked by faculty at the military's medical school, the Uniformed Services University of the Health Sciences, to speak at a forum on the ethics of clinical work with detainees. A tentative date in late summer of 2004 was set. I was then told by the event's sponsors that then-Defense Secretary Donald H. Rumsfeld's civilian staff had ordered the session canceled.
Later that year, Maj. Scott Uithol, an Army psychiatrist deployed to Abu Ghraib to help plan interrogations, was to speak at a forensic psychiatry conference on the ethical and other challenges this work posed. The Army Medical Command, headed then as now by Kiley, ordered him not to do so. Kiley ran Walter Reed from 2002 to 2004.
Many other Army doctors gave us similar accounts of being told to keep silent. Several junior officers spoke of threats from above to end their careers and bring criminal charges against anyone who broke with the brass' "don't-ask, don't-tell" approach to mounting evidence of medical complicity in prisoner abuse. A reservist, Maj. David Auch, was scathingly criticized by Pentagon higher-ups when we quoted him in a New York Times article about nightmarish staff and equipment shortages at Abu Ghraib, to the point that a dentist did heart surgery and chest tubes were taken from the dead for reuse.
Kiley and Winkenwerder, who announced that he would resign as assistant secretary of Defense for health affairs a few days after the Washington Post broke the Walter Reed story, ordered reports on detainee healthcare from their subordinates rather than asking for inquiries from outsiders of equal or greater rank. The message was clear: Evidence of misconduct and neglect was to be cloaked demurely, not bared. Kiley's deputy, Maj. Gen. Lester Martinez-Lopez, who wrote the only, even mildly critical, assessment of prisoner treatment, retired within weeks of submitting his findings.
Army doctors have performed heroically in the Iraq war. But many have become disillusioned about supply and personnel shortages and about the silencing of their concerns by higher-ups. There is some anecdotal evidence that recruitment and retention have become problems, aggravated by a sense that those who go along to get along are promoted over more able officers who are more inclined to speak freely.
At Walter Reed, news reports and congressional hearings have made it clear that lower-ranking and noncommissioned officers knew about the conditions under which hundreds of wounded and recovering U.S. soldiers lived until last month. It appears that those near the bottom of the chain of command found the squalor unspeakable, but word of it didn't move upward along the usual channels, and those at the top never "walked the barracks" to preempt trouble.
"There's a need for anyone in a leadership post to walk around, to talk to people, to not rely on subordinates only," a predecessor of Kiley as Army surgeon general, retired Lt. Gen. Ronald Blanck, told me last week. Blanck did not criticize Kiley directly, but he spoke proudly of military medicine's tradition of outspokenness from below.
For efforts by clinicians and administrators to improve the quality of medical care, evasion and denial of mistakes is toxic. The National Academies of Sciences and other bodies have embraced approaches to healthcare quality that stress sharing and vigorous discussion of clinical, bureaucratic and ethical problems. Within military medicine, the climate of fear created from above since 9/11 has made such discussion difficult, if not impossible.
It's urgent that the Walter Reed investigations getting underway address the causes for this climate of fear. Fixing responsibility on a few generals won't be enough (though surely it's time for Kiley to go). We owe America's military health professionals more protection for their independence and willingness to speak out because they deserve it and because their professional judgment is a potent safeguard against clinical, administrative and moral error.
Military medicine will always pose awkward administrative and ethical challenges, arising from tensions between the ideals of professional autonomy and obedience to command and between patient well-being and protecting the nation. Silence, enforced by fear, can submerge these tensions for a time. But when they're not talked about, they can emerge explosively, as they did at Guantanamo, Abu Ghraib and now Walter Reed.
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This article is right on the money. We have all said something similar as the way we ended up in trouble. We chose to speak up, and fared the consequences. This is one of the many reasons military medicine will continue to decline and be a toxic environment for physicians who want to by physicians first, and officers second. The environment is just not conducive to the practice of medicine, as many times, the demands of officership will inpinge on the demands of providing quality care.
It still fathoms me that after reading article after article, and hearing us tell of our experience that people still defend the military and want to be part of the Medical corps?
It still fathoms me that after reading article after article, and hearing us tell of our experience that people still defend the military and want to be part of the Medical corps?
what do you think will happen as retention continues to be low and new hpsp schoalrship numbers are less than the service needs? Will they stop loss MDs?
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Since the needs of the military come first, I'm sure that will be one strategy. Eventually they will outsource everything except wartime deployments, and eventually that may even have to be done. I would not expect that for decades.
wouldnt it be less costly and more inconvient (ofcourse) to just clean up the problems that milmed face. Won't the MDs start really complaining if they face stop loss (i know the regular mil folks hate it) and therefore increase the issues- 1) the personel doesnt want to work for military anymore 2) lets med students know that milmed is not a place to go and 3) start hollering at congress?
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Milmed is going to continue to get much worse before it gets any better. As the above article perfectly points out, the culture of fear propagated by our superiors will effectively kill any dissent. This means the "do more with less" attitude our leaders have been selling to the line and to the congress for the past several years will continue. We will fall deeper and deeper into the abyss until retention is <1% and the HPSP pipeline is dry. At this point, stop-loss will be a bandaid on the hemorrhage because there won't be enough active duty docs to forcibly keep around. In a decade or so, you are looking at IRR callups and the dreaded doctor draft. Because our leadership is morally bankrupt and afraid to face the truth, the soldiers, sailors, airmen, and marines will ultimately suffer. I can think of no crime higher.
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I was a PA filling a GMO slot. I was PROFIS and thus exempted from the stop loss when the warning order came down, allowing my ADSO to expire in that very narrow window.
I missed Iraq by about 4 days. I'm sure somebody has plugged that loophole by now. The chicken**** 0-5 that was able to get his PROFIS order deleted ( they didn't even scrub the deletion off my orders) and replaced with my name on his orders, oh how I would have loved to have seen the look on his face the day my name was deleted from the PROFIS roster and his put back on.
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Yes, in a fairy land where people acutally cared about pts, and not their own self fullfilment, money is boundless, and a persons career ethics and morals supercede the needs of the military. In other words, it will never happen. BomberDoc's assesment is sadly on line with what will likely happen. Sad times ahead.
given my experiece with milmed is limited since i am only a graduating med student.....but most personel did care about the patients and were ethical (except for the higher ups/admin people). I know needs of the military come first, but when you have problems filling your milmed positions and resort to a backdoor MD draft (stop loss) that will add to the problems b/c that will cause the regular MDs to dislilke the system and not show proper concern for the patients, etc. Maybe I'm a little naive.
Ill admit my concerns are also selfish in nature: since I will be one of those MDs and I hope that milmed never reaches that point!
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Yup, you're naive. They don't view us as different from the regular soldier who they'll stop-loss in a heartbeat. If there aren't enough docs, you may well be kept around, damn the long-term consequences (which will become relevant long after that current commander has retired to the land of tricare consulting).
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By Gregg Zoroya, USA TODAY
FORT STEWART, Ga. — Winn Army Community Hospital has a baby boom it cannot handle.
Mothers and children and strollers pack the pediatrics department, another hassle after long waits for hard-to-get appointments. The problems don't stop there. From gynecology to internal medicine, this hospital on the grounds of Fort Stewart, the biggest Army base in the South, is overwhelmed. Too many patients are demanding too many services from a medical facility with too few doctors and too little space.
Military families complain they can't get in to see a doctor. The hospital's top commander points to a lack of money and staff to meet basic needs. And everyone involved agonizes about whether the problems can be fixed any time soon.
The Army's acting surgeon general says the situation here illustrates the challenge the service faces nationwide in keeping health care promises that were made to soldiers when they enlisted. Months after the problems revealed at Walter Reed Army Medical Center caused a massive shake-up throughout the military's system of care, the service is struggling to find enough doctors and nurses to care for troops and their families.
"If you're sending someone off into harm's way, if you're asking them to do the nation's business, you need to take care of them," says Col. Scott Goodrich, Winn's commander. "Whenever we can't provide the care we need to a soldier, that's very, very painful to me.
FIND MORE STORIES IN: Iraq | Army | Pentagon | Fort | Medical Center | Military families | Fort Stewart
The Army operates 36 medical facilities worldwide. For the past two years, more than half have failed to meet Pentagon standards for providing a doctor within seven days for routine medical care. And the Army has been forced to spend more money sending military families to doctors in nearby communities. Payments for outside referrals have jumped from $200 million in 2000 to nearly $1 billion last year, records show. Outpatient care accounts for 70% of those costs.
Here at Fort Stewart, home of the 3rd Infantry Division, Winn Community Hospital is among the worst in terms of access to routine medical care. Other problem facilities, according to Army statistics, include Walter Reed, the Army's premier hospital; Fort Hood, Texas, the Army's largest base; Fort Campbell, Ky., home of the 101st Airborne Division; Fort Jackson, S.C., a training facility; and Fort Riley, Kan., home of the 1st Infantry Division.
Maj. Gen. Gale Pollock, the Army's acting surgeon general, says the Army's entire health system has trouble providing care quickly enough. Pollock visited Fort Stewart in April and calls the situation at Winn "not acceptable."
Goodrich and Pollock say the reasons for the problems include: the demand for doctors in Iraq; a shortage of Reserve caregivers, and a cumbersome government process for hiring civilian replacements.
Such challenges are not solved easily.
The Army has 4,170 doctors, about 180 shy of what it says it needs. Pollock says she hopes the Pentagon's plans to expand the Army to 547,000 members — an increase of 65,000 — will provide the doctors that military families need. Last year, Congress approved paying bonuses up to $400,000 for medical officers with critical wartime specialties if they agree to remain on active duty for four years.
"It takes a while to recruit them, to develop them as professionals," Pollock says. "(But) now that we are growing the Army I'm optimistic I'm going to be allowed to grow the Army medical department staff so that we can start to address some of these issues."
Goodrich points to a more immediate problem: the conflicting demands for limited funds. "(The Pentagon) says you're authorized this many people. It's not enough," Goodrich says of his staffing. "There's only so many dollars. If you've got a war, you need equipment, you need soldiers, you need body armor. If I had more money, I'd buy more doctors."
'It was good, it really was'
Care at Winn was excellent a few years ago, families say. "It was good, it really was," says Gloria Smith, 50, wife of retired Master Sgt. Anthony Smith. "Since the deployment started, everybody is overworked."
Many families share that view:
•Sgt. Joseph Waterman returned from Iraq in October 2005 with ribs and vertebrae broken in a roadside explosion. The hospital did not have enough doctors or therapists to help him.
So each week his wife, Mary, drove him three hours to Augusta, Ga., for therapy at Eisenhower Army Medical Center. That required taking their three children, including two who had to miss school, and paying $69-a-night hotel bills the Army was slow to reimburse.
"It was breaking us," says Mary Waterman, 31. "He was hurt (in Iraq), so I thought they would go out of their way to take care of him."
Early last year, Joseph Waterman's case manager at Winn allowed him to finish his therapy at a private facility in Savannah, Ga., a 45-minute drive from Fort Stewart.
•Warrant Officer Dan Howison and his wife, Kathryn, wanted to have a second child before he went back to war. Kathryn Howison, 29, says the family care doctors at Winn were slow to see her and slow to refer her to the hospital's gynecology department.
"They'd say, 'I'm sorry we don't have any appointments this month, call back next month,' " she says. "And you're like, 'What? You know I have a limited time here where I can try to have this baby. You guys got to get me in there!' "
After nearly a year of delays, Kathryn was sent to a private fertility clinic in Savannah, where hormonal treatments led to conception last year. The Howisons' daughter, Piper, was born last week. Dan Howison will head to Iraq this summer.
•Amy Lambert, 40, a mother of three whose husband is being deployed to Iraq in two to three months, says Winn doesn't have enough staff members to follow up with patients after office visits.
"You have to be the one who pesters them and calls them," she says. "If you say, 'Fine, I'm tired of dealing with this,' that's what they're hoping for."
Patient complaints rise
Linda King, a hospital patient representative since 1990, says there are more complaints than ever. Complaints filed with the hospital hit a record 616 in March, four times as many as March 2006. Three out of four were about access to care or service delays.
Soldiers and families from closed bases have moved to Fort Stewart, adding to the number of those eligible for care at Winn. The potential patient population has swollen 40% to 74,000 since the facility opened in 1983, officials say.
The hospital's emergency room often has only one doctor on duty and strains to handle the demand, receiving 70 to 110 patients per day. Visits jumped to 36,000 last year, up from 30,000 in 2005.
Hospital data show most of those seeking care should not be there in the first place because they are not emergency cases. Seventy-five percent of ER visits in March were for issues such as flu symptoms, chronic pains or prescription fills — matters the hospital's family doctors should handle, but are too busy or short-staffed to take on.
"They (patients) say, 'I've been trying to get an appointment for two weeks and I'm tired of waiting, I just need to see somebody,' " says Maj. Chad Marley, chief of Winn's emergency room. "Although it makes our job difficult at times, I take some pride in the fact that I'm the only place in the hospital that doesn't say, 'No.' "
Carol Reynolds, 39, the wife of a deployed lieutenant colonel, says she had to change her doctor four times in four years. Goodrich says continuity of care at Stewart is "non-existent."
And while out-patient services are strapped for space, in-patient rooms are empty because of the shortage of doctors and nurses. Winn is listed as a 112-bed facility, but it can staff only 91 in a major emergency and 40-45 beds routinely, Goodrich says.
Overall, the hospital's annual budget has nearly doubled since 2001 to $72 million. That's still nearly $10 million shy of expenses.
Reconfiguration and expansion of the hospital could help ease overcrowding and improve access to care, Goodrich says.
A 2006 Winn hospital Master Plan calls for seven new expansion projects to add 45,000 square feet and renovate another 74,500 square feet of space. Only one project has been approved by the Pentagon, however, and it is delayed until 2013, budget records show.
"Build me a bigger hospital, I'll take care of more," Goodrich says.
Hopes for improvement
The situation adds to the stress for family members of soldiers fighting in Iraq or Afghanistan, says Col. Todd Buchs, the Fort Stewart base commander.
"If you look at the average life of a military spouse, it's a stressful life," Buchs says. "You're raising your children with basically a single-parent family. Throw one more stressor on them — being frustrated with the hospital — it just makes your life more frustrating."
One solution would be to send more patients to see doctors in nearby communities.
However, fewer private doctors want to accept military patients. Some doctors shun Tricare, the military insurance program, which pays the same modest rates as Medicare.
Other doctors only accept military patients if they can prescribe whatever medical treatments they deem necessary, which often conflicts with Army physicians who may prefer more limited procedures, Goodrich says.
Goodrich says he believes Winn is about to get better. With much of the 3rd Division gone to Iraq and some new doctors hired, Goodrich says he can improve access to care and take the pressure off the ER.
Buchs says he hopes the changes work. Families "don't expect people to feel sorry for them," he says. "All they want is to be treated with the appropriate care that we can give them because of the sacrifices they are making."
Posted 5d 22h ago
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another article (from the ARMY TIMES)
good read.http://www.armytimes.com/community/opinion/navy_opinions_welling_070430/
Privatization problems
Civilians in military medical jobs make more money, lower troop morale
By David R. Welling
It is refreshing to read that the surgeons general are fighting to keep more active-duty medics instead of allowing them to be replaced with civilians.
Civilianizing our medics is not a new idea. This march toward mediocrity began more than 10 years ago with the institution of Tricare. Gradually, the folks running things are dismantling a proud and effective system and replacing it with what one of my patients called "mangled care." Before these rocket scientists drive our train completely over the cliff, it would be educational to consider the reasons we have a medical corps and some of its advantages.
The present system was not dreamed up in a vacuum. It was the product of some bad years and some bad medicine. At various times, the medical corps has been caught unprepared to respond when we needed to go to war. At other times, we have had poorly trained doctors, doctors who fled malpractice claims by coming into the military, or doctors who could not make it in civilian practice because of a variety of inadequacies — strangers to excellence. Military medical care suffered; patients paid a price.
In 1978, when I reported to Eglin Air Force Base, Fla., some doctors couldn't speak English. Some were graduates of questionable medical schools in strange foreign countries. And we had dissatisfied patients who were getting shoddy care.
About that time, some of our leaders decided we could create a better system. We would acquire a core group of leaders in the medical world. We would eliminate the bad apples. We would offer scholarships to medical students at the world's best medical schools, and those students would incur a military obligation in return. We would also begin a military medical school of our own in Bethesda, Md.
Our medical centers would be staffed by the very best minds in the business. We would establish training programs for specialists. We would grow our own world-class doctors who could seek full careers in the military.
By about 1990, we had everything in place and working beautifully. Traditions were established. Important research was accomplished. Centers of excellence were springing up within the military.
Then came Tricare, which has nibbled away at the system we had until we today are looking at the collapse of a national treasure. Tricare was supposed to save us money. Instead, we have sacrificed excellence for mediocrity, and we are paying huge bucks for the privilege. Tricare has emptied our hospitals and left many active-duty doctors without enough to do. Thus, it has perversely worked to make us less ready to go to war. It has made lots of business folks very rich.
This new plan will not attract the best and the brightest civilians into military medicine, but it will eliminate a generation of physicians who wear the uniform proudly, who have served with distinction and who are needed.
We lose command and control when we civilianize. We demoralize the active-duty medics, who take call, get deployed and do all the heavy lifting while civilians sometimes get two to three times as much pay.
We need to keep a "full-service bank" going in the military. Surgeons need pediatricians, who need internists, who need pathologists. Once destroyed, our medical corps will take much blood and treasure to recreate.
The writer, a retired colonel, was a surgeon in the Air Force for 30 years. His e-mail address is [email protected].
good read.http://www.armytimes.com/community/opinion/navy_opinions_welling_070430/
Privatization problems
Civilians in military medical jobs make more money, lower troop morale
By David R. Welling
It is refreshing to read that the surgeons general are fighting to keep more active-duty medics instead of allowing them to be replaced with civilians.
Civilianizing our medics is not a new idea. This march toward mediocrity began more than 10 years ago with the institution of Tricare. Gradually, the folks running things are dismantling a proud and effective system and replacing it with what one of my patients called "mangled care." Before these rocket scientists drive our train completely over the cliff, it would be educational to consider the reasons we have a medical corps and some of its advantages.
The present system was not dreamed up in a vacuum. It was the product of some bad years and some bad medicine. At various times, the medical corps has been caught unprepared to respond when we needed to go to war. At other times, we have had poorly trained doctors, doctors who fled malpractice claims by coming into the military, or doctors who could not make it in civilian practice because of a variety of inadequacies — strangers to excellence. Military medical care suffered; patients paid a price.
In 1978, when I reported to Eglin Air Force Base, Fla., some doctors couldn't speak English. Some were graduates of questionable medical schools in strange foreign countries. And we had dissatisfied patients who were getting shoddy care.
About that time, some of our leaders decided we could create a better system. We would acquire a core group of leaders in the medical world. We would eliminate the bad apples. We would offer scholarships to medical students at the world's best medical schools, and those students would incur a military obligation in return. We would also begin a military medical school of our own in Bethesda, Md.
Our medical centers would be staffed by the very best minds in the business. We would establish training programs for specialists. We would grow our own world-class doctors who could seek full careers in the military.
By about 1990, we had everything in place and working beautifully. Traditions were established. Important research was accomplished. Centers of excellence were springing up within the military.
Then came Tricare, which has nibbled away at the system we had until we today are looking at the collapse of a national treasure. Tricare was supposed to save us money. Instead, we have sacrificed excellence for mediocrity, and we are paying huge bucks for the privilege. Tricare has emptied our hospitals and left many active-duty doctors without enough to do. Thus, it has perversely worked to make us less ready to go to war. It has made lots of business folks very rich.
This new plan will not attract the best and the brightest civilians into military medicine, but it will eliminate a generation of physicians who wear the uniform proudly, who have served with distinction and who are needed.
We lose command and control when we civilianize. We demoralize the active-duty medics, who take call, get deployed and do all the heavy lifting while civilians sometimes get two to three times as much pay.
We need to keep a "full-service bank" going in the military. Surgeons need pediatricians, who need internists, who need pathologists. Once destroyed, our medical corps will take much blood and treasure to recreate.
The writer, a retired colonel, was a surgeon in the Air Force for 30 years. His e-mail address is [email protected].
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