BRAC bombshells

[squishymutts]

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granted this is all rumor, but i do have my sources:

1. USUHS just narrowly avoided the BRAC. Reportedly, Adm. Arthur actively campaigned to get the place closed with the Sec of the AF being rather noncommital. Supposedly the Sec of the Army had to fight to keep it going.

bigger yet:

2. WRAMC on BRAC list. Yep, the rumor is that it will convert to a Orthopedics only facility (note the new Amputee center) with the remainder of services moving over to Bethesda and combining with the flagging staff over there. A new building is to be built on the premises to facilitate the influx. This is similar to a previous rumor that I have heard from on high that WRAMC, NNMC, and MGMC will all close their inpt. services and become clinics with a new inpt. facility to be built at Ft. Belvoir in VA.

Now you and I know that nothing is done until the list is published, but mark my words some big changes are afoot in the National Capital area. If you think about it it makes sense - there is a lot of redundancy of bases in the area that could stand some "realignment" and "closure".


let the fussin' begin....

squish

 

[RichL025]

Now, not to pull the "old-timer card" out, but I've been in the military for quite awhile now. I've seen BRAC do it's work since.... well, since we've had a BRAC <g>.

The one thing I've learned is to ingnore the rumor mill. The rumor mill about BRAC has NEVER been correct.

Dean Laughlin sent out an email message to all the USUHS students a few weeks ago due to similar rumors. He pretty much said the same thing as me.

As far as "redundancy" in the hospitals in the NCA, all of them are pretty damn near their maximum census as we speak. Where is this "redundancy" of which you speak? Unless you postulate a sudden win against the "war on terror", and a near-instantaneous segue to a golden age of world peace, we're gonna be needing both NNMC and WRAMC for quite some time...

 

[texdrake]

granted this is all rumor, but i do have my sources:

1. USUHS just narrowly avoided the BRAC. Reportedly, Adm. Arthur actively campaigned to get the place closed with the Sec of the AF being rather noncommital. Supposedly the Sec of the Army had to fight to keep it going.

bigger yet:

2. WRAMC on BRAC list. Yep, the rumor is that it will convert to a Orthopedics only facility (note the new Amputee center) with the remainder of services moving over to Bethesda and combining with the flagging staff over there. A new building is to be built on the premises to facilitate the influx. This is similar to a previous rumor that I have heard from on high that WRAMC, NNMC, and MGMC will all close their inpt. services and become clinics with a new inpt. facility to be built at Ft. Belvoir in VA.

Now you and I know that nothing is done until the list is published, but mark my words some big changes are afoot in the National Capital area. If you think about it it makes sense - there is a lot of redundancy of bases in the area that could stand some "realignment" and "closure".


let the fussin' begin....

squish

Walter Reed is the army's formost medical center and flagstaff to the media. It has zero chance of being closed. They would close the Georgia or Tacoma ones long before Walter Reed or Brooke.

 

[cavaor]

Forgive my ignorance..but what is BRAC?

 

[tran1123]

Forgive my ignorance..but what is BRAC?

BRAC = Base Realignment and Closures

 

[squishymutts]

if you read my post you will realize that USUHS will stay open. And unless you are here at either WRAMC or NNMC (as I am) you don't fully appreciate what is needed to support the GWOT. I knew that my post would bring out the many "forum-educated" military who have no military, medical, or specifically NCC experience and decide they are experts. Bases close, hospitals (Letterman) close, things change.

I carefully cushioned my original post to say that it is all conjecture, but believe me things are going to change around here soon.

 

[RichL025]

if you read my post you will realize that USUHS will stay open. And unless you are here at either WRAMC or NNMC (as I am) you don't fully appreciate what is needed to support the GWOT. I knew that my post would bring out the many "forum-educated" military who have no military, medical, or specifically NCC experience and decide they are experts. Bases close, hospitals (Letterman) close, things change.

I carefully cushioned my original post to say that it is all conjecture, but believe me things are going to change around here soon.

Umm, I AM working at both NNMC and WRAMC. And I see how busy both of them are.

Yes, bases close, and so do hospitals. But Letterman is a rather poor example - a hospital without a military base! (Oh, yeah, care for all the DLI students <g>). I will grant you, though, that they chopped the hospital at Ft Carson Colorado (forgot the name already) - but if you think Wally World (WRAMC) or the Prez's own hospital (NNMC) is on the chopping block, I'd stay away from Vegas if I were you <g>.

Oh, and one final plug for WRAMC - who has the final say on BRAC closures? Congress. And where does congress get it's OWN medical care ?

EDIT: Sorry, I guess the hospital (Evans) at Ft Carson is still there, they just d/c'ed all residency programs...

 

[squishymutts]

Oh, and one final plug for WRAMC - who has the final say on BRAC closures? Congress. And where does congress get it's OWN medical care ?

NNMC. And notice they come out on top in the scenario that I proposed. NNMC blatantly caters to the pursestring crowd and as such will be around a while.

 

[RichL025]

NNMC. And notice they come out on top in the scenario that I proposed. NNMC blatantly caters to the pursestring crowd and as such will be around a while.

Actually, both.

For some reason, it seems the urologists at NNMC see all the congresspeople, but WRAMC has them for many (most?) other things.

Friend of mine shared an elevator at WRAMC with a famous senator the other day. I've seen a few myself at the Death Star <g>.

Maybe they get to choose?

 

[Termwean]

True, Funny Story!
I was a Resp Therapist at NNMC from 94,95 and 96'. I once got on an elevator w/ a urologist named Dr. Penix
Since I looked cleancut and good in my uniform(lots of ribbons from time w/ marines as corpsmen) I was designatd as the official RT for the special wing one week when Gores daughter was there. She was hot, and had a surg to repair deviated septum...yeah right...it was a nose job...I had to set up humidified air thru a face tent or something like that...met Tipper and Gore. Was there for the death of a famous supreme court judge too.

 

[helo doc]

I am completely disappointed, unhappy and damn near bitter. We've only got 7 more days until the preliminary BRAC list is published by the SecDef and we've waited this long to fire up ye olde' BRAC rumor mill! That is totally unsatisfactory. We need more gnashing of teeth, wailing and speculation. And we need it NOW.

Let me add fuel to the fire:

Navy medicine changes - I've heard they are going to close San Diego and Portsmouth and incorporate those patient populations into NNMC. That's because SD and Portsmouth are so far away from any "real" Navy. Wait... I have that all wrong...

Army medicine changes - BAMC and WRAMC will merge to a more geographically centered located near Dollywood, Tennessee. It will be aptly named 44DDAMC.

Air Force medicine changes - All facilities will be expanded and upgraded to accomodate golf carts in all hospital hallways and putting greens installed in all the physicians' lounges and call rooms (then again, do the AF docs have call?).

Tallyho!

 

[GeoLeoX]

I like rumors!

I heard more along the lines that Portsmouth would be pumped up and Bethesda closed.

For those who like to speculate:
http://g2mil.com/2005.htm

For those who don't:
http://www.hqda.army.mil/acsim/brac/FAQ.htm

I guess we all have to wait until May 16.

 

[RichL025]

I am completely disappointed, unhappy and damn near bitter. We've only got 7 more days until the preliminary BRAC list is published by the SecDef and we've waited this long to fire up ye olde' BRAC rumor mill! That is totally unsatisfactory. We need more gnashing of teeth, wailing and speculation. And we need it NOW.

Let me add fuel to the fire:

Navy medicine changes - I've heard they are going to close San Diego and Portsmouth and incorporate those patient populations into NNMC. That's because SD and Portsmouth are so far away from any "real" Navy. Wait... I have that all wrong...

Army medicine changes - BAMC and WRAMC will merge to a more geographically centered located near Dollywood, Tennessee. It will be aptly named 44DDAMC.

Air Force medicine changes - All facilities will be expanded and upgraded to accomodate golf carts in all hospital hallways and putting greens installed in all the physicians' lounges and call rooms (then again, do the AF docs have call?).

Tallyho!

*snort*

<soda dripping down monitor>

Helo Doc, I'm a-gonna bill you for that monitor unless you give us a "coke alert" next time 😉

 

[blueSkies]

I am completely disappointed, unhappy and damn near bitter. We've only got 7 more days until the preliminary BRAC list is published by the SecDef and we've waited this long to fire up ye olde' BRAC rumor mill! That is totally unsatisfactory. We need more gnashing of teeth, wailing and speculation. And we need it NOW.

Let me add fuel to the fire:

Navy medicine changes - I've heard they are going to close San Diego and Portsmouth and incorporate those patient populations into NNMC. That's because SD and Portsmouth are so far away from any "real" Navy. Wait... I have that all wrong...

Army medicine changes - BAMC and WRAMC will merge to a more geographically centered located near Dollywood, Tennessee. It will be aptly named 44DDAMC.

Air Force medicine changes - All facilities will be expanded and upgraded to accomodate golf carts in all hospital hallways and putting greens installed in all the physicians' lounges and call rooms (then again, do the AF docs have call?).

Tallyho!

LOL!

Wait a minute. . .you're not supposed to know about the putting greens!! 🙂

-BlueSkies

 

[Croooz]

USUHS has been on the chopping block forever. Nothing new there.

WRAMC & NNMC have also been on the BRAC list...means nothing. Most equate BRAC to closure but forget the realignment. I'm going thru one now. Do I think it's going to happen....YEP! We're on about 4 different scenario sheets which means we have 4 different groups of people thinking on ways to realign us...we can't be shut down but realigned. If the order comes down tomorrow the soonest we will move is 2007...highly doubtful, more like 2009-2011 Hurry up and wait

 

[R-Me-Doc]

True, Funny Story!
... Since I looked cleancut and good in my uniform(lots of ribbons from time w/ marines as corpsmen) I was designatd as the official RT for the special wing one week when Gores daughter was there. She was hot, and had a surg to repair deviated septum...yeah right...it was a nose job...I had to set up humidified air thru a face tent or something like that...met Tipper and Gore. Was there for the death of a famous supreme court judge too.

Hmmmmm. Guess they're not teaching much about HIPPA laws at LSU. 😉

RMD 1-1-22

 

[RichL025]

Yeah, it's easy to forget about the HIPAA stuff when it's someone famous involved. The first version of a previous post on this subject I wrote had the "famous senators" name in it. Luckily I reconsidered <g>.

Damn, I've gotten to treat some famous (and infamous) people recently. Shame about the HIPAA stuff, otherwise it'd make for some interesting celebrity stories...

 

[Termwean]

Ooooooooppss...my bad 👎 . Sorry to the mentioned people.

 

[Homunculus]

at san antonio and NCC peds has already been realigned. in san antonio peds is a joint airforce/army and in DC it is army/navy. WRAMC has the peds ward,PICU and clinic and NNMC has the nursery, NICU, and clinic.

i have a hard time seeing NNMC or WRAMC closing-- they're both packed to the gills with patients.

honestly, and this is long, long term, they should completely detach the medical corps from each service and create a new uniformed service of just medical personnel. it would simplify things tremendously, not to mention give a standard of care across the board. each service has their own little idiosyncracies that are redundant and inefficient. the move is toward tri-service care anyway, if you look at current staffing in Iraq. (and C4, lol). One medical service for everyone 👍

--your friendly neighborhood glad to be off the NICU caveman

 

[backrow]

Just to add to the rumor mill I just received this email...

-------------------------------------------------------
Latest BRAC list from Deputy Assistant to the Secretary of Defense
(Intelligence Oversight) CLOSURES FOR 2005

BRAC List - Just off the Press



Army bases currently proposed for closure or realignment in 2005
include:

* Carlisle Barracks, Pennsylvania
* Detroit Arsenal, Michigan
* Fort Belvoir, Virginia
* Fort Buchanan, Puerto Rico
* Fort McPherson/Gillem, Georgia
* Fort Monmouth, New Jersey
* Fort Monroe, Virginia
* Fort Polk, Louisiana (to realign)
* Fort Richardson, Alaska
* Fort Sam Houston, Texas
* Fort Shafter, Hawaii
* Lima Army Tank Plant, Ohio
* Natick Soldier Center, Massachusetts
* Picatinny Arsenal, New Jersey
* Redstone Arsenal, Alabama
* Rock Island Arsenal, Illinois
* Sierra Army Depot, California
* Yuma Proving Ground, Arizona


Air Force base closures and realignments include:

* Altus AFB, Oklahoma
* Beale AFB, California
* Brooks AFB, Texas
* Cannon AFB, New Mexico
* Columbus AFB, Mississippi
* Ellsworth AFB, South Dakota
* Goodfellow AFB, Texas
* Grand Forks AFB, North Dakota
* Hanscom AFB, Massachusetts
* Kirtland AFB, New Mexico
* Los Angeles AFB, California
* McConnell AFB, Kansas
* Nellis AFB, Nevada (to realign)
* Seymour Johnson AFB, North Carolina (to realign)
* Shaw AFB, South Carolina
* Vance AFB, Oklahoma

The Air Force will lose 2,260 military and 2,839 civilian manpower
positions, and 1,055 reserve drill authorizations next year, according
to the 2004 force-structure announcement released July 23. Many bases,
both active duty and reserve component, are affected by the realignment.
In many cases, units will gain aircraft and missions, while others will
pare down.

Besides manpower reductions, the realignment formally announces the
retirement of the C-9A Nightingale and KC-135E Stratotanker aircraft.

According to Air Force officials, the 20 C-9s are being retired because
of reduced-patient movement, range limitations and increasing
maintenance and upgrade costs. The aeromedical evacuation mission will
become a requirements-based system using all passenger-capable aircraft.


The service will retire 44 of the Air National Guard and Air Force
Reserve Command's 43-year-old KC-135Es next year, replacing them with 24
KC-135Rs from the active-duty fleet. By the end of fiscal 2006, the Air
Force will have retired 68 of the KC-135Es.


Naval base closures and realignments include:

* Ingleside Naval Station, Texas
* Naval Postgraduate School, California
* Naval Air Station Meridian, Mississippi
* Naval Air Engineering Station Lakehurst, New Jersey
* Naval Recreation Station Solomons Island,
* Naval Surface Warfare Center Crane, Indiana
* Naval Surface Warfare Center, Dahlgren Division, Virginia
* Navy Supply Corps School, Georgia
* New Orleans Naval Support Activity, Louisiana
* Pascagoula Naval Station, Mississippi
* Portsmouth Naval Shipyard, New Hampshire
* Saratoga Springs Naval Support Unit, New York


Marine base closures and realignments include:

* Marine Corps Logistics Base Albany, Georgia
* Marine Corps Logistics Base Barstow, California (realignment)
* Marine Corps Air Station Miramar, California
* Marine Corps Mountain Warfare School, California
* Marine Reserve Support Unit, Kansas City
* Marine Corps Recruit Depot San Diego, California (realign or close).

 

[denali]

That list has been going around various websites, unconfirmed, since Feb 2004.

 

[GeoLeoX]

I believe this is the list I mentioned previously:

For those who like to speculate:
http://g2mil.com/2005.htm

G

 

[squishymutts]

hot off the presses:

Senate Appropriations Committee

Defense Subcommittee

Hearing

The Senate Appropriations Committee's Subcommittee on Defense held a hearing this morning on the Defense Health Program.

There were two panels of witnesses. The first panel was the Surgeons General of the three Services. The second panel was the heads of the Nursing Corps of the various Services.

It was noteworthy that, during their question and answer period, the Surgeons General often exchanged information and looks before answering. This spoke to the current high level of interoperability of their activities. At the same time, their testimony proved that each Service does have distinct needs and challenges.

This hearing may have seen the birth of a new program, the "Mikulski Plan." as can be seen in more detail below, Sen. Mikulski proposed implementing some form of loan repayment or debt forgiveness in return for long-term commitments from doctors. Stevens latched onto this idea, named it, and expanded to consideration of it for the nurses, as well. More can be expected to be seen in this area in the coming year.


Witnesses

Panel 1:
LTG Kevin C. Kiley, MD, The Surgeon General of the United States Army
Vice Admiral Donald C. Arthur, MC, Surgeon General, Chief, Bureau of Medicine and Surgery
LTG (Dr.) George Peach Taylor, Jr., Air Force Surgeon General


Questions and Answers, Panel 1

Stevens asked how successful they have been in recruiting and retaining medical personnel. This would include young people coming in to be trained as a medical person. He wanted to know if bonuses and incentives are adequate. Kiley said that recruiting and retaining combat medics seems to be going pretty well. For the professional officers corps (nurses and doctors), there are bigger problems. They expect to end this year about 200 nurses and 200 doctors short. There is a nationwide shortage of nurses occurring. The Army is trying to get some interest in nursing scholarships and also through ROTC. There has been a very high level of tempo for physicians. Between Bosnia, Afghanistan and Iraq, some of them are now on their third deployment. Kiley is concerned. Some bonuses are beginning to run out. Nurses do seem to respond well to bonuses and incentives. Depending upon the nature of the mission, they could be stretched very thin depending upon the reserves for medical officers. The nature of the private practice of medicine today is such that reserves physicians cannot afford to leave their practices for very long or very often.

Taylor echoed much of what Kiley and Arthur said. The Air Force is seeing problems with the Dental and Nurse Corps.

Stevens said that "we" were disturbed to hear that USUHS and WRAMC might be closed. He is also disturbed that some medical personnel would be allowed to leave early after receiving substantial financial assistance. Taylor said that there is still a service requirement. There seems to be some confusion on this issue, and Stevens requested a report on it.

Inouye asked what the retention levels are for gradates of USUHS as compared with other training locales. The witnesses did not know the exact numbers. Taylor did say that USUHS graduates tend to stay longer due to the longer commitments they make in return for that training.

Inouye also asked if WRAMC continues to support 40 medical specialties. Kiley said that training at Walter Reed is considered to be very prestigious, not only due to location but also due to the research and other activities that go on there. It is a very big, complex organization that offers very high level health care. It is also the major receiving facility stateside for casualties. "Walter Reed is the linchpin for Army medical programs." Having Walter Reed experience as a career potential also works as a retention tool.

Inouye brought up "Section 8" casualties. Arthur said that we are only just now beginning to see the impacts of combat stress. The Services need to be very sensitive to picking up on these issues. They need to treat it at the lowest levels: in garrison, rather then sending individuals to hospitals. All three Services have enlisted retirees to ensure that everyone in the community is reached, including those who do not return to garrisons after deployment. They want to do everything they can to prevent service members from having to go to civilian centers, where they will not receive as high quality care. He is encouraged by the level of care and attention being brought to this issue.

Mikulski (D) also expressed concern over the possibility of the closing of USUHS and WRAMC. She, too, asked about retention levels of USUHS graduates. Kiley explained that these graduates have a seven year commitment after all training is concluded. As a result, many of these graduates are in their eleventh or twelth year of service before they have finished this commitment. In addition, if they have a five year commitment from West Point, that is added to the seven years. Kiley noted that some of these physicians are close to retirement before they finish with their commitments, and can actually make decisions as to whether to stay in the service or not.


Mikulski also encouraged looking at the scholarship program, to see about increasing obligations and retentions. She noted that DoD is competing for physicians with not only private academic institutions but also with the VA. Surprisingly, the VA can pay physicians more than DoD can. Stevens was very interested in this information, which was clearly new to him.

Mikulski asked if they have considered debt reduction. Kiley said they do have some debt reduction programs. However, there is a question as to whether the program is robust enough, which it is not. In addition, with regards to the VA, as part of the retirement program, bonuses are counted toward retirement pay. That does not happen in the DoD.

Stevens instructed the witnesses to confer, and to submit to the committee a fleshed out version of the "Mikulski plan" for debt reduction. He said it would be interesting to see if something can be done on this issue this year.

 

[backrow]

Here's the latest from the AP

They are putting it up in pieces so it may not be a complete list as of yet, but it's getting there. Nothing too crazy yet that I have noticed, but of course it still has to be approved by everyone.

http://www.nytimes.com/2005/05/13/national/13list-base.html

 

[cavaor]

I think this MAY be a complete list

http://www.foxnews.com/projects/pdf/appendix_c.pdf

 

[denali]

SecDef wasn't kidding about the Guard and Reserve playing in this one. Nice to see DFAS fat getting trimmed; less people for them to point fingers to when pay gets screwed up. Like to hear more about the massive WRAMC realignment.

 

[RichL025]

SecDef wasn't kidding about the Guard and Reserve playing in this one. Nice to see DFAS fat getting trimmed; less people for them to point fingers to when pay gets screwed up. Like to hear more about the massive WRAMC realignment.

On NPR as I write this:

The Surgeon General of the USAF used the NCA as an example of what the medical BRAC people are recommending, and has been approved by the SecDef

- A Brand new "Walter Reed National Medical Center" located on the Navy's Bethesda campus (current site of the NNMC). It will be tri-serivce, and presumable encompass the total current bed capacity of WRAMC + NNMC.

- Brand-new hospital at Ft Belvoir

- Downgrading of Malcom Grow (Andrews AFB) to a clinic with ambulatory surgery

For those above examples alone, they claim that the $1 billion investment will yield a permanent yearly savings of 100 million.

 

[squishymutts]

On NPR as I write this:

The Surgeon General of the USAF used the NCA as an example of what the medical BRAC people are recommending, and has been approved by the SecDef

- A Brand new "Walter Reed National Medical Center" located on the Navy's Bethesda campus (current site of the NNMC). It will be tri-serivce, and presumable encompass the total current bed capacity of WRAMC + NNMC.

- Brand-new hospital at Ft Belvoir

- Downgrading of Malcom Grow (Andrews AFB) to a clinic with ambulatory surgery

For those above examples alone, they claim that the $1 billion investment will yield a permanent yearly savings of 100 million.

Dude, I told you so.


Walter Reed Army Medical Center Realign
28 Military In
(2,679) Military Out
31 Civilians In
(2,388) Civilians Out
(2,651) Net Mil. Loss
(2,357) Net Civ. Loss
(5,630) Total Loss

Notice the approximately 1000 military person increase at Bethesda with no losses.

The goal is to streamline the district area.

squish.

 

[RichL025]

Yup, I didn't believe it <g>.

I guess I was thinking more of BRAC closing one or the other, instead of consolidating at Bethesda.

As an aside, a long-timer at WRAMC told me that when the "new" part was going to be built, the pentagon wanted to locate it at the current site of the WRAMC Annex at Forrest Glen (just inside the beltway in Silver Spring). A young DC councilmember named Marrion Barry 😉 convinced the army to keep it within the district by promising free parking and a metro stop....

In the army's defense, Barry hadn't quite manifested his credibility gap back then....

 

[denali]

Heh, I expect the "District" may still have something to say considering it's a loss of > 5000 jobs. I wonder what's going to happen to the ~1500 military positions not moving to Bethesda, and Army's GME positions. Obviously Stevens and Inouye had more than just rumors to go by on Tuesday.

If anything, those of you who own houses in Bethesda/Chevy Chase/Kensington/270-corridor may want to wait until after this fall to sell 😉

 

[RichL025]

Yeah, the "district" might have something to say, but then again, the district doesn't have a vote in congress. Maryland does <g>.

As for selling, unfortunatly, don't have much of a choice right now.

 

[backrow]

By Metro Stop did Berry mean a free shuttle from the stop??? Figures that we finally get a shuttle between metro and WRAMC and now they're going to move everything to NNMC. I'll be glad to see no more DC traffic, even though MD isn't much better

 

[BOHICA-FIGMO]

If you read section six of part one of the report (available at: http://www.defenselink.mil/brac/) starting at page 327, you will notice that the USAF will no longer have any inpatient facilites, except maybe at Wright-Pat 😱 . Andrews, MacDill, Keeser, Scott are all eliminating their in-patient functions. Wilford Hall and USAFA are transferring their inpatient functions to BAMC and Ft. Carson, respectively. McChord is transferring ALL medical functions to Ft. Lewis.

 

[Homunculus]

i think the WRAMC/NNMC consolidation will be good for everyone. though it won't be til 2010 or so, at least some of the redundancy will be trimmed. Though they *are* going to have to build a bajillion dollar facility to house all of us army adoptees and our patients when we move over there 😎

i also like how they're keeping the Walter Reed name. 👍 All your base are belong to us!

the AF transferring its inpatient services is rather odd. . . 😕

now we only need that little iraq thing to blow over and we'll be sitting pretty, lol

--your friendly neighborhood consolidating caveman

 

[kch207]

Ok, so I'm a little confused. What does this mean that the Air Force is drastically cutting back on in-patients? What's going on??!!

 

[Homunculus]

Ok, so I'm a little confused. What does this mean that the Air Force is drastically cutting back on in-patients? What's going on??!!

sounds like more of a "move" than a cut-back. the cut-back will happen later methinks.

--your friendly neighborhood speculating caveman

 

[denali]

It could also be writing on the wall: we'll be purple sooner rather than later. At the very least, more of our facilities will be like Landstuhl with lots of multiservice positions built-in to the staffing documents.

ETA: My comment about Landstuhl was made before I read the DOD Medical BRAC press release.

 

[grumbo]

Looks like some interesting changes for all of us.

BRAC 2005: DoD Uses Process to Revamp Medical System
By Jim Garamone
American Forces Press Service

WASHINGTON, May 13, 2005 – Defense officials have used the base realignment and closure process to transform the way military medicine operates.
Medical facilities will become more joint, they will consolidate where patients reside and they will become state-of-the-art. "We want to rival Johns Hopkins or the Mayo Clinics," said Dr. William Winkenwerder Jr., assistant defense secretary for health affairs.

Defense Secretary Donald H. Rumsfeld delivered his recommendations for base realignment and closure to the BRAC Commission today. The medical recommendations are part of this process.

The recommendations mean changes to military medicine in the nation's capital and San Antonio, as well as changes in many other military health facilities in the United States.

The major recommendation would establish the Walter Reed National Military Medical Center on the grounds of the Bethesda Naval Hospital in Maryland. It also will create a brand-new 165-bed community hospital at Fort Belvoir, Va. If approved, this will cost around $1 billion, said Dr. (Lt. Gen.) George P. Taylor, Air Force surgeon general, who headed the joint cross-service group that worked on DoD's medical BRAC recommendations.

Army, Navy and Air Force medical personnel will staff both facilities. The current hospitals - Walter Reed Army Medical Center and Bethesda - are separated by just seven miles. They are the primary receiving hospitals for casualties from Iraq and Afghanistan. "We believe the best way to do this is to place the facility on the Bethesda campus," Taylor said.

In addition to housing the Walter Reed National Medical Center, the Bethesda campus will keep the Uniformed Services University of the Health Sciences. The National Institutes of Health is also right across the street from the Bethesda facility. "The facility is able to accommodate the in-patient activities at this location," Taylor said.

Part of this recommendation would close the Army's Walter Reed campus in Washington, D.C., and Malcolm Grow Hospital at Andrews Air Force Base, Md., would close its in-patient facilities and become a large same-day surgery center.

"We know these types of joint medical facilities work," Taylor said. "We have two of them today: Landstuhl Regional Medical Center in Germany has been staffed by Army and Air Force for more than 10 years. If you go to Balad Hospital in Balad (Iraq), it is Army and Air Force run."

Changes would take place in San Antonio also. The two big medical platforms there are Brooke Army Medical Center at Fort Sam Houston and the 59th Medical Wing's Wilford Hall Medical Center at Lackland Air Force Base. Plans call for medical care to center at Brooke. It will become the San Antonio Regional Medical Center, and will be a jointly staffed, 425-bed center. At Lackland, BRAC recommends building a world-class outpatient and ambulatory surgery center. The trauma center at Lackland will close, and Brooke will expand to handle the need.

San Antonio also will become the hub for training enlisted medical technicians of all services. Currently, the Army trains at Sam Houston, but the Air Force trains medics at Sheppard Air Force Base, Texas, and sailors train at Great Lakes, Ill., San Diego, and Portsmouth, Va. "All enlisted specialty training would be done at Fort Sam Houston," Taylor said. The approximate student load would be about 4,500.

Aerospace medicine research will move from Brooks City Base (the one-time Brooks Air Force Base) to Wright-Patterson Air Force Base, Ohio. The Navy's Aeromedical Research Lab will move from Pensacola, Fla., to Wright-Patterson also.

The recommendations create six new centers of excellence for biomedical research, and all are joint. Assets will come from Navy, Air Force and Army locations to these new centers. They are the Joint Center of Excellence in Battlefield Health and Trauma at the Brooke Regional Medical Center, the Joint Center of Excellence in Infectious Disease Research at the Forest Glen Complex in Maryland, the Joint Center of Excellence for Aerospace Medicine Research at Wright-Patterson Air Force Base, the Joint Center of Excellence in Regulated Medical Product Development and Acquisition at Fort Detrick, Md., the Joint Center of Excellence in Biomedical Defense Research at Fort Detrick, and the Joint Center of Excellence in Chemical, Biological Defense Research, Development and Acquisition at Aberdeen Proving Ground, Md.

Overall, the recommendations will cost $2.4 billion to build new facilities and capabilities. Once in place, the services will save $400 million per year, officials said.

The joint cross-service group, new in this round of BRAC, was able to make recommendations to the secretary. In past BRAC rounds, joint groups merely advised service leaders.

"It is my view that the group put together a very thoughtful, very comprehensive plan for improving military health care," said Winkenwerder. "It is a plan that allows us to invest in, and modernize key flagship facilities and at the same time, it will allow the military health system to be more efficient."

 

[bobbyseal]

"We want to rival Johns Hopkins or the Mayo Clinics," said Dr. William Winkenwerder Jr., assistant defense secretary for health affairs.

Ha! Honestly, give me a break. If you believe this then I've got some great ocean front property to sell you in....

 

[porokeratosis]

Ha! Honestly, give me a break. If you believe this then I've got some great ocean front property to sell you in....

Hehehehehe...that's a good one Yeah, I got some great ocean front properties with lots of beautiful babes to sell you. They are located in Diego Garcia and GITMO 😛

To think military medicine could rival Mayo, Harvard, or Johns Hopkins is absolutely ridiculous. In the military, you get paid significantly less $$$ than your civilian counterparts, you are not paid more $$$ to see more patients, there's no malpractice, and there's little cutting edge research. So let's see, as a military doc I can get paid the same for seeing the fewest patients possible, I can totally screw up on a patient and not get sued (and not worry about it), and the military gives me little funding for research other than CBRNE. Plus, they deploy me every 6 months so I cannot continue any long-term research. Without incentives and resources, military medicine will never come close to the Big Three

 

[texdrake]

Just my two cents but I can see the military revamping the whole medical core whereby one just joins the "Military Medical Corp" and then chooses a service. In otherwords all the hospitals and training would become joint and everyone would wear the same uniform for medical corp (some modification of the army's probably) and then when you finish residency you would either maintain status quo (if staying at the training institutions) or you would realign with your service, switch uniforms and work on you assigned post (much like the way the navy treats the marine doctors)

 

[squishymutts]

Just my two cents but I can see the military revamping the whole medical core whereby one just joins the "Military Medical Corp" and then chooses a service. In otherwords all the hospitals and training would become joint and everyone would wear the same uniform for medical corp (some modification of the army's probably) and then when you finish residency you would either maintain status quo (if staying at the training institutions) or you would realign with your service, switch uniforms and work on you assigned post (much like the way the navy treats the marine doctors)

I think a more likely scenario (borne out in the Navy, starting in the Army, and from the look of the BRAC list - the AF will be hit hard) is the complete civilianization of military medical care. The prevailing sentiment is that no one in their right mind would join the military medical corps (and the resultant paltry pay scales) if they were not in the military. However, there are hundreds of civilian physicians who already have. With no tort reform on the horizon and the insane soaring costs of malpractice I see it becoming more and more of a reality. One thing is for sure, the military is becoming less interested in the field of GME. Perhaps GME will die first, then the military medical corps.

The handwriting is on the wall. And the BRAC list.

SQ

 

[blueSkies]

I concur with squishy's bottom line (we are moving towards civilianization of military medical care), but for a different reason: can we say "A-76"?

Short story: The gov't will "identify all activities. . .as either commercial or inherently governmental"; gov't will perform all "inherently governmental activities"; the rest will be outsourced (Src: OMB Circular A-76). For the DoD this has meant outsourcing most jobs that are not "traditionally military" or do not have a deployable function. At first blush the cost savings are not always obvious; but after full analysis they become apparent.

The proposed BRAC list medicine realignments appear to me to be fairly sensible consolidations of capacity and resources, while eliminating redundant overhead. The taxpayer inside me smiles, the HPSP student furrows his brow and ponders his residency options. 😳

Am curious if the analogous thing will happen to docs that happened to line officers during the mid-1990's drawdown: ROTC seniors were offered the option of taking 4 years of active reserve to fulfill their obligation, instead of the normal 4 years active duty. Will "they" say to some of us in 2010-ish, "You know, thanks for letting us pay for your education, but we don't need you now. Go join the Reserves or Guard." Thoughts?

Anyone been involved with A-76 studies in the context of military medicine? Cheers,

-Blue

Further reading:
OMB Circular A-76:
http://www.whitehouse.gov/omb/circulars/a076/a76_rev2003.pdf

DoD's A-76 idea-swap site:
http://sharea76.fedworx.org/inst/sharea76.nsf/CONTDEFLOOK/HOME-INDEX

 

[RichL025]

Umm, you guys seem to forget why no one has ever tried this before.

For the DoD this has meant outsourcing most jobs that are not "traditionally military" or do not have a deployable function.

And this exactly describes military medicine. Short of Interventional Radiology, I can't think of too many other specialties that haven't been deploying people in this war.

And the one before it.

And the ones to come.

Could the active duty medical corps shrink some more? Possibly. Will it go away? Not a chance.

 

[blueSkies]

RichL025,
will you be more clear: what has "no one ever tried before"?

And FYI, there are many specialities that do not typically deploy into the theater of operations--think pediatrics, emergency med, psychiatry, ob/gyn, etc. This is particularly true for the USAF, whose specialists generally "deploy" to Germany to receive med-evacs.

No need to take a derogatory tone, either. Particularly when your point lacks clarity and your "facts" are questionable.

-Blue

 

[militarymd]

RichL025,
will you be more clear: what has "no one ever tried before"?

And FYI, there are many specialities that do not typically deploy into the theater of operations--think pediatrics, emergency med, psychiatry, ob/gyn, etc. This is particularly true for the USAF, whose specialists generally "deploy" to Germany to receive med-evacs.

No need to take a derogatory tone, either. Particularly when your point lacks clarity and your "facts" are questionable.

-Blue

In the Navy, all of the above listed specialties deployed.....I know...I ran into them in the Gulf 2 years ago.

 

[Homunculus]

In the Navy, all of the above listed specialties deployed.....I know...I ran into them in the Gulf 2 years ago.

and they're all there now. i must have missed his point-- 'cause to list EM as a specialty that is not typically deployed is nuts, lol.

--your friendly neighborhood third most deployed army specialty caveman

 

[denali]

RichL025,
will you be more clear: what has "no one ever tried before"?

And FYI, there are many specialities that do not typically deploy into the theater of operations--think pediatrics, emergency med, psychiatry, ob/gyn, etc. This is particularly true for the USAF, whose specialists generally "deploy" to Germany to receive med-evacs.

No need to take a derogatory tone, either. Particularly when your point lacks clarity and your "facts" are questionable.

-Blue

Not interested in starting a service tiff here, but in the Army the converse is true: there aren't hardly any specialties that don't deploy. You're a "cardiologist with l33t interventional fellowship skillz"--well you're also board certified in IM so off you go to be a TO&E hospitalist for 12 mos. Derm guys can fill in for IM/FP slots all the way forward to a BAS. With the hearts and minds mission it makes absolute sense to be sending peds and ob/gyn, and at least 1 psych is PROFIS to each division.

FWIW,

 

[blueSkies]

In my trips to the desert I have only seen flight surgeons. Granted, they may be certified in other specialities prior to going to FS school, but they were serving as FS's, not their "old" specialities.

As I mentioned, so far as USAF goes, I believe it is the exception for our specialists go in-theater. I've heard the Army is different due to their forward hospital/surgery/trauma requirements; don't know about the USN.

I'd like to hear what the pediatricians, psychiatrists and ob/gyns were doing in SWA, and in what number they were present. To suggest that all of our medical specialties are forward during war--as it seems milMD and Homunc are doing--implies that definitive care is also provided forward, and that isn't consistent with the present concept of deployed medical ops.

Exceptions aside (e.g. medical support to Iraqis, a doc who really wanted to go, substituting one speciality for another to fill an empty billet, HQ billet, etc.), I stand by my statement that many/most specialties won't deploy. I'll concede the Army deploys EM docs, as well as several other surgical/trauma specialists to their field hospitals. Don't believe you'll see that with the USAF unless we're filling in when the Army doesn't have enough docs. Am interested to hear how the USN works docs on deployments.

-Blue

 

[benjiboy]

any guesses as to how soon the IM residency at wilford hall will die? would those spots be eliminated altogether or would the size of the IM program at BAMC be increased? this is crazy. i was planning on heading to Big Willie next year for IM residency. everyone always said that no matter what happened to AF medicine, Lackland would stay strong as its "flagship." i guess not eh? apparently wright-patterson becomes the flagship by default as the only remaining hospital in the AF with an inpatient service