Air Force [HELP REQUEST] Research on military physicians retention rate

[paulee1983]

To all military physicians,

My name is Paul, a general dentist working in USAF, 4 years in service. I am working on a critical analysis research. My topic is about course of actions that can increase retention rate of USAF physicians. Do you mind provide me some insights to this problem?

1. To my understanding, even with the current special pay and MSP, the differential of median civilian and military pay is still huge (from $25k - $350k depends on specialty, according to a RAND report back in 2009). Adjusting special pay and MSP to match with civilian level seems unpractical, but if you can make the changes, how much raise would be appropriate to make you consider staying in?
- I tried to look up the current special pay/MSP document in knowledge exchange, but could not find it. Do you know where can I locate it/AFI #?

2. I interviewed couple AF physicians that are separating, they mentioned even though civilian sector pays 2x more pay, financial is not the main reason they are getting out. Instead, the insane working hour (12-14 hrs/day, sometimes may have to come in on weekend), the excessive paperwork/additional duties, the stressful perfect standard of "zero harm" working atmosphere, and poor leadership are driving them out. What are the reasons that make you want to separate?

3. If you can implement some policies to help retain physicians, what will you do?

4. Currently my proposed course of actions are streamline additional duties, hire more civilians for admin workload, and possibly expand the function of physician assistants so more delegation can be made. The end state is to reduce the working hours, boost morale, and increase retention rate by providing a better lifestyle than civilian sector even though the pay is less. Education opportunities and oversea experience are bonus, but potential deployment becomes a major concern to lifestyle. What are your comments on that?
- What additional duties do military physicians generally have and which one can possibly assign to civilians admin?


Thank you so much for helping! I am trying to make some impacts if possible, even they are baby steps....

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[Apollyon]

I am not military - I can "talk the talk", but have not "walked the walk". More than once, here on SDN, people have stated a rate of separation at 90% after fulfillment of the ADSO. That right there tells you something. 90%, man! Nine out of 10 get out ASAP. They give you the minimum, then GTFO.

That's gotta mean something, man.

 

[Monty Python]

I was a Navy Professional Schools Liaison Officer for several years in the mid-2000s. We met annually at the Bethesda motherhouse to hear the Surgeon General praise the glories of mil med. While there I would annually marvel at how the Navy couldn't even plan/build enough hospital parking garage space (a subjective symptom of the entire system's dysfunctionality?), nor get a sky bridge installed from the closest Metro station across the busy street at NIH. If memory serves from those meetings and information pushed out to us from BUMED, the retention rate post-ADSO was a single digit. Number one reason on surveys was supposedly frustration generated by AHLTA, with the usual suspects close behind (admin work, hours, nonsupportive staff, military BS, GMO tour interfering with desire to start residency, etc).

The AF is somewhat unique in that they have no separate medical corps. The military assets/people/money all belong to the line commander. In contrast, Army and Navy have separate medical commands with their own budget, etc. I'm curious if that has any affect on anything substantial, or if those service differences are just window dressing.

And for a good-natured jab at our Army colleagues: the now-departed Army Nurseon General's legacy after committing so much time and political capital on creating a "system for health" (you know, sleep 8 hours/night, eat all your vegetables, etc.) is a headline-grabbing story on current obesity levels in the service. Matters not, she's now making $$$ doing speeches. This type of "leadership," combined with the q2yr turnover of senior hospital leadership, also leads to a nauseating revolving door culture of holding no one accountable ... or in the case of Dr. Smith, being thrown under the bus: http://www.military.com/daily-news/...-again-army-court-sets.html?ESRC=eb_161013.nl

 

[Kilgoretrout 65]

Paul - do they really want people to stay? Don't they want 80% of the docs to be 03 or 04 GMOs or one time ADSC FP docs and get out? That is like saying they want every enlisted member to be an E8. I stayed despite the stupidity, not because I was amazed at how well things worked. The things that are broken probably aren't fixable:

-Nurses and Physical therapists in charge
-multiple EMRs/LIS none of which talk to each other and the proposed solutions taking many many many years to implement
-low pay yes but also uncertainty in how the changes will take place
-leadership not understanding that the patient is the mission - most act as if the patients and docs are inconveninces to overcome on their way to stellar metrics
-poor civilian personnel offices that take 9 months to hire someone into a position and 18 months or more to fire a worthless one
-don't even talk about going to conferences/CME because the AF has no money for that and totally screwed up the approval process years back AND the way
this is handled base to base is totally different so the doc doing very little at a podunk base gets to do CME while the busier doc at the busier base does not
-cycbersecurity issues that we don't understand but still prevent us from implementing new useful technology or even using the right network that currently exists
-currency and competency issues as addressed numerous times on this forum

The biggest thing is keep the docs doing doc stuff - respect their skill set and their time and do not bog them down with any other BS

 

[pgg]

They DON'T want people to stay, because the pension is expensive.

The new retirement scheme isn't clever because it cuts the pension value by a little bit. It's clever because by giving people a pittance they can take with them at 10 years and making the 20-year prize less attractive, more people will get out.

Retention is an anti-goal for the medical corps - so long as the training pipeline is full enough to keep the billets manned, everything is good. The more junior the corps, the fewer pensions they pay, the better. They have judged that the cost of having senior doctors around is not worth the extra value they get from having those senior doctors. They might be right.


edit - To be clear, I am of two minds about this. It'd be nice if they valued senior clinical talent enough to incentivize more of it to stay. Surely the best possible care would be had if the military threw $millions and $millions at experienced, senior physicians and surgeons in busy private practices and prestigious academic hospitals and convinced them to come on active duty. But they also have an obligation to meet the mission needs at the lowest possible cost, to keep funds going to the kill-people-break-things budgets our military exists for in the first place. A medical corps that is 90% junior doctors serving their 4-7 years and getting out is, in truth, probably the best answer from a distant view of the whole.

 

[Gastrapathy]

Paul, these sort of thought exercises are pointless. The leadership is fully aware of the reasons for poor retention. At best, they are neutral on the subject. At worst, they want us to quit. When I quit, an admiral told me "well G, not everyone can stay." And that dude liked me.

 

[Shikima]

I wonder if MILMED would be better served with more reservist billets than actual AD physicians.