I think, based off the retention pitches I keep hearing, and all the higher ups supposedly very interested in "how can we keep you" if you're thinking about getting out, along with this, that they're seeing physicians leaving faster than they think they can be replaced. I know in EM, a lot of folks are getting out as soon as their 4 years are up.
It seems like most of the Navy's attempts at retaining EM is a losing battle with our previously stable retention rates dropping to all time lows. Though to be fair, I am not sure what they can do in the current environment to entice those in the EM community to stay beyond their service obligation; unless another conflict breaks out.
We remain "manned" near 100%, but with a disproportionate amount of EM holding leadership billets or other non-EM billets we have been effectively understaffed for years and now with plummeting O4 retention rate the strain is increasing. We are now struggling to minimally staff our MTFs on top of our Marine Corps obligations. Their have been talks of downgrading CONUS/OCONUS EDs to non-EM staffed urgent cares however, unsurprisingly this results in immediate uproar from the line community. On top of this, OP tempo seems to be slowly creeping upwards despite "peace time" with no ship/shore balance. Every other Navy community, SWOs/Pilots/Nukes, seem to recognize that constantly shuffling staff between deployable billets is not sustainable. And yet, Navy medicine seems to increasingly feel the need to be operationally relevant with increasing ERSS and other blue side platforms, plus our long standing green side operational obligations. Now almost every EM billet is "operational" with people getting deployed from even minimally staffed OCONUS MTFs or key leadership/GME positions. Additionally, the constant burden of these taskers further strains those left holding down the fort; no one at my MTF has worked less than 1.3 FTE in the past 2 years. The Navy reserves seem to be experiencing a similar push towards EXMED platforms so getting AD positions back filled by reservist on ADT is next to impossible. Combine this with difficulty maintaining KSAs and increasingly busy MTF (urgent cares) EDs, with short staffing in other primary care communities pushing more people to the EDs. Sure, some of the MTFs are increasing trauma capability which helps KSAs, but this is a small portion of our skill set. Perhaps they could start allowing sick civilian cases at the MTFs like Guam, but most of them can barely handle their current workload due to bare bones staffing, and I'm sure this would be a bureaucratic nightmare.
As with most specialties, I don't think they could realistically bridge the gap with money. They did increase the specialty pay, retention bonuses, and are decreasing the time to O4 (and I suspect decreasing time to O5/O6 will soon follow). However, given most can match their Navy pay working half-time as a civilian, with little-to-no admin requirements ,I think the pay gap is unsurmountable. It seems the current plan is keep pumping up the number of NADDS EM Grads who almost never stay beyond their obligation.
