Military medicine ‘peaked’ in the 90’s

[armytrainingsir]

As far as physicians are concerned.

The military was flush with cash leading up to Desert Shield/Storm. No major conflicts for a decade. Major TAMC upgrades and BAMC and MAMC both got a new hospitals. Doc’s were overall happy in MEDCENs with plenty to do since retirees were still abundant and welcomed. Fellowships we’re encouraged and most went to a MEDCEN and practiced. GMO spots were filled with future ortho and opthalmology docs in exchange for a near guaranteed residency spot. And Fitzsimons and Letterman were both open and sweet spots to land. Sure WR sucked, but that was the price you paid to impress civilians since Walter Reed and the Brooke burn unit were the only two things the average civilian knew about military medicine.

Now?
Not so much.

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[DrMetal]

Now?
Not so much.

Now? Not at all!

If a reporter walked through the halls of my MTF and noticed the paucity of patients, she'd have no trouble in writing a waste-fraud-abuse piece regarding the current state of military medicine.

 

[armytrainingsir]

I was trying to be generous.

 

[DD214]

I would have loved to expose attending clinic schedules to the media where I did residency

They would complain about how busy they were in clinic seeing 3-5 patients in a half day (with the afternoon reserved for "Admin Time" of course)

And that was when they had no inpatient or consult duties LOL

 

[Vandalia]

Disagree. It was the 80’s no question. I was around for both.

At least in the AF it was pretty clear that if it was war it would quickly go nuclear. In other words, who cares?

The one upside was that in the 90’s the smallest rural places shut down. The counter was Tricare

 

[orbitsurgMD]

Letterman, Oak Knoll, both gone in the 80s. Retirees were sent out with CHAMPUS and then Tricare in the 80s. Busy hospitals became much less busy. Surgery programs were forced to reduce their size to comply with expected per-resident case numbers. Some residents were RIFd mid-program, others made to step back a year where there were openings. Opportunities for residency, pretty much to be expected in earlier years became more scarce. Anyone with their eyes open could see where it was all going, and a lot of junior medical officers decided to head for the door after GMO tours. The down-trend began in the 80s when the DOD managers drank the HMO Kool Aid.

 

[HighPriest]

Like Ska

 

[HighPriest]

Disagree. It was the 80’s no question. I was around for both.

At least in the AF it was pretty clear that if it was war it would quickly go nuclear. In other words, who cares?

The one upside was that in the 90’s the smallest rural places shut down. The counter was Tricare

Like Wham!

 

[DrMetal]

Letterman, Oak Knoll, both gone in the 80s. Retirees were sent out with CHAMPUS and then Tricare in the 80s. Busy hospitals became much less busy. Surgery programs were forced to reduce their size to comply with expected per-resident case numbers. Some residents were RIFd mid-program, others made to step back a year where there were openings. Opportunities for residency, pretty much to be expected in earlier years became more scarce. Anyone with their eyes open could see where it was all going, and a lot of junior medical officers decided to head for the door after GMO tours. The down-trend began in the 80s when the DOD managers drank the HMO Kool Aid.

Funny thing is, I don't mind all of this. It's called the Department of Defense, not the Department of Healthcare or GME.

The military was never meant to be a bastion of great medical care and education.

What I do mind, is that we in the Medical Corps can't seem to understand or accept this, and we continue to perpetuate the façade of stellar healthcare and education. Or we'll take a small MTF and crown it a 'trauma center', when in reality it's a Level 3 (can repair scalp lacerations only).

 

[Vandalia]

Funny thing is, I don't mind all of this. It's called the Department of Defense, not the Department of Healthcare or GME.

The military was never meant to be a bastion of great medical care and education.

What I do mind, is that we in the Medical Corps can't seem to understand or accept this, and we continue to perpetuate the façade of stellar healthcare and education. Or we'll take a small MTF and crown it a 'trauma center', when in reality it's a Level 3 (can repair scalp lacerations only).

I would disagree; for that era.

The medical education infrastructure created a significant portion of the physician population with military medical training. If World War III were to break out, or a very significant natural disaster, it was hoped that some of those skills and training would stick around in their heads.

There is a lot of talk now about maintaining a defense infrastructure in the U.S. Semiconductor fabrication is but one example. You can view the military medical education infrastructure in this country in the same light. A little before my time all male students at land grant universities were required to take at least one year of ROTC. Again, to have some training in the population in case they needed to be drafted and quickly placed in Army units. I think you can view the defense medical education infrastructure of that time in the same way.

It may not be the most efficient use of resources, but I know for a fact that is how the military medical education infrastructure was justified.

The other factor is that well into the 70's residency training was not all that common. If you had an operation before 1970 that a general surgeon would perform today, it was almost certainly done by a "general physician" with a one year internship. If the DoD didn't do GME, the hospitals at that time were very unlikely to do so.

Again, it goes back to that view - still present today with respect to science and engineering - that a well trained civilian population benefits the national defense.

However, so much has changed in medicine and the national security threats that that model no longer really holds. At least with respect to GME.

 

[DrMetal]

I would disagree; for that era.

 

[Vandalia]

Up until the end of the Cold War, most people assumed that at some point there would be World War III. A "total war" with all of the population mobilized for the fight. In that scenario, it makes sense to have a lot of physicians around in civilian practice with basic training in military medicine. That is why we had the contingency hospitals ready to go, particularly in Europe.

The chances of that today are miniscule. It is difficult to envision the U.S. involved in a "total war" scenario;; again it will either quickly go nuclear, or it will evolve without significant ground forces. I don't see any scenario that will involve conscripts in the infantry marching through Beijing or Moscow.

The two fundamental laws of war are do not get involved in a ground war with Russia or China. (The third is don't get the United States united.)