NDAA 2017

[Chonal Atresia]

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Wow...not good for those that chose to stay in.

Attached is the Senate's summary of the 2017 National Defense Authorization
Act.

Pages 6-8 discusses the Military Health System reform (see bottom of page
for page number) make for interesting read (pdf pages 8-10)

These lines particularly stood out to me, but the Senate and House versions
essentially agree on these points, so I suspect it will go forward:

..."Eliminates graduate medical education training programs not directly
supporting operational medical readiness requirements and the medical
readiness of the Armed Forces."

Also "Authorizes conversion of military healthcare provider positions to
civilian or contractor positions."

And finally "Transfers financial risk for the delivery of healthcare
services to contractors and healthcare providers."

 

[Gastrapathy]

Quick thoughts:

Such a hodgepodge. Just shows how poorly they understand the system. Downsize everything while improving access and allowing veterans to be eligible for care. Will create an expensive new research apparatus that will create nothing.
This is the Senate summary and we've ignored them many time before (see getting rid of GMOs circa 2002 and yet...).

I love the comment about creating the Cleveland Clinic (wonder which Senator added a little free advertising to that organization). The model they need to follow is the Kaiser model.

The interesting question will be whether this really kills off GME. I'd argue that the only specialties we need to train under this standard are adult primary care, critical care, anesthesiology, EM, Ortho, ENT, Neurosurgery and General Surgery. Maybe Urology and Ophtho. Kills off the other 20+ residencies and fellowships.

 

[Atlas Shrugged]

You could argue that every specialty directly contributes to readiness, because they do no matter how tenuous.

 

[Gastrapathy]

Sure, thats the argument that will be made by the entrenched bureaucracy and it might work. But you know what they meant. They mean only train doctors who deploy in their specialty. The real truth is that you don't need a military trained radiologist when anyone can read the studies from anywhere in the world. You don't need a gastroenterologist when you can fly someone to Germany to see a contractor. You don't need a cardiologist (theres no cath lab there anyway so what they do can be done by an internist or intensivist). You don't need any subspecialty-trained anesthesiologists (good timing there pgg). The list goes on: Allergy, Nephro, Path, OB, Peds, all Peds subs, most subspecialty surgical fellowships, colorectal, MIS, etc.

BTW, this will cause a major GME crunch in the civilian world that they won't see coming. It's also going to destroy recruiting. Residents see A LOT of patients in the MHS.

I'd say anyone out there who wants to get trained rather than GMO and out had better get back ASAP.

 

[WernickeDO]

All those lazy military docs lagging way behind their civilian counterparts in productivity!

 

[psychbender]

Sure, thats the argument that will be made by the entrenched bureaucracy and it might work. But you know what they meant. They mean only train doctors who deploy in their specialty. The real truth is that you don't need a military trained radiologist when anyone can read the studies from anywhere in the world. You don't need a gastroenterologist when you can fly someone to Germany to see a contractor. You don't need a cardiologist (theres no cath lab there anyway so what they do can be done by an internist or intensivist). You don't need any subspecialty-trained anesthesiologists (good timing there pgg). The list goes on: Allergy, Nephro, Path, OB, Peds, all Peds subs, most subspecialty surgical fellowships, colorectal, MIS, etc. ).

Maybe you wouldn't need CT, but I can make the argument for CCM and Pain (although both can be covered by other specialties, as well).

Honestly, I think a system where physicians in the military work at civilian hospitals (VAs, trauma/academic medical centers) primarily, and are pulled to deploy as needed, would work rather nicely. GME would be handled by the civilian sector, as would maintaining most necessary skills between deployments. The stateside care of soldiers and their families can be handled by most hospitals local to the base. To ensure that the military has only the types of physicians that they want, they can handle it more like FAP. As a civilian resident/fellow, apply for financial assistance, and if selected receive $X for loan repayment while in training, and some other $Y as a retainer while you're deployable staff (primary salary covered by your main employer

 

[Gastrapathy]

Thats how the Brits do it and it isn't perfect either. Their hospital in AFG was a **** show.

The problem with this model is the assumption that you'll get enough folks via a FAP-style program. We get folks before they know they are going to be orthopods making bank. The most needed specialties are highly paid.

You can make an argument for lots of specialties. That's going to be the interesting part of this process if it comes down. I still think theres an 80% chance that this document leads to no measurable change other than more bureaucracy. That stat that there are 12,000 people working in the medical HQs is stunning.

 

[turkish]

"Although set at an unreasonably low level, DOD’s productivity goal for physicians – 40 percent of the Medical Group Management Association median – cannot be met by many military medical providers."

Someone's never had the pleasure of using AHLTA.

 

[Gastrapathy]

It would be a great study to see the productivity of separated military docs in their second to last year in the military and their second year in their new practice. Surprise! It's not the young doctors.

 

[HighPriest]

That's the truth. After only a few years, I'm already looking at larger cases and thinking to myself "I can help this patient. I can do it well. I won't get anything for taking on the risk or doing the additional work, but I want to help the patient. But...I don't want the headache of fighting every single step of the way against the quicksand inertia of the system just to do this properly, efficiently, and up to standard of care. I don't want to fight the OR. I don't want to fight the nurses. I don't want to fight the ancillary staff. I don't want to fight the bed manager, the lab staff, the pharmacy, CMS...all of the people who are inevitably going to make it their goal to each individually fight me because I might ask them to do a bit more work to help this patient...and I'm going to get paid the same either way. And the Army doesn't care if I do the case or not, because all that matters are FTEs/RVUs and operational work. So...why should I do this? Why not send the case to the network?"

I imagine once that goes, it's an easy next step to ask why I should try to be better than 40% of the mean productivity at all.

Luckily, I'm within target range of getting out.

 

[Chonal Atresia]

It would be a great study to see the productivity of separated military docs in their second to last year in the military and their second year in their new practice. Surprise! It's not the young doctors.

Anecdotal obviously, but my total wRVUs my 2nd year out was around 12,000 (I think average for ENT is 7700). Not sure where I fell my last year in the military. You're right, it's the lazy, institutionalized LTCs/COLs who push the young CPTs and MAJs to increase RVUs bringing productivity levels down. Surprise!

 

[deleted772858]

Wonder how Combined GME will be?

Part of the NDAA 2017 Draft

 

[c85]

Also, to add salt to the wound, I believe this NDAA draft had verbage so pilots can be authorized a retention bonus of up to 60K a year (sorta like our MSP, its called aviation continuation pay), not including their standard flight pay and other bonuses. My wife is in AF and the pilots have the same retention issues we do. All the pilots were talking about it today how it would be a game changer perhaps.

Additionally, the watering down of the 20 yr retirement in 2018 for new entrants will also be a huge problem for the people starting then. It probably wouldn't have effected the vast majority of HPSP people, but for the USUHS people this is another reason not to stay in.

The items the OP brought up are quite scary obviously. Does this mean personal liability now???

In any event, by the tail end of my payback the military medical system is going to be run by a bunch of O3s and junior O4s. I can't think of why anyone will stay in if there is bad retirement, GME is continually gutted, and to top it off pilots make more than you.

 

[DD214_DOC]

So I have been observing lots of changes over the past 2-3 years and even now, and always had a gut feeling they were all connected some how. Now I know they are, and it all makes a lot more sense. If they really want to eliminate active-duty physicians in non-operational specialties, it would be a lot easier to just ask about early separation.

 

[HighPriest]

So I have been observing lots of changes over the past 2-3 years and even now, and always had a gut feeling they were all connected some how. Now I know they are, and it all makes a lot more sense. If they really want to eliminate active-duty physicians in non-operational specialties, it would be a lot easier to just ask about early separation.

Naw. Once you start squeezing a nut, you start to wonder what's inside.

 

[pgg]

So I have been observing lots of changes over the past 2-3 years and even now, and always had a gut feeling they were all connected some how. Now I know they are, and it all makes a lot more sense. If they really want to eliminate active-duty physicians in non-operational specialties, it would be a lot easier to just ask about early separation.

I'd entertain an early retirement option, but not early separation. The Navy ain't getting rid of me that cheap.

 

[grotto]

Interesting part of the NDAA not mentioned above is the mandate to combine all military medical corps under DHA (as WRNMMC/FBCH is right now). Wonder what people think the outcome of that change will be?