New Koenig article?

[IgD]

Check out: http://www.usminstitute.org/content/HPSP.doc

Is this a new Koenig article? I don't recognize it.

Here are some selected quotes:

"It reveals the system may collapse in only three years unless swift and effective action is taken to change course. Action must begin now."

"This review concludes by offering four prioritized specific recommendations that, if promptly implemented, would prevent system collapse. System collapse will mean resorting again to a "Doctor Draft," which will not set well with America's public."

"Failing to quickly correct the HPSP program accessions problem will likely result in only one remaining choice for the nation: resume the doctor draft as authorized in the Military Selective Service Act (50 U.S.C. App. 451)."

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[Galo]

Interesting read.

Looks like it came out May 06. I need to read it more carefully to make intelligent comments, but it clearly states there are severe problems with military medicine.

http://www.usminstitute.org/roundtables.html

 

[pgg]

Now the problem is not retention; it is at the accession end of the career ladder

Uh, so retention isn't a problem?

And the recommendations, except for #4 (eliminate GMO-land), strike me as pointless handwaving and deck chair rearranging.

For an article that started off so well, it sure didn't go anywhere interesting.

 

[Ex-44E3A]

I agree... that article misses the mark. It tickles my hidden-agenda-o-meter, in that they seem primarily interested in getting fresh meat into the pipeline, rather than attempting to retain fully-qualified, trained, and experienced physicians.

Where's the matching article about improving working conditions for military physicians, and increasing retention on the other end?

Military physicians are a specialized and generally patriotic crew. Beyond their existing medical and sub-specialty knowledge, they need to know the CMRT stuff, how to treat injuries that simply aren't seen in the civilian world, Bioterror and WMD prevention and treatment, medicine in austere environments, how to deploy, med-evac procedures, dealing with family separation, etc. It takes a different breed of cat to be a military physician, and you'd think the services would recognize that, and make some effort to retain those who have already demonstrated that they have what it takes.

Speaking only for myself, I know that my utility, comfort level, and general adeptness were much higher on my second deployment to the desert than on my first. The experience and seasoning that military docs gain is very valuable, and it pains me that the services don't seem to care about that, preferring instead to focus on feeding fresh raw material to the grinder.

My gut suspicion is that they prefer younger, fresh docs because they're more malleable, and cheaper.

 

[trixmd]

I found it interesting that Dr. Koenig so strongly advocates eliminating GMOs when he was the Navy SG under whom interns eligible for the "residencies" in undersea and aerospacemedicine, which were essentially 4 year transitional internships. (jacks of all trades, masters of nothing). Currently, applicants are required to be residency trained in clinical specialties prior to RAM/RUM training. Prior RAMs/RUM who haven't done them are being required to do clinical residencies for successful promotion to O5.

Was Dr. Koenig not paying attention when he was the SG, or has something changed drastically in the last 8 or so years (besides going to war, of course..)

Also disturbs me that he didn't really address retention, because it's not clear to me that "the big people running military medicine" see that as a problem either. At what point does retention become important, other than when you are the person deciding to stay or go?

Trix

 

[orbitsurgMD]

I found it interesting that Dr. Koenig so strongly advocates eliminating GMOs when he was the Navy SG under whom interns eligible for the "residencies" in undersea and aerospacemedicine, which were essentially 4 year transitional internships. (jacks of all trades, masters of nothing). Currently, applicants are required to be residency trained in clinical specialties prior to RAM/RUM training. Prior RAMs/RUM who haven't done them are being required to do clinical residencies for successful promotion to O5.

Was Dr. Koenig not paying attention when he was the SG, or has something changed drastically in the last 8 or so years (besides going to war, of course..)

Also disturbs me that he didn't really address retention, because it's not clear to me that "the big people running military medicine" see that as a problem either. At what point does retention become important, other than when you are the person deciding to stay or go?

Trix

Retention becomes a problem only when accession becomes a problem, which it has. Replacing BC staff who leave is easier, obviously, when you have a former GMO in the training pipeline who himself has been replaced by a recent intern. The whole disreputable process fails when you run out of interns, which is what is going to happen very soon. So in the short term, you make more GMOs stew in GMO hell until they get frustrated and quit at the end of their EAOS. And then you don't have enough GMOs or enough staff, because the last thing fully-trained staff want is to be sent back out to become GMOs again.

 

[Croooz]

orbits is right. The jest of the article is there aren't going to be enough new ones coming in to address the shortages now and in the immediate future. Things are going to get really bad because students are not taking the HPSP. The only issues that are even slightly related to retention are counting medical school years as time in service and rank. Before any system collapse they will attempt the "doctor draft", which will be interesting to say the least.

IMO no one really wants retention to increase. They want a few to stay in but the majority of mil med is to be handled by those who payback their time and get out of dodge. The problem is there aren't many who are even coming in to begin with. Paper says it started around 2002....when did XMilMD join the forum?

 

[orbitsurgMD]

Retention becomes a problem only when accession becomes a problem, which it has. Replacing BC staff who leave is easier, obviously, when you have a former GMO in the training pipeline who himself has been replaced by a recent intern. The whole disreputable process fails when you run out of interns, which is what is going to happen very soon. So in the short term, you make more GMOs stew in GMO hell until they get frustrated and quit at the end of their EAOS. And then you don't have enough GMOs or enough staff, because the last thing fully-trained staff want is to be sent back out to become GMOs again.

There is a solution, but it costs real money. You have to get rid of the post-internship GMO altogether. You can offer deferments or train accessions yourself in-service, and then everyone enters a lottery to see who gets a GMO assignment or, alternatively, everyone gets a GMO assignment. To keep the situation from becoming too burdensome, the GMO assignments should be limited to one calendar year followed by a minimum of two or three years guaranteed assignment back in your specialty, or a fellowship of choice, fully supported. GMOs should have the blow softened by receiving a substantial additional pay while on GMO duty, IMO at least $100K/ year.

Not that the cheapa** services would ever do anything so creative.

 

[ExNavyRad]

Koenig is an idiot, IMO. The man stood not 10 feet from me during Admiral's call at NH Keflavik, and stated, "We have a gender-neutral Navy, and we need to learn how to manage early pregnancy aboard ship."

A salty CWO P.A. and myself were the only ones to stare in slack-jawed amazement at the sheer inane in-your-face stupidity of that statement. Everyone else in the room was busy nodding their heads in sycophantic agreement.

That was my first inkling that perhaps I was in the wrong Navy.

ExNavyRad

 

[Bubblehead-to-MD]

I just found this article by doing a different search on google. I was going to create a new thread about it, but wisely did a search in the forum before doing so.

Interesting read for those of you that have not seen it before.