When you say that 50% will stay beyond initial obligation, does that mean that 50% stay beyond their entire obligated service or just their HPSP obligation? For us Navy types, anyone who did a GMO and then GME2+ would fit in the former which makes it a fairly meaningless statistic IMHO. I think all this reflects is the bait and switch of the added obligation for GME training.
I can't speak for the global numbers but I know what I see around me. I know of a couple of folks with huge obligations who took MSPs that will obligate them the rest of the way to 20. But otherwise, I can't think of anyone who is staying past their GME2 obligation. That is the stat I want to see...the percentage of people who choose to stay after completing a GME2 obligation prior to the 14-15 year mark (when people like yourself get priced in). I bet its closer to iwantout's 4% than your 50%.
I don't have that stat readily available, but anecdotaly (which is part of all of our problem), I have many friends who have stayed beyond all obligations and have taken MSPs. Considering Navy med has shot the wad and then some on special pays, there are more than a few that have taken MSPs. Are they all people obligating themselves to 20? That I don't know. It would be worth investigation though.
That was pretty much my experience too. Almost everyone got out at their first opportunity unless they decided to do a fellowship, had prior service or had an obligation so long that the obvious choice was to stay in a few more years to earn a retirement. I keeping going back to the Marines. It seems pretty well publicized that the Marine Corps had a high retention rate. I would be interested in comparing their rate to the medical corps. I suspect Navy medicine's retention rate is much lower.
NavyFP, appreciate your comments. I felt you were mainly focused on accession but I think it would be a better strategy to focus on retention. I think if you can improve retention, your accession will shoot way up and become competitive.
I completely agree that more needs to be done with retention and just throwing money at it is not the solution. Some initiatives have been decidedly anti-retention and PBD-712, for those who remember it, was a big one. That was the military to civilian initiative that basically stated the only place we needed uniformed docs was in the operational and overseas arenas. The rest we could hire contractors for. It was devastating to our peds community. Even I had to do some soul searching to decide to stay. The thought of spending the majority of my time overseas or operational was not something I wanted to put my family through. Fortunately, it was a dismal failure and we have started to buy back some of the lost billets. As the earlier graph also shows, the total number of physician billets has decreased over the last several years, yet the operational demands have increased. Op tempo has to be addressed. Deploying 6+ months every other year is also hard on families.
So what do I think we should do?
1) Strengthen GME. While I still believe our GME programs are very good, we can do better. We need to recapture much of our over 65 population. Tapping into Medicare to the maximum extent would be needed to assure we don't break the bank. This also means hiring professional coders to educate providers on documenting to allow for the highest possible reimbursement. Don't miss out on money owed. Good training and opportunity for more training is excellent for both accessions and retention. Teaching opportunities are also great for retention. Keeping a higher level of accuity will prevent eroding skill sets and that is good for retention.
2) Limit most deployments to 90 days. I have always felt that instead of deploying 4 people for 1 year break it into 3 month cycles and have the same 4 individuals take the same 3 months for 4 years. Uncertainty is lousy for morale and retention. Wouldn't you rather know exactly when you are going, when you will return, and who is replacing you? Some suggest this would be too much turnover, but I disagree. The jobs don't change that much every year. One week of turnover should be adequate. 90 day rotations would also limit skill atrophy and would be easier on families.
3) AHLTA - we all know it is a failure. Let's build a new dam, and not try to fix the leaks in the current one.
4) Admin. This is an area that I think people need a more realistic view. Physicians need to be involved in the administrative processes. We frequently complain that NC and MSCs are taking over. The bottom line is that we are letting them by not stepping up to do the jobs ourselves. We all need to rotate through the admin jobs and allow it to take up to 25% of our work week. Put good docs in the chain to prevent some of the stupidity.
5) Pay. The military will never be able to pay specialists what they can make on the outside. They have improved over the last several years, but there is still room for improvement. Getting at least a portion of our bonuses in retirement might also help. GS docs do get their bonuses considered in their retirement.
6) Eliminate 90% of the GMOs. Some will still want to do them. I think they should be able to, but it should be 100% voluntary.
This list is certainly not a panacea, but a decent start. How does it happen? By having good docs work within the system to make the proper changes. A wise person once told me: "Never think outside the box. Change the box." So it is time to start changing the box.
