what are your DOGE VA, mil med predictions?

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They want to privatize the VA. Why? So they can use a 3rd party contractor they own stock in. I guarantee if they released all the financial records of everyone in congress who has pushed for care in the community in the VA or expanding it all own stock in the company that manages it.

CITC has been an absolute dumpster fire. I say this as a veteran and a government worker.

I foresee DOGE firing most of the administrative staff and then expecting the providers to do their work and still somehow see more patients. Wait times will increase. Hold times for calls, processing claims, processing burial documents for the VA cemeteries, etc. will all increase. The veterans and their families will get angry. They will of course blame the VA rather than blaming the real cause of the problems. I say people are getting what they voted for.
 
TheEarDoc said:
They want to privatize the VA. Why? So they can use a 3rd party contractor they own stock in. I guarantee if they released all the financial records of everyone in congress who has pushed for care in the community in the VA or expanding it all own stock in the company that manages it.

CITC has been an absolute dumpster fire. I say this as a veteran and a government worker.

I foresee DOGE firing most of the administrative staff and then expecting the providers to do their work and still somehow see more patients. Wait times will increase. Hold times for calls, processing claims, processing burial documents for the VA cemeteries, etc. will all increase. The veterans and their families will get angry. They will of course blame the VA rather than blaming the real cause of the problems. I say people are getting what they voted for.
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For starters, my guess is they will fire the dentists like the one in my old unit. They still weren’t seeing patients in person in early 2023. Just sending everyone to civilian dentists.
 
armytrainingsir said:
I’m thinking much of it will be sent to the private sector.

And I can’t see DHA lasting, lol
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Shut down the MTFs. They're a shell of what they used to be, devoid of any complex care, just wasteful. Don't believe me? Walk around your local MTF, note the dearth of patients in lobbies, common areas, quads, etc. They're now even deferring active duty members to the civilian network, so why does the MTF exist?

At 1430, take note of the traffic jam leaving base; its all staff leaving for the day. No patients.
 
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TheEarDoc said:
They want to privatize the VA. Why? So they can use a 3rd party contractor they own stock in. I guarantee if they released all the financial records of everyone in congress who has pushed for care in the community in the VA or expanding it all own stock in the company that manages it.

CITC has been an absolute dumpster fire. I say this as a veteran and a government worker.

I foresee DOGE firing most of the administrative staff and then expecting the providers to do their work and still somehow see more patients. Wait times will increase. Hold times for calls, processing claims, processing burial documents for the VA cemeteries, etc. will all increase. The veterans and their families will get angry. They will of course blame the VA rather than blaming the real cause of the problems. I say people are getting what they voted for.
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VA care is already largely privatized. When you pay specialists pennies on the dollar compared to what they can make in the private sector, only problem children will join the VA. Our local VA (which is right next door to the largest army post in the world and thus has a huge veteran population) has zero urologists, ENTs or orthopods. Unbelievable, isn't it?

When the VA does dump veterans into community care, they never send any records either. The whole VA system is broken beyond repair.

Same goes for MTFs as stated above. The local MTF (10 minutes from my satellite office) has 4 ENT providers and I am still seeing at least 10 new Tricare patients (with many active duty)/day when I am at my satellite. What in the h^&* are they doing at the MTF? Bring DOGE in and clean it up.
 
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So when they first tossed out the idea of offering severance packages (9 months' pay or something like that) to any federal employee who quit, I texted one of my Navy residency classmates who now works at a VA not far from me. Easy commuting distance.

"You should take the Trump federal worker buyout, quit the VA, and come join my group"

His response:

"M-F 830-4, with 1hr wellness/lunch time. Home call, and 100% 1:1 supervision"

Even mommy-track private practice anesthesia can't beat that lifestyle.


Also, 1:1 supervision of CRNAs?!? They could - no exaggeration - actually truly fire 100% of the CRNAs there and still have ZERO reduction in capability.


Chonal Atresia said:
Bring DOGE in and clean it up.
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I'm just going to go ahead and hold my breath on any "cleaning up" that happens anywhere because of President Musk.
 
pgg said:
So when they first tossed out the idea of offering severance packages (9 months' pay or something like that) to any federal employee who quit, I texted one of my Navy residency classmates who now works at a VA not far from me. Easy commuting distance.

"You should take the Trump federal worker buyout, quit the VA, and come join my group"

His response:

"M-F 830-4, with 1hr wellness/lunch time. Home call, and 100% 1:1 supervision"

Even mommy-track private practice anesthesia can't beat that lifestyle.


Also, 1:1 supervision of CRNAs?!? They could - no exaggeration - actually truly fire 100% of the CRNAs there and still have ZERO reduction in capability.




I'm just going to go ahead and hold my breath on any "cleaning up" that happens anywhere because of President Musk.
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I am not going to get into a political argument but your statement above outlines the need for an agency like DOGE. Whether you trust Musk/Trump or not is a different story but at least someone is finally trying to curtail runaway government bureaucracy and spending. Our government is a leviathan in its' current state and needs to be reigned in.
 
Chonal Atresia said:
VA care is already largely privatized. When you pay specialists pennies on the dollar compared to what they can make in the private sector, only problem children will join the VA. Our local VA (which is right next door to the largest army post in the world and thus has a huge veteran population) has zero urologists, ENTs or orthopods. Unbelievable, isn't it?

When the VA does dump veterans into community care, they never send any records either. The whole VA system is broken beyond repair.

Same goes for MTFs as stated above. The local MTF (10 minutes from my satellite office) has 4 ENT providers and I am still seeing at least 10 new Tricare patients (with many active duty)/day when I am at my satellite. What in the h^&* are they doing at the MTF? Bring DOGE in and clean it up.
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One of the VA facilities I worked at for over 5 years tried to hire another ENT, but the facility kept shooting it down. The VA has been on a hiring freeze for over a year at most facilities.
 
pgg said:
So when they first tossed out the idea of offering severance packages (9 months' pay or something like that) to any federal employee who quit, I texted one of my Navy residency classmates who now works at a VA not far from me. Easy commuting distance.

"You should take the Trump federal worker buyout, quit the VA, and come join my group"

His response:

"M-F 830-4, with 1hr wellness/lunch time. Home call, and 100% 1:1 supervision"

Even mommy-track private practice anesthesia can't beat that lifestyle.


Also, 1:1 supervision of CRNAs?!? They could - no exaggeration - actually truly fire 100% of the CRNAs there and still have ZERO reduction in capability.




I'm just going to go ahead and hold my breath on any "cleaning up" that happens anywhere because of President Musk.
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Lunch? He gets lunch? I haven't taken a lunch in over 3 years.....
 
Chonal Atresia said:
I am not going to get into a political argument but your statement above outlines the need for an agency like DOGE. Whether you trust Musk/Trump or not is a different story but at least someone is finally trying to curtail runaway government bureaucracy and spending. Our government is a leviathan in its' current state and needs to be reigned in.
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I don't disagree with any of that. There's a lot of waste, inefficiency, and outright uselessness in much of government.

But the notion that there are significant savings to be found by firing people (even useless people) when 3/4 of the federal budget is "untouchable" things like social security, defense, Medicare, and interest ... is just misdirection. DOGE is bread and circus for the short-attention-span outrage industry.

We know they're not serious about saving money because the things they're doing, even if 100% successful, won't make a significant difference. They won't raise taxes and they won't touch 3/4 of the budget.

Bread and circus.
 
pgg said:
I don't disagree with any of that. There's a lot of waste, inefficiency, and outright uselessness in much of government.

But the notion that there are significant savings to be found by firing people (even useless people) when 3/4 of the federal budget is "untouchable" things like social security, defense, Medicare, and interest ... is just misdirection. DOGE is bread and circus for the short-attention-span outrage industry.

We know they're not serious about saving money because the things they're doing, even if 100% successful, won't make a significant difference. They won't raise taxes and they won't touch 3/4 of the budget.

Bread and circus.
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Getting fat people to lose the first 100 pounds is nearly impossible. So you get them to lose three pounds by the next visit.

Same as DOGE


And those programs aren’t untouchable.
They are touched every year.

For example:

Is your ‘full retirement age’ 65? Why not? It was touched.

Are the Medicare/Tricare/VA/Medicaid formularies the same in 25 as they were in 22? More touching.

Restrict access to those programs to American citizens. More touching that >50% of America want.

Biologics make up merely 2% of prescriptions yet 37% of the cost of prescription medications. Pretty easy to convince 95% of the population to go along with curtailing that pesky problem.


You can kill Medusa. You just can’t attack her with a simple frontal assault.

Political third rail mythology is just that. Myth.
 
armytrainingsir said:
Getting fat people to lose the first 100 pounds is nearly impossible. So you get them to lose three pounds by the next visit.

Same as DOGE


And those programs aren’t untouchable.
They are touched every year.

For example:

Is your ‘full retirement age’ 65? Why not? It was touched.

Are the Medicare/Tricare/VA/Medicaid formularies the same in 25 as they were in 22? More touching.

Restrict access to those programs to American citizens. More touching that >50% of America want.

Biologics make up merely 2% of prescriptions yet 37% of the cost of prescription medications. Pretty easy to convince 95% of the population to go along with curtailing that pesky problem.


You can kill Medusa. You just can’t attack her with a simple frontal assault.

Political third rail mythology is just that. Myth.
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Sure, and yet for all that alleged touching the budget for all of those things continues to increase year over year. The fat people are walking out of the clinic with directions to lose 3 pounds as a first step, and at the next visit they've gained 17 and ride in on their new mobility scooter.

The primary touching of Medicare in the last few decades was to add an entirely new benefit to it (part D).

The primary touching on the revenue side has been tax cuts.

They won't touch social security with any kind of means testing, even though that's what it needs.

Will they touch the DOD in a meaningful late 80s early 90s BRAC kind of way? Nope.

Bread and circus.
 
Defense Health Agency director retires abruptly

Defense Health Agency director retires abruptly​

By Karen Jowers
Feb 28, 2025, 12:58 PM

VIQ22L5U7BEPJH5J2SHPTCU7BM.jpg
Army Lt. Gen. Telita Crosland has retired as director of the Defense Health Agency, officials announced Friday. (Robert Hammer/Defense Health Agency)
Army Lt. Gen. Telita Crosland has retired as director of the Defense Health Agency, officials announced Friday.


Abruptly retires?
 
Also known as, forced into retirement against her will because she's a black woman, much like I'm going to forced out against my will because I'm transgender. 👍👍👍👍👍👍
 
Nontrad_FL_LGBT said:
Care to explain what other possibilities exist for a sudden, unannounced departure of a LTG?
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I can think of about nine off the top of my head. 🙂

About a third involve the flag officer's own misconduct (usually it's a male flag officer and sex is involved), a third involve a sweet sweet civilian gig opening up (that happy and profitable land where aaaaallllllll retired flag officers end up), and about a third involve misconduct/screwups of the flag officer's subordinates resulting in a "loss of confidence in leadership" ...

Outside chance this actually is Trumpian anti-DEI backlash at work purging minorities from flag ranks, but I doubt it.

Nontrad_FL_LGBT said:
And yeah, transgender personnel are going to be separated in the next two months unless the courts say otherwise.
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I'm genuinely sorry to hear that this might affect you. I think you've mentioned it before but I don't remember - aren't you a current HPSP student? On the bright side, you'll be out of the military, free of obligated service, and they're not going to ask for the tuition to be repaid. That's not a horrible outcome.
 
pgg said:
Outside chance this actually is Trumpian anti-DEI backlash at work purging minorities from flag ranks, but I doubt it.
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Based on the demographics of the other flag officers he's fired, I don't. He's obviously purging people he doesn't like, who weirdly tend to be black, women, or both. Probably because they're "DEI hires."

pgg said:
I'm genuinely sorry to hear that this might affect you. I think you've mentioned it before but I don't remember - aren't you a current HPSP student? On the bright side, you'll be out of the military, free of obligated service, and they're not going to ask for the tuition to be repaid. That's not a horrible outcome.
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I appreciate the sentiment, but the memo they put out says they're going to claw back bonuses, which includes tuition payments and stipend per 37USC §373, unless you request voluntary separation within the next month (before the matter is legally decided in court). So you're basically strong armed into getting the fk out or risking having to pay back whatever money you owe on some unknown term and payment amount, probably while still in school. I would literally have to drop out if that were the case, especially considering they're now trying to get rid of Grad Plus loans which bridge the gap between Stanford loans and CoA.

I also actually wanted to serve. Almost every male in my family has served for at least hundreds of years and I am the first officer, at least for a very very short period of time. This is the equivalent of kicking out all the women or black people, just nobody cares because there's only 15k of us. We're truly going backwards and we've got 3 years and 10 months to go. Very frightening times lie ahead.
 
Nontrad_FL_LGBT said:
Based on the demographics of the other flag officers he's fired, I don't. He's obviously purging people he doesn't like, who weirdly tend to be black, women, or both. Probably because they're "DEI hires."


I appreciate the sentiment, but the memo they put out says they're going to claw back bonuses, which includes tuition payments and stipend per 37USC §373, unless you request voluntary separation within the next month (before the matter is legally decided in court). So you're basically strong armed into getting the fk out or risking having to pay back whatever money you owe on some unknown term and payment amount, probably while still in school. I would literally have to drop out if that were the case, especially considering they're now trying to get rid of Grad Plus loans which bridge the gap between Stanford loans and CoA.

I also actually wanted to serve. Almost every male in my family has served for at least hundreds of years and I am the first officer, at least for a very very short period of time. This is the equivalent of kicking out all the women or black people, just nobody cares because there's only 15k of us. We're truly going backwards and we've got 3 years and 10 months to go. Very frightening times lie ahead.
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No way that tuition ever gets clawed back if the military changes its policy and separates all transgender people. You joined and served in good faith, and they changed the deal. Would never hold up in court.

Though I understand that there's still the stress, cost, and non-zero risk of fighting that legal fight. Don't know what the best option is for you.


Also, not that the number really matters - but you're saying there are 15,000 transgender people in the military now? Almost 1%? That strikes me as unlikely. What's the source of that stat?
 
Nontrad_FL_LGBT said:
Also known as, forced into retirement against her will because she's a black woman, much like I'm going to forced out against my will because I'm transgender. 👍👍👍👍👍👍
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Tricare snafus cause medical shortfalls for military families

As DHA director, this mess falls directly on her shoulders. It's her responsibility....plain and simple. Please don't make it a race thing.

As an aside, I am also sorry to hear about your situation. It's not right and I hope the decision is overturned in court.
 
pgg said:
No way that tuition ever gets clawed back if the military changes its policy and separates all transgender people. You joined and served in good faith, and they changed the deal. Would never hold up in court.

Though I understand that there's still the stress, cost, and non-zero risk of fighting that legal fight. Don't know what the best option is for you.


Also, not that the number really matters - but you're saying there are 15,000 transgender people in the military now? Almost 1%? That strikes me as unlikely. What's the source of that stat?
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I hope you're right, but frankly this mess has completely destroyed my confidence level. I'm obviously in a heightened emotional state right now but I just have zero faith in this administration to do the right thing and I don't know that the court would disagree with them atp.

Link to the study from 2018 in this article: https://www.npr.org/sections/shots-...06/trump-executive-order-transgender-military

I can only imagine this number has gone up since then considering we were freely allowed to serve for the Biden administration but obviously that's not scientific.
 
Nontrad_FL_LGBT said:
Care to explain what other possibilities exist for a sudden, unannounced departure of a LTG? And yeah, transgender personnel are going to be separated in the next two months unless the courts say otherwise.
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Whenever any sort of protected class has any adverse action taken against them, the knee jerk “this is because of whateverism ” gets tiresome. More so when there are no facts presented to support the accusation.


Regarding Crosland, the recent dismal failure of the Tricare West transition alone would be grounds enough to fire her.


Regarding trans in the military, I can see the courts allowing enlisted to continue to serve, but constitutionally, they have no say on commissioned officers. Congress creates the slot, but the President has sole say on who fills it because the officer’s authority directly flows from the office of President.


Don’t feel bad. Most officers don’t really understand their commission. Your recruiter surely isn’t going to explain it to you either.

Good article on what a commission is:

Know What An Officer Commission Means


From your posts, you seem to be a pretty decent person. I do feel compassion for you and the situation you find yourself in. But a military commission is by it very nature inextricably political and thus entirely subject to who sits in the Oval Office. Might not seem very fair but it is what it is. Always has been and always will be.
 
armytrainingsir said:
Regarding Crosland, the recent dismal failure of the Tricare West transition alone would be grounds enough to fire her.
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This 100%. Mental Health patients, autistic dependents who can’t see their provider anymore and a mountain to climb to get in with a new one any time soon. Not to mention every other specialty out in town.

DHA should be run by a civilian. Ideally a prior service civilian but someone who is willing to 100% support readiness and care for our fighting forces but not let the ridiculous needs of line commanders negatively impact the care we are providing at the MTF. DHA owned hospitals and clinics should and will be functioning at high volume and complexity with high patient satisfaction regardless of Op tempo, humanitarian operations or training exercises.
 
Nontrad_FL_LGBT said:
Link to the study from 2018 in this article: https://www.npr.org/sections/shots-...06/trump-executive-order-transgender-military
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Interesting - I was curious about the way they arrived at that number, because it seemed high to me. The PDF linked in that article had some more details.


The 2014 Gates/Herman estimate is a bit sketchy. It "depended on the assumption that the ratio of veterans to currently serving troops among transgender adults was the same as the ratio among all adults" which is a hell of an assumption.

I mean ... they didn't actually even talk to or survey anyone in the military to ask them if they were transgender. Seriously.


Rand corporation's methodology in 2016 was absolute trash, even worse. They also didn't actually talk to or survey anyone in the military, just took some figures on what someone else estimated the populations were in CA and MA (I'm almost afraid to look at their methodology), and made the leap to extrapolate those estimates to the AD military population.

That's like taking the % of the US population that is gay or lesbian and assuming that there's no negative self-selection amongst gays/lesbians against joining the military (obviously there is), and publishing an estimate that the same % of the military is gay.

I'll take that methodology to its logical extreme: we know that 49.1% of the US population is male, so 49.1% of the military is probably male too, right?


The DOD finally got around to actually asking servicemembers in the 2016 Workplace and Gender Relations Survey of Active Duty Members, and estimated 8980 in the active component. The actual question was refreshingly direct:
Some people describe themselves as transgender when they experience a different gender identity from their sex at birth. For example, a person born into a male body, but who feels female or lives as a woman. Do you consider yourself to be transgender?
1) Yes, transgender, male to female;
2) Yes, transgender, female to male;
3) Yes, transgender, gender non-conforming;
4) No;
5) Unsure;
6) Prefer not to answer.
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They "relied on surveys completed by 126,234 active duty personnel, but results were weighted 'so findings can be generalized to the full population of active duty members.'" Such weighting is usually necessary and unavoidable in survey-based research, but it's always a source of some error. The question itself is general/vague enough to be an upper bound.


Once again I find myself underwhelmed by the quality of survey-based research and sociologists in general.


Anyway, however big or small the population of serving transgender persons is, none of them deserve to be treated this way.
 
militaryPHYS said:
This 100%. Mental Health patients, autistic dependents who can’t see their provider anymore and a mountain to climb to get in with a new one any time soon. Not to mention every other specialty out in town.

DHA should be run by a civilian. Ideally a prior service civilian but someone who is willing to 100% support readiness and care for our fighting forces but not let the ridiculous needs of line commanders negatively impact the care we are providing at the MTF. DHA owned hospitals and clinics should and will be functioning at high volume and complexity with high patient satisfaction regardless of Op tempo, humanitarian operations or training exercises.
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DHA was doomed to be led poorly for the same reason most MTFs are led poorly - the people who are selected for command, some of whom eventually reach flag rank, are dramatically unqualified to run hospitals and manage healthcare systems.

It's not really their fault. I'm not making a character judgment or maligning their service. But it's a crazy notion that you can pluck some O6 who's done a couple years as an XO somewhere and maybe done an online MBA and slept through some war college classes ... maybe ticked a couple of "operational leadership" boxes ... and then put them in charge of a tertiary medical facility. Sheesh. It's all OJT and by the time they're starting to get a clue, even the 30 year people are retired and gone.

Contrast to civilian hospital systems. As much as we gripe about hospital administrators and the dumb things they do, running hospitals and healthcare systems is what they've been doing for their entire multi-decade careers. They have real degrees, real experience, and there's real competition amongst their peers for the top jobs. What did the CO of [any military MTF] do to get there? Beat out the 6% of physicians who didn't leave at 20 years for greener civilian pastures? Realize their first calling in life (medicine) didn't work out for one reason or another, and bail to the admin track to get away from clinic? The whole pipeline and process is fundamentally flawed.
 
pgg said:
What did the CO of [any military MTF] do to get there? Beat out the 6% of physicians who didn't leave at 20 years for greener civilian pastures? Realize their first calling in life (medicine) didn't work out for one reason or another, and bail to the admin track to get away from clinic? The whole pipeline and process is fundamentally flawed.
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This is a standard and bad generalization. Sure, there are some who are incompetent, were poor clinicians or just stuck around long enough. There are also those who are qualified with at least MTF experience, civilian masters or PHDs but get too much line/operational influence (via politics/ bureaucracy) that undercuts their initiatives. In the military, making common sense change is often impossible.
 
militaryPHYS said:
This 100%. Mental Health patients, autistic dependents who can’t see their provider anymore and a mountain to climb to get in with a new one any time soon. Not to mention every other specialty out in town.

DHA should be run by a civilian. Ideally a prior service civilian but someone who is willing to 100% support readiness and care for our fighting forces but not let the ridiculous needs of line commanders negatively impact the care we are providing at the MTF. DHA owned hospitals and clinics should and will be functioning at high volume and complexity with high patient satisfaction regardless of Op tempo, humanitarian operations or training exercises.
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My satellite clinic is one mile (as the crow flies) outside the gates of the largest army military post in the nation. About 2/3 of my new referrals are Tricare (at that satellite). We.ve stopped seeing all Tricare indefinitely because of these problems. This includes ortho, gen surgery, urology, optho, OB/GYN, pain/spine. No referral....no visit. Whenever they decide to fix this problem, we'll resume seeing these patients. Unfortunately, patients are caught in the middle but we can't run a business with a piece of paper essentially saying you'll probably get paid at some point in the future.

It amazes me how this happens every time a new company wins a Tricare contract.
 
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I live in a part of the country with many Tricare beneficiaries. The organization is unacceptably disorganized, and the default condition for any defect in their referral process is that a provider to an eligible Tricare beneficiary does not get paid for services. Keep in mind, the payment schedule is no better than Medicare, which these days must result in swift, timely payment for there not to be a loss to the provider. Tricare just doesn't treat their charge with the same degree of seriousness and urgency as even do Medicare local administrators. Their inaction is more akin to the sloppy way the VA handles referral and payment. That simply does not cut it from the standpoint of a civilian private practice where payroll must be met on time every time and all bills must be paid in full.
 
Chonal Atresia said:
My satellite clinic is one mile (as the crow flies) outside the gates of the largest army military post in the nation. About 2/3 of my new referrals are Tricare (at that satellite). We.ve stopped seeing all Tricare indefinitely because of these problems. This includes ortho, gen surgery, urology, optho, OB/GYN, pain/spine. No referral....no visit. Whenever they decide to fix this problem, we'll resume seeing these patients. Unfortunately, patients are caught in the middle but we can't run a business with a piece of paper essentially saying you'll probably get paid at some point in the future.

It amazes me how this happens every time a new company wins a Tricare contract.
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We saw a civilian pediatrician when I was active duty for my kids because we were sent off base due to the on base peds being "full." Anyway - everytime we brought the kids to the pediatrician, we apologized to him for the poor reimbursement by Tricare for his expert care and skills. I am not exaggerating. We said we were sorry every time.
 
orbitsurgMD said:
I live in a part of the country with many Tricare beneficiaries.
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Ya know, interestingly enough, in San Diego: all of our dependents and retirees are deferred out to the network. The local civilian networks (SHARP, Scripps, Childrens Radys) all seem to welcome and fiercely hang on to the Tricare patients.

So much so, that the MTF is having a hard time bringing many back to itself (Balboa is trying to rejuvenate itself by bringing back the retirees and dependents that Tricare has so successfully deferred out for the last 30 years . . . .it's not going to happen, is a pipe dream).

No sure why this is, San Diego does have a significant poor indignant population (especially south San Diego) without any insurance. So I guess Tricare is a better payer than 'no insurance'.

I observed the same in the Tidewater-Portsmouth network.
 
orbitsurgMD said:
I live in a part of the country with many Tricare beneficiaries. The organization is unacceptably disorganized, and the default condition for any defect in their referral process is that a provider to an eligible Tricare beneficiary does not get paid for services. Keep in mind, the payment schedule is no better than Medicare, which these days must result in swift, timely payment for there not to be a loss to the provider. Tricare just doesn't treat their charge with the same degree of seriousness and urgency as even do Medicare local administrators. Their inaction is more akin to the sloppy way the VA handles referral and payment. That simply does not cut it from the standpoint of a civilian private practice where payroll must be met on time every time and all bills must be paid in full.
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Ha. Sounds familiar.

I get tons of referrals from the local AF base.

No prior records, nothing.

They will send imaging referral to one hospital system and the patients to another.

So much fun to see a patient who had a CT the day before and no way to look at it.

The overall quality of character of Tricare patients is the only redeeming aspect. It’s certainly not the payer.
 
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DrMetal said:
Ya know, interestingly enough, in San Diego: all of our dependents and retirees are deferred out to the network. The local civilian networks (SHARP, Scripps, Childrens Radys) all seem to welcome and fiercely hang on to the Tricare patients.

So much so, that the MTF is having a hard time bringing many back to itself (Balboa is trying to rejuvenate itself by bringing back the retirees and dependents that Tricare has so successfully deferred out for the last 30 years . . . .it's not going to happen, is a pipe dream).

No sure why this is, San Diego does have a significant poor indignant population (especially south San Diego) without any insurance. So I guess Tricare is a better payer than 'no insurance'.

I observed the same in the Tidewater-Portsmouth network.
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It is happening because DHA is now in control and has had time to realize that paying twice by sending people out is not a good idea. We have also hit a nadir in terms of patient volume and staff # (unless doge decides to cut more).

We all knew sending people out was a bad idea. Oh, then decreasing tricare reimbursement also did not help. DHA is trying to reverse course on select hospitals that can be maintained.
 
militaryPHYS said:
DHA is trying to reverse course on select hospitals that can be maintained.
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And do we think DHA will be successful in that endeavor? Successful in reversing what Tricare has systemically done (deferring out) for the last 30 years?

Tricare was created for that exact purpose: deferring out care, because the DoD is not interested in doing voluminous and complex health care. And who could blame the DoD for that sentiment? It's the Department of Defense, not the Dept of Health Care.

The DHA's attempt to reverse that makes no sense. The small dinky pizza shop is closer to being out of business, makes no sense to try to expand the shop. Would make more sense to just shut it down. Our MTFs are much closer to 'zero' than '100 mph'.
 
DrMetal said:
And do we think DHA will be successful in that endeavor? Successful in reversing what Tricare has systemically done (deferring out) for the last 30 years?

Tricare was created for that exact purpose: deferring out care, because the DoD is not interested in doing voluminous and complex health care. And who could blame the DoD for that sentiment? It's the Department of Defense, not the Dept of Health Care.

The DHA's attempt to reverse that makes no sense. The small dinky pizza shop is closer to being out of business, makes no sense to try to expand the shop. Would make more sense to just shut it down. Our MTFs are much closer to 'zero' than '100 mph'.
Click to expand...

This isn’t true. We used to defer much less. Last 10 years has been cut cut cut, defer defer. Who knows if reversing course will ever be successful. If leadership listens to realistic opinions for successful future operations it could work.

After joining with the VA, DHA should do one of two things: 1) open the gates for civilian care and trauma designation everywhere or 2) only maintain (and bolster) service lines that are high volume and complexity during peacetime while letting everyone else exist in a civilian partnership or in the reserves.

We’ve been trying to make this work for too long. So many lessons learned but nobody willing or able (due to politics) to make drastic change.
 
militaryPHYS said:
1) open the gates for civilian care and trauma designation everywhere or 2) only maintain (and bolster) service lines that are high volume and complexity during peacetime
Click to expand...

Never gonna happen . . . I have a better chance of joining the PGA tour with my +18 handicap.

If this goal of becoming a huge civilian care center, with Level 1 Trauma (real trauma, not just scalp lacerations) is say a "10" on the professional scale . . . the MTFs right now are at a "3" , maybe a "4" at best. It's a bridge too far. We don't have the leadership nor the longevity to get there.

militaryPHYS said:
while letting everyone else exist in a civilian partnership or in the reserves.
Click to expand...

Oh we've got plenty of 'civilian partnerships' going on right now . . .lets hope DOGE doesn't get a whiff of that!
 
Nontrad_FL_LGBT said:
You can't seriously be using Breitbart as an unbiased source.
Click to expand...
Breitbart is junk, but it's merely quoting a Pentagon study that is reported elsewhere too. The NYT article is paywalled so I wasn't able to read that.

I'd like to see the methodology used to estimate 4240 transgender persons in the military, and when this study was actually done (prior or after Trump's inauguration?)

As I described above, the other studies that arrived at 15,000+ are garbage.


I think most of us are sympathetic to you and others, but we'd still like to see accurate information.
 
usma05 said:

#17...Y'all going to get what you want. And the dog will catch the proverbial car if a true near peer war plays out and combat trauma is civilianized too with the doctor draft and ICMOP.
Click to expand...

If a true near peer conflict breaks out, we will be recruiting lots of civilian trauma physicians and nurses . . .all of whom are eons better at trauma care than anyone in an active-duty uniform. Let's not kid ourselves.
 
DrMetal said:
If a true near peer conflict breaks out, we will be recruiting lots of civilian trauma physicians and nurses . . .all of whom are eons better at trauma care than anyone in an active-duty uniform. Let's not kid ourselves.
Click to expand...
I've worked in both worlds. Stateside I agree with you. Overseas, no way. Some, but many have no idea how to operate outside of robust systems with plenty of people and resources. Austere settings not so much.
 
usma05 said:
Austere settings not so much.
Click to expand...

I'd venture to say most surgeons (civilian or active duty) don't have much experience operating in austere conditions.

But at least the civilian surgeon has done a thoracotomy this week (on a real human being, not a manikin nor sim)
 
DrMetal said:
I'd venture to say most surgeons (civilian or active duty) don't have much experience operating in austere conditions.

But at least the civilian surgeon has done a thoracotomy this week (on a real human being, not a manikin nor sim)
Click to expand...
I'll stick to what I know. Anesthesia. There are plenty of my colleagues that have never operated on a generator run OR, with an oxygen concentrator, without an aline, limited blood, truly dependent on surgical blocks, having to truly triage, and function as the ER and ICU, and experienced a real mascal. And to be willing to do it day after day after day. Those that have are the exception and should be really valued. Most have zero interest in that. Anesthesia is going to be a real problem.
 
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