Who really controls military medicine

[bogatyr]

Why even bother training physicians anymore?

https://blog.amedd.army.mil/tsg/index.cfm?Page=PostViewSingle&PostId=369

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[backrow]

Why even bother training physicians anymore?

There's got to be more behind your post than those two lines. Care to expand??

 

[Dr Ypaint]

There's got to be more behind your post than those two lines. Care to expand??

A female nurse is now the army surgeon general. Kind of odd...

 

[244913]

I simply can't believe this.

-Earmuffs for those who are easily offended-

"MG" Horoho is a slick sleeve nurse who if I recall correctly was awarded a Soldier's Medal (usually a big deal) for actions during the crash at Pope in 1994. Apparently she "organized triage activities" during this deal.

I cannot comprehend how the powers that be could nominate a NURSE to be SURGEON GENERAL. Especially one who has never deployed (not that nurses are combat multipliers anyway) This whole thing is so bass-ackwards I want to puke. Oh yeah, somehow she skipped rank from COL to "Major General" too. Real Generals like MG Terry Allen (Big Red One commander during WWII) must be rolling in their graves.

Granted, the Army I think treats its Docs better than the Navy or AF but to nominate a nurse to be Surgeon General is disgraceful.

Embarrassing. Indicative. Time to punch out.

 

[Apollyon]

You gotta be kidding me. Seriously? How does someone who is not in the Medical Corps, command the Medical Corps? Armor ain't doin' infantry. There might be overlap, but it is NOT the same.

How about this: what if a doc wanted to command the Nurse Corps? Can you imagine the outcry? Can you hear the screams of "s/he is not a nurse! S/he doesn't know the Nurse Corps!"

 

[a1qwerty55]

I simply can't believe this.

-Earmuffs for those who are easily offended-

"MG" Horoho is a slick sleeve nurse who if I recall correctly was awarded a Soldier's Medal (usually a big deal) for actions during the crash at Pope in 1994. Apparently she "organized triage activities" during this deal.

I cannot comprehend how the powers that be could nominate a NURSE to be SURGEON GENERAL. Especially one who has never deployed (not that nurses are combat multipliers anyway) This whole thing is so bass-ackwards I want to puke. Oh yeah, somehow she skipped rank from COL to "Major General" too. Real Generals like MG Terry Allen (Big Red One commander during WWII) must be rolling in their graves.

Granted, the Army I think treats its Docs better than the Navy or AF but to nominate a nurse to be Surgeon General is disgraceful.

Embarrassing. Indicative. Time to punch out.

I completely agree. This is utterly embarrassing. She didn't exactly do a good job leading the Nurse Corps - so why not give her more responsibility. This is utterly atrocious I also count my days - The military has been good to me but bad times are coming. I think all of us can expect extremely lean and toxic times ahead, in terms of funding and leadership... Hopefully I'm wrong.

 

[haujun]

I completely agree. This is utterly embarrassing. She didn't exactly do a good job leading the Nurse Corps - so why not give her more responsibility. This is utterly atrocious I also count my days - The military has been good to me but bad times are coming. I think all of us can expect extremely lean and toxic times ahead, in terms of funding and leadership... Hopefully I'm wrong.

When you look at her previous assignments (Deputy Army Surgeon General) and the fact that she replaced MG Gale Pollock (previous Army Surgeon General (interim) before it is not suprising she has been selected to lead us. I am sure her OER was very positive despite what we think of her.

 

[Perrotfish]

Again, NVM

 

[pgg]

I'd like to think the Navy wouldn't do this, but they put a NC admiral in charge of Bethesda a while back, with predictable results.


I don't generally object to non-physicians being placed in positions of administrative authority. God knows I'd rather put a gun in my mouth than my name on a door over on the admin wing, and I know I'm not alone on the physician side in feeling this way. Someone's got to do those jobs.

My current dept head is a CRNA, the DSS is a nurse, the hospital XO is a nurse, the hospital CO is a physician who hasn't practiced in forever. Sound like hell? It's not - it all works just fine because they're reasonable people and good administrators who (generally) don't try to micromanage medical care or get in the way of physicians delivering care.

They aren't the ones inflicting online training on me. They aren't the ones who decided I need to spend 4 hours getting mandatory diversity training at the base theater next Monday. The non-physicians in the chain above me are good people. I don't always 100% agree with them, but I'm not deluded enough to think I would if only they were doctors.


All that said, the Surgeon General of the Army should be a doctor.

 

[AF M4]

I'd like to think the Navy wouldn't do this, but they put a NC admiral in charge of Bethesda a while back, with predictable results.


I don't generally object to non-physicians being placed in positions of administrative authority. God knows I'd rather put a gun in my mouth than my name on a door over on the admin wing, and I know I'm not alone on the physician side in feeling this way. Someone's got to do those jobs.

My current dept head is a CRNA, the DSS is a nurse, the hospital XO is a nurse, the hospital CO is a physician who hasn't practiced in forever. Sound like hell? It's not - it all works just fine because they're reasonable people and good administrators who (generally) don't try to micromanage medical care or get in the way of physicians delivering care.

They aren't the ones inflicting online training on me. They aren't the ones who decided I need to spend 4 hours getting mandatory diversity training at the base theater next Monday. The non-physicians in the chain above me are good people. I don't always 100% agree with them, but I'm not deluded enough to think I would if only they were doctors.


All that said, the Surgeon General of the Army should be a doctor.

The AF absolutely would do this, and quite frankly it is only a matter of time.

Doctors can be poor administrators too, but you need someone who knows what it's like to be at the top of the clinical food chain (i.e., it's the doc's signature on everything and the doc is responsible for everything) at the top of the administrative food chain too. Otherwise it's far too easy to get wrapped up in the bubble of the administrative world and make bad decisions for the folks in the clinic.

The best admins - line and medical side - I've known always find time to be in the clinic or fly with their troops. The mediocre or bad ones are always "too busy" to do so.

This is likely just another step in the decay of military medicine, and unfortunately will probably be the first down a very slippery slope. Good luck fellas.

 

[IgD]

The story is missing from the Surgeon General's Blog for me. Is it coming up for you guys?

 

[Apollyon]

The story is missing from the Surgeon General's Blog for me. Is it coming up for you guys?

Interesting...looks like it's gone. There's a link on the left, but, when I click it, the page reloads, and the second listed entry on the left - "Mental Health Month" - comes up, and that is listed as the newest entry. I did see the original one yesterday.

 

[244913]

I'm still trying to digest this one.

I'm not sure what the solution is. As Pgg points out, none of us (Doctors) really want to do the administrative crap b/c we're too busy....being Doctors. The Nurse Corps on the other hand is focused on one "mission"- promoting their interests above all others, advancing the "unified health care team" in which nurses and other non-physicians get more and more power over the worker bees while padding their OER's and championing BS initiatives while exponentially expanding their BMI's.

Wish you could just squash this crap, put it out like a used cigarette, but the fact is that most Doctors get out ASAP and we don't do a good job of looking out for each other. We don't have a union, or a powerful lobby etc.

At the end of the day though, we are held responsible when **** hits the fan. Even if the mistakes are perpetrated by midlevels, or floor nurses, whatever, we bear the responsibility. And we have no voice. What a mess .MilMed has become.

The whole thing is just such an incredible, embarrassing travesty. I don't have the answers but am counting the days until I am out of this place, where the lunatics are running the asylum.

 

[Gastrapathy]

The whole thing is just such an incredible, embarrassing travesty. I don't have the answers but am counting the days until I am out of this place, where the lunatics are running the asylum.

The worst part is that they don't even know they are crazy.

I just about lost it today. Can't tell the story without outing myself. Today may have been the final straw for me.

Anyone think you could make it 7 good years on IRR just taking the online courses?

 

[IgD]

How come the story isn't in any major media outlet? I didn't see it on Army Times or anywhere else...

 

[Apollyon]

Something is certainly going on, as there isn't even a cached version of the blog on Google.

Could this have been kiboshed? There are only a very few pages on Google about it (like 5, including one from SDN). One person quoted and reformatted the blog post (on nurse-anesthesia.org), and the other person on SDN quoted the letter from LTG Schoomaker.

I thought the nurses would be deliriously ecstatic about this, blowing it all over everything like clouds at Chernobyl.

 

[IgD]

Really haven't heard a thing more about this. Any news??

 

[NavyFP]

Really haven't heard a thing more about this. Any news??

Googled it. Found a few articles. A couple of interesting notes on her "career." Of course there is the direct promotion from Col to MG. Likely a result of being assigned as Chief of the Nurse Corps. So, she has been a General Officer for what 3 years? Great qualification. Especially when you could have chosen MG Phil Volpe, an operational animal who has been in multiple hot spots including Somalia when Blackhawk Down occurred.

The other is her participation in 9/11. Having been there, I can't say I remember her nor do I remember stories about her at the time. Can't have played that big a role.

Agree this is more Politically Correct BS. Suspect Sen. Dan Inouye (D-HI) has a hand in this. He has been trying to get a nurse into this position for years.

The good news for the Navy is that the Director of the Nurse Corps has been downgraded from a two star to a one star position. This will make it more difficult for a nurse to worm herself into the position to be SG.

 

[Homunculus]

it apparently requires the confirmation of the senate. my suggestion would be to contact your senators and see if the issues raised have any traction. we received an interesting email from the public affairs office today but were told: "This release is for internal use only. Please do not forward or post to any external audiences or publications, per MEDCOM request."

really? a news release for only the MEDCOM? wtf? definitely sounds like they are trying to keep it under wraps. i'm not a consipracy theorist, but the release even states (in the second paragraph) that she's the first non-physician to be nominated for this position.

leading the medical corps but having never deployed to OIF or OEF to me is problematic. it's one thing for a hospital commander to be a slick sleeve (please tell me haiti didn't count as a "deployment"), it's another for them to lead the whole magilla-- when it's a huge burden for the corps to bear. there has to be people somewhere with some paygrade behind them that feel the same way we do. i wonder what the real story is?

--your friendly neighborhood lobbyist caveman

 

[vikingsfan]

leading the medical corps but having never deployed to OIF or OEF to me is problematic. it's one thing for a hospital commander to be a slick sleeve (please tell me haiti didn't count as a "deployment"),

Once worked with another Army physician (who at the time hadn't deployed and was actively trying to avoid one) who had worked at the Pentagon as a GMO during the events of 9/11 and claimed that the time after the attacks "counted as a deployment".

I assume it was the same as our next Surgeon General...regardless, she is STILL slicked sleeved/light on the right/fuzzy armed etc. etc.

 

[deleted77919]

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[IgD]

I sent off a few letters today including to the American Medical Association. I have the utmost respect for nurses and believe in a multidisciplinary team approach but the Surgeon General is a physician!!

 

[haujun]

I sent off a few letters today including to the American Medical Association. I have the utmost respect for nurses and believe in a multidisciplinary team approach but the Surgeon General is a physician!!

Here is a crazy question: Why SG be filled by a nurse? I really did not feel that Army medicine was all that great under the leadership by SG who was a physician during last few years. For example Nurses running the clinic and the hospital. Why can't nurse now be a SG? They stay long enough in admin position to groom for the job whereas docs get out at soonest opportunity. At my level I do no think a nurse or a physican working as SG makes any difference. I guess I will find out...

 

[orbitsurgMD]

Here is a crazy question: Why SG be filled by a nurse? I really did not feel that Army medicine was all that great under the leadership by SG who was a physician during last few years. For example Nurses running the clinic and the hospital. Why can't nurse now be a SG? They stay long enough in admin position to groom for the job whereas docs get out at soonest opportunity. At my level I do no think a nurse or a physican working as SG makes any difference. I guess I will find out...

I understand the concern some physicians might have seeing that a non-physician is at the top of their corps structure. But the reality is that the SG job is mostly as a mouthpiece for the line leadership and the defense secretariat, and the fact that the person is a doctor or nurse is probably not all that relevant; advocacy for the medical corps has never been much a part of their brief. Most have followed a train of administrative assignments, most with a mid-career masters in some area of organizational management, MBA or MHA or the like. They are ribbon cutters and budget cutters.

 

[AF M4]

I understand the concern some physicians might have seeing that a non-physician is at the top of their corps structure. But the reality is that the SG job is mostly as a mouthpiece for the line leadership and the defense secretariat, and the fact that the person is a doctor or nurse is probably not all that relevant; advocacy for the medical corps has never been much a part of their brief. Most have followed a train of administrative assignments, most with a mid-career masters in some area of organizational management, MBA or MHA or the like. They are ribbon cutters and budget cutters.

Understood that it's an administrative job. But it's one with a lot of symbolism. Sure, the person who occupies it probably won't be seeing a patient in the clinic or hospital anytime soon (although I think it would be great if they did), but the title is still Surgeon General. The job description is right there in the title: a surgeon is a title that in the current day and age is universally associated with a physician. A general is a leader. A Surgeon General is therefore a physician-leader.

Now you put someone in that job who isn't a doctor. Guess what? You just took the heart out of the meaning of the title, and the word "Surgeon" in the Medical Corps. Given that "Surgeon" is so closely related to "Doctor" or "Physician", you also take a lot of prestige out of those titles as well.

It's like those commercials: so easy a caveman could do it. Look: the LEADER of the Medical Corps has the title of Surgeon General, and she's not even a doctor. How hard could being a doctor be if the top "surgeon" didn't even go to medical school? If you thought non-physicians in admin positions tried to influence medical decisions before, wait for this to come to pass.

I actually don't have much problem with a non-physician being on top of the Medical Corps, so long as they're a competent leader and administrator. Heaven knows that there have been physicians in the job who have schlubbed things up despite their MDs. But if the person occupying the top job is not a physician, then their title should be Secretary of the Medical Corps or something to that effect. The top physician in the Medical Corps should be the only one with the title of Surgeon General; whether or not he/she happens to be the top person in the Medical Corps itself could vary.

 

[IgD]

Seemed like in the Navy's operational force both blueside and greenside the medical leadership positions are always physicians. SMO, CATF surgeon, Battalion Surgeon, Division Surgeon MEF surgeon and Force Surgeon. It's a time honored tradition. The Surgeon General is the medical advisor to the CNO(?). The physician is the subject matter expert. It is like the relationship between the CG and the Chaplain and other members of the principal staff.

The DoD and Army must know the decision is controversial. The DoD must be extremely dissatisfied with military medicine to support an appointment like that.

 

[pgg]

Here is a crazy question: Why SG be filled by a nurse? I really did not feel that Army medicine was all that great under the leadership by SG who was a physician during last few years. For example Nurses running the clinic and the hospital. Why can't nurse now be a SG? They stay long enough in admin position to groom for the job whereas docs get out at soonest opportunity. At my level I do no think a nurse or a physican working as SG makes any difference. I guess I will find out...

Short answer: When the people running things aren't or never have been involved in actually managing a patient's care, they seem to forget why the rest of us are here.

There is a "clue gap" between the administrative and clinical sides of military medicine. The more detached from patient care our administrators are, and especially the fewer practicing physicians (or formerly practicing physicians) we have in such positions, the wider this gap gets.

This is a bad thing, and this is why so many of us find nominating a nurse to be Army Surgeon General abhorrent. It's not just symbolic. It's not that we hate nurses because they're nurses and grind our teeth when good nurses (as Gen Horoho probably is) succeed and get promoted.


In the civilian world, it's OK to have non-physicians running things, because they recognize that physicians bring patients to the hospital. They have incentive to do things that facilitate the work of $-bringing physicians.

In the military world, it's not OK to have non-physicians running things, because the military views the entire medical corps as a huge line-draining expense they'd rather outsource. They have incentive to do things that obstruct the work of $-spending physicians.


We should have leaders who have at some point in their lives actually managed a patient's care, because at least they might remember why we're here.

 

[pgg]

The DoD and Army must know the decision is controversial. The DoD must be extremely dissatisfied with military medicine to support an appointment like that.

I think you're reading too much into this. I don't believe this nomination is a rebuke directed at physicians.

I believe it's a "hmm, where can we install a senior female officer in a position where nothing really important is at risk, in an area the line doesn't care about, in order to massage our diversity numbers" ...

 

[haujun]

The job description is right there in the title: a surgeon is a title that in the current day and age is universally associated with a physician. A general is a leader. A Surgeon General is therefore a physician-leader.

I agreed with your points. But if the future events are predictor based on past events I am not suprise at all. In case you don't know the battalion surgeon can be filled by physician assistant. And yes they are Not physician. And nurses run the clinic and order doctors around. You just do not encounter these issues in the civilian sector. The convincing argument is we are in the military.

As fewer physicians make the top rank due to heavy attrition I knew this day would come where any non-physician wearing administrative hat wining the political battle could occupy this SG...Only in the military...

 

[BOHICA-FIGMO]

I would have to agree with PGG that I generally like have "other people" (i.e., usually NC or MSC) in charge of all the admin BS out there. THe fewer useless meetings I have to go to the better. But, the perception of the whole thing just makes me want to do a face-palm.

And FWIW, this is the only "official" army link I could find that was still active announcing this: http://www.winn.amedd.army.mil/inde...nt-obama-nominates-43rd-army-surgeon-general/

Also, no mention in any of the major news outlets or military specific outlets like Military.com or militarytimes.com. I wonder if this is because the **** storm has reached Category 5 strength?

 

[DD214_DOC]

Here is a crazy question: Why SG be filled by a nurse? I really did not feel that Army medicine was all that great under the leadership by SG who was a physician during last few years. For example Nurses running the clinic and the hospital. Why can't nurse now be a SG? They stay long enough in admin position to groom for the job whereas docs get out at soonest opportunity. At my level I do no think a nurse or a physican working as SG makes any difference. I guess I will find out...

I think more people would take offense of the change in the title of the position from, "Surgeon" to, "Secretary" once it is occupied by a female.

 

[IgD]

Does the Surgeon General really contribute or add any value to the medical system, GME or patient care? Seems like on the operational side the higher ranking generals are involved but maybe it is opposite in the medical system.

 

[bustbones26]

Why are people apalled by this?

The answer is simple, "politics"

We all know that the Army has a "good 'ol boy" system and if you are regarded as a "golden boy" (or in this case golden girl) then you can do no wrong and get awarded positions such as this.

I am sure that each and every one of us here can state countless examples of where he have seen some like this happen. Thus, this news should not surprise anybody.

 

[Gastrapathy]

Can't we be appalled without being surprised?

 

[deuist]

Does the Surgeon General really contribute or add any value to the medical system, GME or patient care?

Sure does. Several years ago Peach Taylor (AF SG at the time) unilaterally decided that any medical student who did not match into a specialty would be forced directly into flight medicine without a shot at applying for advanced GME during internship. He made that decision to fill holes in flight surgery billets and therefore, has a lot of influence over GME and patient care.

Oh, you asked "add any value." In that case, no.

 

[Gastrapathy]

Does the Surgeon General really contribute or add any value to the medical system, GME or patient care? Seems like on the operational side the higher ranking generals are involved but maybe it is opposite in the medical system.

Yes. The SG has the keys to the castle. Want to save money? Just stop taking TFL. Send anyone over 65 out. You'll kill GME, but the effects won't be clear for a few years and, in the meantime, you'll have saved billions.

The AF has abdicated medical care to the Army and GME to the civilian world. Pretty clever from a cost perspective.

These people do matter. Thats why its discouraging. We all know plenty of senior nurses and I don't know one that really understands what it takes to make a doctor.

 

[haujun]

Why are people apalled by this?

The answer is simple, "politics"

We all know that the Army has a "good 'ol boy" system and if you are regarded as a "golden boy" (or in this case golden girl) then you can do no wrong and get awarded positions such as this.

I am sure that each and every one of us here can state countless examples of where he have seen some like this happen. Thus, this news should not surprise anybody.

We are just disappointed that is all...as a physician. Politics or not.

Bottom line: It is not a good idea. (SG=Nurse).

 

[AF M4]

Sure does. Several years ago Peach Taylor (AF SG at the time) unilaterally decided that any medical student who did not match into a specialty would be forced directly into flight medicine without a shot at applying for advanced GME during internship. He made that decision to fill holes in flight surgery billets and therefore, has a lot of influence over GME and patient care.

Oh, you asked "add any value." In that case, no.

Probably subtracted value. That fiasco embittered a whole class of young docs, most of whom are now separating to go on to finally do their residency. The SG got to put "solved flight surgeon manning crisis!" on his OPR, but now the manning crisis is worse than ever PLUS the AF is losing an increased number of physicians, many of whom are negative advocates for the AF after the experience.

 

[pgg]

Probably subtracted value. That fiasco embittered a whole class of young docs, most of whom are now separating to go on to finally do their residency. The SG got to put "solved flight surgeon manning crisis!" on his OPR, but now the manning crisis is worse than ever PLUS the AF is losing an increased number of physicians, many of whom are negative advocates for the AF after the experience.

Well, sure, but that's just a problem opportunity for the next SG.


To be fair though, we exist to support the line. The line needed flight surgeons. They had to come from someplace. If the AF had taken board eligible/certified docs from their clinics they'd be angry that the pool of PGY-1 grads wasn't tapped. It was a bad situation with no perfect solution.

The negligence and guilt for the FS shortage and its GME impact doesn't belong only with that SG; it was 100 bad decisions made by as many people over the previous decade (or longer).

 

[Perrotfish]

Well, sure, but that's just a problem opportunity for the next SG.


To be fair though, we exist to support the line. The line needed flight surgeons. They had to come from someplace. If the AF had taken board eligible/certified docs from their clinics they'd be angry that the pool of PGY-1 grads wasn't tapped. It was a bad situation with no perfect solution.

The negligence and guilt for the FS shortage and its GME impact doesn't belong only with that SG; it was 100 bad decisions made by as many people over the previous decade (or longer).

I would say that the perfect solution would be to push for Flight surgery to be converted primarily to a midlevel billet, with regimantal level physician supervision. The midlevel get the increased responsibility and deployments that they crave while practicing the basic level of primary care they're actually qualified for, while the docs can focus their attention on first training and then providing physician level care to patients who are actually sick like they're trained for.

 

[pgg]

I would say that the perfect solution would be to push for Flight surgery to be converted primarily to a midlevel billet, with regimantal level physician supervision. The midlevel get the increased responsibility and deployments that they crave while practicing the basic level of primary care they're actually qualified for, while the docs can focus their attention on first training and then providing physician level care to patients who are actually sick like they're trained for.

I've long been in favor of the same thing for the Marine GMO community. PAs and IDCs at the battalion level, board eligible/certified physicians at the regimental level.

Not beginning that process in all three branches, starting ca. 1997 when the Navy first told me those GMO billets were being phased out, is one of those 100 bad decisions.

Another bad decision was failing to recruit, train, and/or retain sufficient physicians and midlevels to avoid the crisis entirely.

 

[AF M4]

.

 

[kingcer0x]

I would say that the perfect solution would be to push for Flight surgery to be converted primarily to a midlevel billet, with regimantal level physician supervision. The midlevel get the increased responsibility and deployments that they crave while practicing the basic level of primary care they're actually qualified for, while the docs can focus their attention on first training and then providing physician level care to patients who are actually sick like they're trained for.

I agree. A PA can do 90% of what I do and free me up to see sicker patients, fly, do line support, etc. Even with the forced FS billets the manning situation is still horrendous. In fact there is a plan to send PAs to AMP (AF flight surgery school) that should start soon.

I would just avoid the nurse infilitration for obvious reasons quoted numerous times on this board...

 

[BOHICA-FIGMO]

I've long been in favor of the same thing for the Marine GMO community. PAs and IDCs at the battalion level, board eligible/certified physicians at the regimental level.

Agree with your marine comment. But that would only work if BC FP/IM/EM docs are put at regiment and you have 2-3 PAs and "some" 8425 IDCs at Battalion. I think putting a GMO physician (I realize you didn't propose this) at regiment would be too overwhelming. just my $0.02

 

[NavyFP]

Agree with your marine comment. But that would only work if BC FP/IM/EM docs are put at regiment and you have 2-3 PAs and "some" 8425 IDCs at Battalion. I think putting a GMO physician (I realize you didn't propose this) at regiment would be too overwhelming. just my $0.02

As a Regimental Surgeon, I would agree. GMOs belong at the BN level. Junior BC/BE primary care docs could be OK, but it is better to have O4s and up at the Regiment. Too many field grades at regiment.

In my case our XO liked to micromanage the staff. As a senior O5, I would not permit it and he left me alone. Drove the rest of the staff crazy. If I were an O4 (like my predecessor) I too would have been driven nuts.

 

[halethsonofhama]

Just a reminder for those who haven't done so yet to write their senators about this issue (any anyone else you may feel can help lobby for this issue).

http://www.congress.org/