Dr. Dukes

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As a potential USUHS MD'11, I would love to hear people's predictions for how this report (and also the Woodruff report) will change Army medicine. Most of the complaints on this forum have been about AF primary care, but Army and Navy docs have also agreed with the substance, if not the specific cirumstances, of the AF complaints. Will the Army Action Plan requested by Lt. Gen. Kiley change understaffing of Army (and more generally, military) medicine, and will docs be allowed to go back to practicing medicine, or will it (and Mag. Gen. Weightman's firing) be used as a cover-up to say "look, we're making changes?"

I have read this forum quite extensively, so please don't give me the "don't go into Mil Med" lecture. Like I said, USUHS is something I'm considering, but I am also thinking very specifically about the implications of that decision. I hope people with more Mil Med experience can shed some unbiased light on this issue.

Thank you in advance.
 

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As a potential USUHS MD'11, I would love to hear people's predictions for how this report (and also the Woodruff report) will change Army medicine. Most of the complaints on this forum have been about AF primary care, but Army and Navy docs have also agreed with the substance, if not the specific cirumstances, of the AF complaints. Will the Army Action Plan requested by Lt. Gen. Kiley change understaffing of Army (and more generally, military) medicine, and will docs be allowed to go back to practicing medicine, or will it (and Mag. Gen. Weightman's firing) be used as a cover-up to say "look, we're making changes?"QUOTE]


1) lets hope that we can all agree here (finally) that there are things going on in milmed that are unbeleivably wrong.

2) what will it take to fix them???? A better question is...even if they fix em, whats to stop the same things from occurring again down the road? NOTHING !

3) what do I think needs to be done to prevent this stuff? Get a civilian committee together that has the ear of congress and more importantly, the media. Let milmed docs have access to this committe and when they see problems with patient care, treatment of patients, staff or docs (and after the doc has got the deaf ear from his local command), then the docs can approach this committee and prevent what I saw in the USAF and prevent what the world is now seeing at Walter Reed.
 
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3) what do I think needs to be done to prevent this stuff? Get a civilian committee together that has the ear of congress and more importantly, the media. Let milmed docs have access to this committe and when they see problems with patient care, treatment of patients, staff or docs (and after the doc has got the deaf ear from his local command), then the docs can approach this committee and prevent what I saw in the USAF and prevent what the world is now seeing at Walter Reed.

Civilian control of the military? What an odd concept! :laugh:
 

USAFdoc

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Civilian control of the military? What an odd concept! :laugh:


the military has proven beyond the shadow of a doubt that it can't get the job done admin wise. medicine is not going to become any less of a cash cow, not any less complex and needing the exact opposite of what the military admin gives; micromanaging at its worse.

the docs in the miitary have the best idea of what is going on, and have pt care at the top of the list. The committe at least gives them some leverage to ensure milmed admin doesn't continue to drag the system thru the gutter. The Walter Reed fiasco does not ever happen if the docs and staff there had even one iota of say-so.

For the Walter Reed Commander who lost his job there, I hope he kept a tape recording of how many times he likely told the SG of the problems and was ignored.
 

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This is such crap. Weightman actually seemed like a decent guy, and he's only been in command for like 6 months. These problems have been around for years. I've heard that the previous hospital commander returned 24 million bucks from the hospital budget last year. That could have helped shape up the barracks!
 

edmadison

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I think I can give an example of how our system is doomed. Because it is a socialist system, no one benefits from working hard -- why should you?

At the MAMC dining facility they have breakfast sandwhiches. They are similar to what is sold at MacDonalds and are very yummy. Every morning, the DFAC makes a certain number of them -- probably about fifty. DFAC opens at 0600 and the sandwhiches are usually gone in the first 45 minutes. They stay open until 0900! They could sell 5-6X what they do. But they don't. Why should they?

Ed
 

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I think I can give an example of how our system is doomed. Because it is a socialist system, no one benefits from working hard -- why should you?

?

Ed


it runs even worse than that..........................in my experience, the harder you work, the more competent you are = the more work they give you. The less work you do, the less work they give you.:smuggrin:
 

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in my experience, the harder you work, the more competent you are = the more work they give you.

Indeed... it's a long-standing business strategy that if you want something done quickly, you give it to a busy man to do.

Closely related is the theorum that if you have a difficult task, you give it to a lazy man... he'll find an easier way to do it.
 

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the military has proven beyond the shadow of a doubt that it can't get the job done admin wise. medicine is not going to become any less of a cash cow, not any less complex and needing the exact opposite of what the military admin gives; micromanaging at its worse.

the docs in the miitary have the best idea of what is going on, and have pt care at the top of the list. The committe at least gives them some leverage to ensure milmed admin doesn't continue to drag the system thru the gutter. The Walter Reed fiasco does not ever happen if the docs and staff there had even one iota of say-so.

For the Walter Reed Commander who lost his job there, I hope he kept a tape recording of how many times he likely told the SG of the problems and was ignored.


I hope you realized I was being sarcastic! I happen to agree with you. Civilian oversight of the military is absolutely necessary to keep it in check.
 

Galo

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As a potential USUHS MD'11, I would love to hear people's predictions for how this report (and also the Woodruff report) will change Army medicine. Most of the complaints on this forum have been about AF primary care, but Army and Navy docs have also agreed with the substance, if not the specific cirumstances, of the AF complaints. Will the Army Action Plan requested by Lt. Gen. Kiley change understaffing of Army (and more generally, military) medicine, and will docs be allowed to go back to practicing medicine, or will it (and Mag. Gen. Weightman's firing) be used as a cover-up to say "look, we're making changes?"

I have read this forum quite extensively, so please don't give me the "don't go into Mil Med" lecture. Like I said, USUHS is something I'm considering, but I am also thinking very specifically about the implications of that decision. I hope people with more Mil Med experience can shed some unbiased light on this issue.

Thank you in advance.


Looking here for unbiased opinions will not be easy. Most of us are heavily biased because we went through this catastrophy that was mil med then, and now. Along the way we in many capacities gave feedback to our leadership about how to fix the immediate problems we saw. You can easily see in the lecture (I've posted it before), for the consultant to the surgeon general of the air force that many of these problems were easily outlined and many suggestions given. I think even ex USAF doc gave or printed an outline of the problems with solutions of a peer review journal. Multiple people of higher influence than us have outlined the problems in multiple of places.

One of the biggest problems is the leadership does not see a reason to change, they are unable to change, and there really is NO accountability. This poor sap who is getting kicked out because of the army debacle is just a sacrificial lamb. Just today in the paper I saw that there have been identical complaints about the system there from 3 years ago. THe only difference is that the media did not publish it then.

So unfortunately, many of us spent considerable time and energy making suggestions that were often pitched in the trash, ignored, laughed at, or simply unable to perform them. You will find, if you choose to go the milmed way, (despite the voluminous detriments), that finding just one incredible idiot who happens to be your boss, can ruin your life and what your mission is. Unfortunately in military medicine, those idiots are the norm, and not the exception.

I cannot predict where it will end up, but I see it getting MUCH worse with many more lifes lost, or placed in jeopardy, before its even considered that there needs to be change. I just do not think doing excellent medicine is ever going to mix with the military culture. Especially now where a nurse can be your boss and exercise complete control over your ability to take care of patients and how you practice your field.

I could go on for days, but its all been said before.
 

i want out

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http://www.cnn.com/2007/US/03/01/walter.reed/index.html

Sure, he's taking a fall for the whole rotten system, but maybe this is what mil med needed to focus attention . . . .

This is typical military damage control.

anything happens that is reported in a seriously negative way, and the CO is fired so that there is at least the smallest trace of truth when the spokes person ,says that the problem is being addressed...


The Navy averages about 1 CO every 1-2months fired for 'loss of confidence' which is the navy way of saying, "if you don't know, we aren't going to tell you"

No, it won't change military medicine. Things may change slightly but not anything significant.

Also, I am willing to bet, that at least a few reporters have googled military medicine, and have found this forum and are reading back threads even as I type. They may even contact some folks on here for a comment, but it won't go much further than that. Some other big news story will break, and this will be forgotten by the middle of next week, and the only thing that will have changed, is the name on the door at WRAMC.

i want out
 

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Tell me what you all think of this idea. I know lately the military has been releasing a lot of "other" jobs not having to do with defending the country directly and have been contracting them out to private companies who get the job done 200% more effectively. What if the same happened with milmed, where say USUHS was still a government school per se but when you graduated you applied for a civilian residency in the same match as everybody else and had some deal where you would work at a government contracted hospital which was established (privately run and owned) to care specifially for US military and their families. Now I know this would proabably never happen (too much money already invested by our gov. in its current milmed facilities etc...) but do you think this type of outsourcing could help?
 
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Tell me what you all think of this idea. I know lately the military has been releasing a lot of "other" jobs not having to do with defending the country directly and have been contracting them out to private companies who get the job done 200% more effectively. What if the same happened with milmed, where say USUHS was still a government school per se but when you graduated you applied for a civilian residency in the same match as everybody else and had some deal where you would work at a government contracted hospital which was established (privately run and owned) to care specifially for US military and their families. Now I know this would proabably never happen (too much money already invested by our gov. in its current milmed facilities etc...) but do you think this type of outsourcing could help?

One of my residency colleagues is, right now, a civilian contractor for the USN, working in an ED in the Carolinas.
 

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Tell me what you all think of this idea. I know lately the military has been releasing a lot of "other" jobs not having to do with defending the country directly and have been contracting them out to private companies who get the job done 200% more effectively. What if the same happened with milmed, where say USUHS was still a government school per se but when you graduated you applied for a civilian residency in the same match as everybody else and had some deal where you would work at a government contracted hospital which was established (privately run and owned) to care specifially for US military and their families. Now I know this would proabably never happen (too much money already invested by our gov. in its current milmed facilities etc...) but do you think this type of outsourcing could help?

Even if outsourcing did work, evidence, at least in Iraq, to the contrary (rotten food, unfinished pipelines, millions of dollars disappearing), it would be 200% more efficient and 1000% more expensive. You can make $120,000 for 3 months of driving truck in Iraq while the PFC's in the humvees protecting you make $15000 a year. That's just wrong. Civilian oversight would help the military med program, as stated above. That would be the best way to fix the problems in milmed.
Contracting to civilians, in my humble opinion, will only lead to cost inflation and a separation of soldiers and their families from a culture that understands what they are going through. I'm an Army Brat. Civilians don't understand military life. They have no conception of the sacrifice required by soldiers and their families, and therefore have no respect for it.
 

i want out

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Tell me what you all think of this idea. I know lately the military has been releasing a lot of "other" jobs not having to do with defending the country directly and have been contracting them out to private companies who get the job done 200% more effectively. What if the same happened with milmed, where say USUHS was still a government school per se but when you graduated you applied for a civilian residency in the same match as everybody else and had some deal where you would work at a government contracted hospital which was established (privately run and owned) to care specifially for US military and their families. Now I know this would proabably never happen (too much money already invested by our gov. in its current milmed facilities etc...) but do you think this type of outsourcing could help?

this is already in progress.

The Navy has cut almost 2000 jobs in the past year and hired Civy contractors to replace, or in some cases not replaced at all, and many of those 2000 are medical.

Just go to any stateside military clinic, and you will likely see many more contractors than active duty providers.

Of course, this means operational tempo will increase from its already high level, as the pool of active duty gets more and more shallow.

the problem then becomes, Who will deploy? when there are no active duty providers left because they all got tired of spending more time deployed than at home.

If you want to know what kind of money is required to get civilian doctors to deploy, then check out Blackwater, they are hiring medical officers and PA's.



Now, if you want to talk about cost effective, then you will do what the federal government has done for their employees for years, you will just buy them an insurance policy with one of the major companies, and not bother to keep the medical infrastructure at all.
This again raises the question, where do you get medical from to deploy?

In the Norfolk area, you can see a gross duplication of services within sight of one another.
On the Portsmouth side of the water is the Navy hospital and on the Norfolk side of the water is Norfolk General (public hospital).

Why have this duplication at all if you aren't keeping the billets as places for your deployers to work between deployments.

After all, if you were to have a trauma occur in the parking lot of the Navy hospital, they would go to Norfolk General anyway. So at some level the Navy has recognized that keeping services that just don't get much use is not cost effective.

i want out
 

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this is already in progress.

The Navy has cut almost 2000 jobs in the past year and hired Civy contractors to replace, or in some cases not replaced at all, and many of those 2000 are medical.

Just go to any stateside military clinic, and you will likely see many more contractors than active duty providers.

Of course, this means operational tempo will increase from its already high level, as the pool of active duty gets more and more shallow.

the problem then becomes, Who will deploy? when there are no active duty providers left because they all got tired of spending more time deployed than at home.

i want out

If I'm not mistaken, these positions that have been converted to civilian contract are the ones previously filled by active duty personnel that would not deploy anyways (i.e. Radiation Oncology, PM & R, etc.). So, in theory, this should not increase the existing op tempo for active duty docs.
 
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If I'm not mistaken, these positions that have been converted to civilian contract are the ones previously filled by active duty personnel that would not deploy anyways (i.e. Radiation Oncology, PM & R, etc.). So, in theory, this should not increase the existing op tempo for active duty docs.

As I said, my civilian colleague is working side-by-side with AD USN MC docs in Emergency Medicine, and that command has had several docs deploy, leaving staffing gaps.
 

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Will the Army Action Plan requested by Lt. Gen. Kiley change understaffing of Army (and more generally, military) medicine, and will docs be allowed to go back to practicing medicine, or will it (and Mag. Gen. Weightman's firing) be used as a cover-up to say "look, we're making changes?"

Lt Gen Kiley was the WRAMC hospital commander before he became the Army Surgeon General. If he had the ability or desire to fix Walter Reed, he would have done it already.
 

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outsource all mil med I say..(evilly grins at all the $ to be made)
 

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As I said, my civilian colleague is working side-by-side with AD USN MC docs in Emergency Medicine, and that command has had several docs deploy, leaving staffing gaps.

I don't doubt for a second that a significant number of Emergency Medicine docs are deployed. But, does that mean these docs are deployed as a result of converting some AD billets to civilian contracts? My point was that the billets that were converted (most likely as a result of PBD 712) were likely non-deployable anyways.
 

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You guys are kind of missing what I am saying. I am not just asking if it would work to contract civ. docs at military facilities (I know this already exists) I am asking if it would be better to let private Hospitals (i.e. no more madigan) handle milmed as everyone on here believes the civilian world is so much better and this would include deployable situations. The gov would have tons of medical contractors jumping at the oppurtuinity to run a hospital in Iraq or Germany for US troops. I know this would lead to some tricky situations but ultimately I beleive it could work.
 

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You guys are kind of missing what I am saying. I am not just asking if it would work to contract civ. docs at military facilities (I know this already exists) I am asking if it would be better to let private Hospitals (i.e. no more madigan) handle milmed as everyone on here believes the civilian world is so much better and this would include deployable situations. The gov would have tons of medical contractors jumping at the oppurtuinity to run a hospital in Iraq or Germany for US troops. I know this would lead to some tricky situations but ultimately I beleive it could work.

Theoretically, this sounds feasible. In practicality, the problem with this is that while some bases (Ft Lewis) are located in metro areas with abundant off-post health care, many other military bases are geographically isolated (Ft Leonard Wood, Ft Drum, Ft Polk, etc) and don't really have much in the way of meaningful civilian hospitals or other health care infrastructure in the immediate area either. Also, part of the problem with mil med is the vast administrative burden of dispositioning sick soldiers. I really can't imagine the private sector putting up with all the paperwork of sick slips, profiles, med boards, Army medical regulations etc etc ect that go into soldier care.

As for contractors running military hospitals in combat zones . . . .hmmm. I guess every man has his price, but I'd bet either the price would be prohibitively high or you just wouldn't get many people to bite.

X-RMD
 

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This is a little off the general direction of this thread but one previous poster mentioned the CO of WRAMC returning $24 million from the annual budget and that, I think, is a big part of the problem. Has anyone else noticed how almost every single award or fitrep bullet mentions money? " Petty Officer Jones diligent efforts resulted in a cost savings of $35,000" etc. It seems the only mark you can make to advance in the military is to show how much money you can save or costs you can cut. I've often look at my back for the footprints of the O-6 (hospital CO) who's looking for his star by making everyone do more with less. In this case I'm sure the officer fitrep appealed much more to his bosses with the $24,000,000 savings vs "He spruced up the dingy barracks and took really good care of our wounded veterans."

It seems like I have to submit a fitrep every 6 months around here and I always want to say. " He stills works hard and takes good care of his patients" but they always want more than that, so I make stuff up.
 
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