Military to shed 17,000 medical personnel

[Devildoc]

I have my own, probably biased opinions about this....

More Than 17,000 Uniformed Medical Jobs Eyed for Elimination

 

[Cookie_]

I'm not involved in healthcare services (yet), but from a layman perspective this seems like it could be a bad choice.

The reduction will allow those billets to be repurposed as war fighters or combat-support skills to increase lethality and size of operational units. Another goal is to deepen the workload of remaining medical billets at base hospitals and clinics to strengthen medical skills and also to improve quality of care for beneficiaries, defense officials explained.

So they want to cut medical personnel to increase combat and combat-support personnel, and deepen medical workloads to improve quality?
This seems like it'll cause an uptick in military personnel not using on-base medical services.

Interested in what you think of it doc, biases and all.

 

[ThunderHorse]

I'm not involved in healthcare services (yet), but from a layman perspective this seems like it could be a bad choice.



So they want to cut medical personnel to increase combat and combat-support personnel, and deepen medical workloads to improve quality?
This seems like it'll cause an uptick in military personnel not using on-base medical services.

Interested in what you think of it doc, biases and all.

Looks to me like they will decrease lethality here. What kind of chances are these even going to be replaced by Civilians. Sorry but I have no faith.

 

[Devildoc]

There is the efficiency issue. Part of the argument is to increase provider-to-service ratio; the example was what, five orthopedists for 10 surgeries, or something like that? That does happen. But instead of axing the billets, they need to right-size the MTF. I am all for right-sizing. You do not need a specific provider in a low-volume MTF or clinic, but one of the issues becomes when the provider moves out of the clinical billet and into a leadership billet, then you have fewer providers for services. Movement in and out of clinical and leadership billets on an ad hoc basis (not supposed to happen, but does) really goofs up the TO of the MTF.

Then there is the backfill issue (in the Navy; I have no idea about the Army). So let's assume Naval Hospital Camp Lejeune deploys 100 staff (docs, nurses, corpsmen) for their secondary billet as fleet hospital, they get backfilled by reservists. I have seen several backfills happen where they force the square provider into round billet; an OB doc assigned to the ED, a FMF corpsman assigned to the ward, etc. So they have not backfilled the right providers to the right billets.

Then there is the training issue. At any given point providers will go to schools, leadership schools, operational medicine schools, grad school, whatever. For short courses they can reassign from within; longer courses require a pre-planned strategy to staff. They are often left with unfilled vacancies and billets when they cannot reassign.

Some of these were more eloquently discussed in the articles.

This sounds like a visit from the good idea fairy; I have seen this same thing come up before with near-disastrous results. Now, if they want to argue right-sizing and realigning the force, I am all for that. But cutting billets without taking into consideration leadership (non-clinical) roles, training, secondary billets, deployable billets, etc., is a horrible idea.

One of the reasons I got out when I did, at 16 years, was that I was in an operational billet (enroute care RN; i.e., flight nurse), but was forced to do my AT in the ED. My colleague? Forced to do his AT in a branch clinic. But then they would staff a helo to fly patients out of the hospital with ED nurses. Personnel mismanagement was a real thing, and cutting the numbers will worsen it.

 

[Devildoc]

Looks to me like they will decrease lethality here. What kind of chances are these even going to be replaced by Civilians. Sorry but I have no faith.

A lot of the MTF providers can be 'moved' from military provider billets to civil service billets, but it still takes managing the billets and personnel. An OB/Gyn likely has a low risk of being deployed, unless aboard a hospital ship or something. It's about matching the resources. Can it be done? Sure. Does it always work? No.

 

[Cookie_]

There is the efficiency issue. Part of the argument is to increase provider-to-service ratio; the example was what, five orthopedists for 10 surgeries, or something like that? That does happen. But instead of axing the billets, they need to right-size the MTF.

Looking through the comments on the article, I saw this one from someone claiming to be a current Orthopedic surgeon in the Army. He basically hits the same concerns you have mentioned; that the reduction doesn't seem to take into account deployments, rotations, etc.

As an active duty orthopaedic surgeon, I am appalled by the following statement:

"If a military hospital now staffed with five orthopedic surgeons performs 10 knee replacements a month, that's only two operations per surgeon. If staff is cut to one surgeon able to still comfortably perform 10 procedures a month, both quality of patient care and the readiness of that surgeon for war will improve."

I agree with the following statement: "A "truism in the medical arena," he added, "is that the more times a provider performs a procedure, the better that provider is at performing that procedure."

However, there's a few counter-points you failed to mention:
Orthopaedic Surgeons that have deployed in the past 4-5 years are doing very few cases during their deployment. On average, an Orthopaedic Surgeon is doing somewhere between 5-10 cases on their 5-month deployment.
I graduated orthopaedic surgery residency in June 2018, primed and ready to do operative cases. Instead, because of the SHORTAGE of orthopaedic surgeons, I was deployed. Over the past 5 months, I have very few cases... That is not good for my clinical practice OR my patients.
The number of reservist Orthopaedic Surgeons is abysmal. Although there's over 100 slots, there's currently around ~10 reservist orthopaedic surgeons (these are estimates). This key point was not mentioned in your article.
As a result, we are deploying every 2-3 years due to a reduced number of available orthopaedic surgeons.
Your argument that "If staff is cut to one surgeon able to still comfortably perform 10 procedures a month, both quality of patient care and the readiness of that surgeon for war will improve." is inherently flawed for the following reasons:
If the number of surgeons decreases by 5x, we will deploy every year.... If it's reduced by 50%, we'll deploy every 1.5 years. WE ARE NOT GETTING OPERATIVE EXPERIENCE WHILE DEPLOYED. The average number of cases is 5-10.
My second point - there's not a single orthopaedic surgeon in the army that does ONLY 10 procedures a month - this is a completely misleading statement. On average, an orthopaedic surgeon probably does 10 procedures a week.
Orthopaedic surgeons in the military get more experience by moonlighting in civilian hospitals. Many spend their "free" time working in civilian trauma hospitals, which better represent the battlefield than military hospitals. If the workload in military hospitals increases, they won't have this civilian trauma experience. They DO NOT sit around during their free time.
From an orthopaedic perspective, MANY patients are referred out to civilian doctors, because of poor staffing due to deployments.
Overall, your article was VERY one-sided, not taking into account many factors that are present.

 

[Devildoc]

@Cookie_101st , when I was 'just' a corpsman and fairly junior, it was easy to go from place to place, and although I am sure there were politics or backs-slapping, I never saw it. I would be assigned to this battalion, or that company, or whatever.

When I got commissioned and saw The Navy in a more macro view, and around officers of the Nurse Corps, Medical Corps, MSC, DC, etc., the politics were much more apparent, and I saw good providers and good officers say "fuck it," do their minimal time, and either go reserves or get out all together. I think it mirrors the civilian side, though. A good friend of mine rose to be S3 of the 4th med battalion; I love him like a brother but he will flat out run you over if it's for his career. My mentor rose to rear admiral and was a great nurse and a great mentor, but I would see her pick up a phone and cank someone's orders because "of a bad run-in" 10 years prior.

Until personnel management and real Naval leadership commands and leads Navy medicine, it'll never change. Until then, it'll just be band-aids (pun intended) to patch holes. I loved my jobs, but when I hit mid-tenure O3 and was told I wouldn't pick up O4 because of bad blood, I knew it was time to get out.

I do hope they fix and right-size military medicine across the board; when they do, it'll be excellent. But shedding 17K billets ain't the way to do it.

 

[ThunderHorse]

Until personnel management and real Naval leadership commands and leads Navy medicine, it'll never change. Until then, it'll just be band-aids (pun intended) to patch holes. I loved my jobs, but when I hit mid-tenure O3 and was told I wouldn't pick up O4 because of bad blood, I knew it was time to get out.

I do hope they fix and right-size military medicine across the board; when they do, it'll be excellent. But shedding 17K billets ain't the way to do it.

I always found this interesting. Moreso because I played Rugby with a bunch of nurse from William Beaumont and the Medical Company CDR was also fucking up in our brigade. I think 2nd AD two different MEDCO CDRs were found liable in FLIPLs for hundreds of thousands in losses.

Our Squadron PA was a nut job, for about 6 months we didn't have Medical Officer and he led the Medic platoon pretty damn well whilst also being the PA. But we'd talk about different things, he was trying to get a Command as the Medical Company Commander and they went with a nurse for some awful reason.

So I'd shoot the shit with the Nurses on the squad and they'd bitch about their commander who had no idea how to do personnel management and they also happened to be a nurse. I know in the Civilian world nurses are administrators. But in the the Army construct they tended to fail often.

 

[61J/L]

I repeatedly feel as though the HR leaders have no idea what doctor/surgeon jobs entail and have made extremely little effort to consult with anyone who is an active clinician when making such sweeping changes. Even at the ground level, at my old MTF, the MS officers somehow thought it would be a good idea to have a vascular surgeon do the job of an interventional cardiologist or a breast surgeon do the job of a medical oncologist. I think even a layman would understand how that makes absolutely no sense. How about just hiring physicians in those specialties that are needed? I completely agree with the comments of the above orthopedic surgeon who said it best - frequent deployments at a time when the conflicts in the middle east have slowed to a simmer have devastated the operative caseload for orthopedic and general surgeons. These two specialties bear the greatest brunt of the shortages, and they are leaving in droves due to poor management and deaf ears from the HR managers above them. Why in the world would we want even less of them in the military? And then to reduce the number of primary care docs who care for all our dependents? How about reducing the number of administrators who make such decisions and increasing the numbers of people who actually work.

 

[DA SWO]

I repeatedly feel as though the HR leaders have no idea what doctor/surgeon jobs entail and have made extremely little effort to consult with anyone who is an active clinician when making such sweeping changes. Even at the ground level, at my old MTF, the MS officers somehow thought it would be a good idea to have a vascular surgeon do the job of an interventional cardiologist or a breast surgeon do the job of a medical oncologist. I think even a layman would understand how that makes absolutely no sense. How about just hiring physicians in those specialties that are needed? I completely agree with the comments of the above orthopedic surgeon who said it best - frequent deployments at a time when the conflicts in the middle east have slowed to a simmer have devastated the operative caseload for orthopedic and general surgeons. These two specialties bear the greatest brunt of the shortages, and they are leaving in droves due to poor management and deaf ears from the HR managers above them. Why in the world would we want even less of them in the military? And then to reduce the number of primary care docs who care for all our dependents? How about reducing the number of administrators who make such decisions and increasing the numbers of people who actually work.

Don't blame HR.
Blame the assholes holding the title of Surgeon General for this shit.
They complain about retiree costs and do everything they can to move retirees out of the system. Congratulations! you just eliminated 30% of your patient population, now justify your staffing levels.

 

[Marauder06]

Don't blame HR.
Blame the assholes holding the title of Surgeon General for this shit.
They complain about retiree costs and do everything they can to move retirees out of the system. Congratulations! you just eliminated 30% of your patient population, now justify your staffing levels.

There's probably a lot of truth here, and not just retirees but disabled servicemembers as well. In many ways we're doing this to ourselves though; the disability system in particular seems set up precisely to allow service members to milk the system to get to, and remain perpetually in, 100% P&T.

 

[61J/L]

I'd be happy to see retirees and disabled SMs instead of leaving those guys out in the cold (VA). One day when I have more of a say...

 

[FIGSTER]

The intended realignment is hands down the best way to go. Right now the MC is bloated with personnel who are useless in the deployed environment. No one needs a rheumatologist or reproductive endocrinologist in Afghanistan.

I've had some recent conversations with the AF anesthesia consultant and they are already increasing drastically the number of residency positions for critical wartime specialties such as surgeons, critical care, and anesthesia to name a few. But since MTFs can in no way accommodate all of these physicians, they will be placed in civilian trauma centers where they gain/maintain skills. Since BAMC is the only level 1 trauma center in the entire DOD, I've been arguing to send physicians out to better hospitals for years. Many physicians do their time and get out because working at an MTF is a miserable slog. With job satisfaction increased, the military will be able to better retain talent. Additionally, the transition to having more providers in civilian trauma centers was inspired largely by the success that the SOF medics have had in said centers and the senior medical corps officers who bitch about this change are only concerned about losing the little relevance they currently have.

Regarding access to care for military and dependents, Tricare is going to farm them out to community providers like they are already doing all over the country where they frequently get better and more convenient care.

 

[SOSTCRNA]

The intended realignment is hands down the best way to go. Right now the MC is bloated with personnel who are useless in the deployed environment. No one needs a rheumatologist or reproductive endocrinologist in Afghanistan.

I've had some recent conversations with the AF anesthesia consultant and they are already increasing drastically the number of residency positions for critical wartime specialties such as surgeons, critical care, and anesthesia to name a few. But since MTFs can in no way accommodate all of these physicians, they will be placed in civilian trauma centers where they gain/maintain skills. Since BAMC is the only level 1 trauma center in the entire DOD, I've been arguing to send physicians out to better hospitals for years. Many physicians do their time and get out because working at an MTF is a miserable slog. With job satisfaction increased, the military will be able to better retain talent. Additionally, the transition to having more providers in civilian trauma centers was inspired largely by the success that the SOF medics have had in said centers and the senior medical corps officers who bitch about this change are only concerned about losing the little relevance they currently have.

Regarding access to care for military and dependents, Tricare is going to farm them out to community providers like they are already doing all over the country where they frequently get better and more convenient care.

What he said!

 

[Devildoc]

The intended realignment is hands down the best way to go. Right now the MC is bloated with personnel who are useless in the deployed environment. No one needs a rheumatologist or reproductive endocrinologist in Afghanistan.

I've had some recent conversations with the AF anesthesia consultant and they are already increasing drastically the number of residency positions for critical wartime specialties such as surgeons, critical care, and anesthesia to name a few. But since MTFs can in no way accommodate all of these physicians, they will be placed in civilian trauma centers where they gain/maintain skills. Since BAMC is the only level 1 trauma center in the entire DOD, I've been arguing to send physicians out to better hospitals for years. Many physicians do their time and get out because working at an MTF is a miserable slog. With job satisfaction increased, the military will be able to better retain talent. Additionally, the transition to having more providers in civilian trauma centers was inspired largely by the success that the SOF medics have had in said centers and the senior medical corps officers who bitch about this change are only concerned about losing the little relevance they currently have.

Regarding access to care for military and dependents, Tricare is going to farm them out to community providers like they are already doing all over the country where they frequently get better and more convenient care.

Well written. I would also add it is not just special operations medical personnel that have benefited from the civilian experience. Navy has been sending medical teams and corpsman to civilian trauma centers for decades, I understand that pararescue also trains in the hospitals. Where I work we have had special forces medics come through for clinical, and there was a plan to expand that Army wide for all medical personnel at Fort Bragg. This did not pan out, but it was enthusiastically received by both our facility and the army.