- Nov 3, 2015
- Reaction score
- Durham, NC
So they want to cut medical personnel to increase combat and combat-support personnel, and deepen medical workloads to improve quality?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.
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.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.
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.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.
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.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.
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.
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.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.
Don't blame HR.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.
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.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.