After reading the Negative threads...

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HumptyDumptyMil

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So after reading through the past couple years of threads on this forum, it seems that the negatives of military medicine seem to outweigh the postives in my opinion. It also seems that the negatives are due to the administrative issues(lack of staffing, out-of-date facilities, etc.)

Being a optimistic pre-med student, I did find one thread that introduced a article about how major reforms are being planned for the next several years. I was hoping I can get feedback from the anti-HPSP people about whether or not they think the proposed changes will help the situation. Below is the actual article. (FYI, i'm considering AF HPSP and am starting med school Fall '06. Decided on AF, because they seem more flexible concerning residency options than Navy. Army just didnt interest me)

BRAC process revamps medical system

by Jim Garamone
American Forces Press Service

5/13/2005 - WASHINGTON (AFPN) -- Defense Department officials have used the Base Realignment and Closure process to transform the way military medicine operates.

Officials said medical facilities will become more joint, will consolidate where patients reside and will become state-of-the-art.

"We want to rival Johns Hopkins or the Mayo Clinics," said Dr. William Winkenwerder Jr., assistant defense secretary for health affairs.

Defense Secretary Donald H. Rumsfeld delivered his recommendations for realignments and closures to the BRAC commission here May 13. The medical recommendations are part of this process.

The recommendations mean changes to military medicine in the nation's capital and San Antonio, as well as changes in many other military health facilities in the United States.

The major recommendation would establish the Walter Reed National Military Medical Center on the grounds of the Bethesda Naval Hospital in Maryland. It also will create a new 165-bed community hospital at Fort Belvoir, Va. If approved, this will cost about $1 billion, said Lt. Gen. (Dr.) George Peach Taylor, Air Force surgeon general, who headed the joint cross-service group that worked on the medical BRAC recommendations.

Army, Navy and Air Force medics will staff both facilities, officials said. The current hospitals -- Walter Reed Army Medical Center and Bethesda -- are separated by just seven miles. They are the primary receiving hospitals for casualties from Iraq and Afghanistan.

"We believe the best way to do this is to place the facility on the Bethesda campus," Dr. Taylor said.

Besides housing the new Walter Reed, the Bethesda campus will keep the Uniformed Services University of the Health Sciences. The National Institutes of Health is also right across the street from the Bethesda facility.

"The facility is able to accommodate the in-patient activities at this location," Dr. Taylor said.

Part of this recommendation would close the Army's Walter Reed campus in Washington, D.C., and Malcolm Grow Hospital at Andrews Air Force Base, Md., would close its in-patient facilities and become a large same-day surgery center, officials said.

"We know these types of joint medical facilities work," Dr. Taylor said. "We have two of them today. Landstuhl Regional Medical Center in Germany has been staffed by Army and Air Force for more than 10 years. If you go to Balad hospital in Balad (Iraq), it is Army- and Air Force-run."

Changes would take place in San Antonio also. The two big medical facilities there are Brooke Army Medical Center at Fort Sam Houston and the 59th Medical Wing's Wilford Hall Medical Center at Lackland AFB. Plans call for medical care to center at Brooke. It will become the San Antonio Regional Medical Center, and will be a jointly staffed, 425-bed center. At Lackland, BRAC recommends building a world-class outpatient and ambulatory surgery center. The trauma center at Lackland will close, and Brooke will expand to handle the need, officials said.

San Antonio also will become the hub for training enlisted medical technicians of all services. Currently, the Army trains at Sam Houston, but the Air Force trains medics at Sheppard AFB, Texas, and Sailors train at Great Lakes, Ill., San Diego, and Portsmouth, Va.

"All enlisted specialty training would be done at Fort Sam Houston," Dr. Taylor said.

The student load would be about 4,500.

Aerospace medicine research will move from Brooks City-Base (the one-time Brooks Air Force Base) to Wright-Patterson AFB, Ohio. The Navy's Aeromedical Research Lab will move from Pensacola, Fla., to Wright-Patterson also.

The recommendations create six new centers of excellence for biomedical research, and all are joint. Assets will come from Navy, Air Force and Army locations to these new centers, officials said.

They are:

-- The Joint Center of Excellence in Battlefield Health and Trauma at the Brooke Regional Medical Center.

-- The Joint Center of Excellence in Infectious Disease Research at the Forest Glen Complex in Maryland.

-- The Joint Center of Excellence for Aerospace Medicine Research at Wright-Patterson.

-- The Joint Center of Excellence in Regulated Medical Product Development and Acquisition at Fort Detrick, Md.

-- The Joint Center of Excellence in Biomedical Defense Research at Fort Detrick.

-- The Joint Center of Excellence in Chemical, Biological Defense Research, Development and Acquisition at Aberdeen Proving Ground, Md.

Overall, the recommendations will cost $2.4 billion to build new facilities and capabilities. Once in place, the services will save $400 million per year, officials said.

The joint cross-service group, new in this round of BRAC, made recommendations to Secretary Rumsfeld. In past BRAC rounds, joint groups merely advised service leaders.

"It is my view that the group put together a very thoughtful, very comprehensive plan for improving military health care," Dr. Winkenwerder said. "It is a plan that allows us to invest in and modernize key flagship facilities, and, at the same time, it will allow the military health system to be more efficient."

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Just another "great" plan that no one will ever see through. No body keeps their job long enough.

How much longer is Rumsfeld going to be there? Each and every flag officer will only hold their job for 3 years....then what?

Some other "great" idea....

Military medicine will never be another Hopkins or Mayo...the very statement had me holding my belly
 
militarymd said:
Just another "great" plan that no one will ever see through. No body keeps their job long enough.

How much longer is Rumsfeld going to be there? Each and every flag officer will only hold their job for 3 years....then what?

Some other "great" idea....

Military medicine will never be another Hopkins or Mayo...the very statement had me holding my belly


Another JHU or Mayo? Just like that? (Plus $2.4 billion or so to make things smaller.) Those lofty ambitions seem contrary to their GME trends; the JHUs of the world are known as much for the quality of their training as for the quality of their care. This seems like more of a high-priced shrink-to-fit scheme, with the bandying-about of bling medical names to create excitement.

Great medical institutions have huge endowments, large research budgets,
and deep ranks of supporting benefactors that have accrued over decades of institutional growth. That isn't something you create in a government budget cycle or two.

A more serious effort would to turn the military medical system over to the administration of an outside organization and eliminate the entire MSC/MC/NC management that exists presently. That model of public-private cooperation exists in institutions like the Lawrence Livermore Laboratory (by Univ. of California), Sandia Laboratories (by Lockheed-Martin), Argonne National Laboratory (by the Univ. of Chicago) and Brookhaven Laboratory (SUNY Stony Brook and Battelle).

They have their work cut out for them. Good luck with all that.
 
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If the military services want quality on the level of the major academic medical institutions, then they should just hire those organizations to set up and run the medical centers for them. Mayo and the Cleveland Clinic have done this themselves in Florida and Arizona; there is no reason that they couldn't do the same for a combined service facility owned by the government but run by a private academic enterprise with long experience and a track record for excellence.

Hurling billions at a program that closes down facilities, reduces training opportunities while claiming to "save" money hardly seems like a pathway to excellence in healthcare.
 
the "friendly fire" that is military medicine admin plays an important role in why so many docs separate asap, and why being a clinic doctor is so frustrating and unacceptable. This happens on a routine basis because of;

1) military micromanagement; nobody does it better (or should I say worse).
2) the best people tend to separate from the military, leaving the worst officers to be appointed to supervise. this is in general, not always the case.
3) docs are obligated for 4 years minimum, so admin has no immediate need to listen to what docs need to perform their job better, and improve morale. they "have you"
4) people with ZERO experience being placed in admin positions over the physicians.
5) people wanting to "make their mark" to achieve rank; leads to frequent unneccessary changes.
6) Admin positions/commanders change about every 2 years.
7) frequent duty station changes; this expecially adversely effects primary care, which relies heavily on continuity to acheive good care.
8) the use of GMOs and new PAs as full, unsupervised "providers".
9) support staff consisting of techs 1 year removed from high school, and admin thinking that that type of support staff and acheive productivity surpassing that of the civilian market.
10) Chronic severe undermanning, without contingency plans to take care of the thousands of uncovered patients when docs separate, deploy, get injured etc.
 
I'm back in Iraq (Balad Air Base) and read this post. I have to comment although I haven't posted in a while. The BRAC will take a MINIMUM of 10-12 years. By that time, the entire military will be more behind the power curve than it is now. Military medicine has continued to decline in my opinion despite a lot of good intentions. I am sorry to say, but I certainly do not think that military medicine will ever come close to a Mayo or Johns Hopkins. The brightest and the best don't stick around because of the oppressive atmosphere in the military. I have continued to watch as some of the best doctors, researchers, and clinical professionals seperate as soon as their commitment ends. They feel limited by the military's lack of interest and failure of resources to advance.
 
Zoomer said:
I'm back in Iraq (Balad Air Base) and read this post. I have to comment although I haven't posted in a while. The BRAC will take a MINIMUM of 10-12 years. By that time, the entire military will be more behind the power curve than it is now. Military medicine has continued to decline in my opinion despite a lot of good intentions. I am sorry to say, but I certainly do not think that military medicine will ever come close to a Mayo or Johns Hopkins. The brightest and the best don't stick around because of the oppressive atmosphere in the military. I have continued to watch as some of the best doctors, researchers, and clinical professionals seperate as soon as their commitment ends. They feel limited by the military's lack of interest and failure of resources to advance.

Your statement about the "brightest and the best" separating ASAP is very true. I am reminded of one the best physicians I have ever known-a Harvard Medical School graduate and Mass General IM Residency trained physician who was assigned to a two man shop IM clinic at a small outpatient MTF. He left at warp speed as soon as he was able to, and now is a faculty member at Emory.
 
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