Army Army about to require 4 more weeks of "Leadership training"

[backrow]

Because I feel this needs higher visibility without being buried within a "how do I get the residency I want" thread I've created this new thread:

Please take a look at the following post and further discussion for further clarification:

http://forums.studentdoctor.net/thr...ting-desired-residency.1119244/#post-16170552

It appears the Army has afoot a plan to add an additional 4 weeks training in addition to the 6 weeks you already get at BOLC.

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[ak44]

Ugh. I already need to find 6 weeks during my 4th year to complete BOLC, and now this? If I can't finish these courses before graduation I'd be starting my internship in September at the earliest. I'm probably too paranoid, but taking this into account right now as I decide whether to take the scholarship or not (3 year HPSP)

 

[BigNavyPedsGuy]

Ugh. I already need to find 6 weeks during my 4th year to complete BOLC, and now this? If I can't finish these courses before graduation I'd be starting my internship in September at the earliest. I'm probably too paranoid, but taking this into account right now as I decide whether to take the scholarship or not (3 year HPSP)

You're not being paranoid at all. This will screw you. If you start internship late, you start the rest of residency late. That might affect what billet you get. You finish late, you start your payback late, you finish your payback late. If you end up wanting a fellowship or other training afterward, this will delay that.

This is a really big deal.

 

[ArmyTiger]

This appears to be the same ridiculous logic that created the BOLC-2 (RIP) concept. Officers were reportedly showing up to BOLC or their first duty station horrifically deficient in basic skills, or, worse yet, that nebulous concept of leadership, so the Army decided to make all officers go to an extra six weeks of training that would magically fill the gaps that four years of undergraduate training plus 3-5 months of branch specific training failed to capture. They also wanted to use it as an opportunity to facilitate interbranch relationships that were supposed to last the rest of our career, just like this is supposed to make all AMEDD officers a stronger team or something. End result? Program was shuttered after about 4 years. Most of the training was redundant, as it was covered in BOLC-1 or 3. Most of the cadre were TRADOC folks looking for a way to hide out from deployments, and couldn't teach leadership to save their lives. Plus, the solution to teaching leadership always ends up being PowerPoint presentations followed by leadership positions over your peers with little responsibility and less actual authority, and I challenge you to find any studies that method actually teaches leadership. At the end of the day, I have trouble believing some hastily thought out 4 week course is the answer to any question other than some COL asking how he could fill out his OER. it's galling that this is happening as the Army leadership is preaching the message of austerity and cutbacks. I just don't see the rationale here one bit.

 

[USArmyHPSP]

BNPG:

As stated earlier, the pilot for this is 2016 a grand total of 25 whole seats! WOW! The HPSP office is looking to fill these with mostly dental students. Start is for DCC is 2017 and it won't be mandatory for at least one and possibly two years past that. ak44 will not have to do this nor will have to later. But, again as stated earlier, it's best to knock out BOLC early in the HPSP. If you do this nobody gets screwed by a late start.

 

[Gastrapathy]

Can we just write the AAR designating the pilot program a huge success right now?

"Officers are better able to understand that their clinics will be open without support staff because of training holidays"

 

[BigNavyPedsGuy]

BNPG:

As stated earlier, the pilot for this is 2016 a grand total of 25 whole seats! WOW! The HPSP office is looking to fill these with mostly dental students. Start is for DCC is 2017 and it won't be mandatory for at least one and possibly two years past that. ak44 will not have to do this nor will have to later. But, again as stated earlier, it's best to knock out BOLC early in the HPSP. If you do this nobody gets screwed by a late start.

When I applied and was accepted to all 3 branches for HPSP, this is something that would've kept away from the Army (obviously other things did as well). The summer before med school, I got married, moved and worked 2 jobs. Having to go to an extended ODS equivalent would've been impossible.

It's fine for you blow it off, because you're not one of the ones who misses out on a good billet, civilian fellowship opportunity or good civilian job because you got screwed and couldn't use an ADT for this course.

 

[USArmyHPSP]

This was not a personal attack. I've been around SDN for a long time and know your story.

Simply put, you said to one particular individual: "This will screw you" You're wrong it won't screw him. Is there the possibility of screwing others? Yep. But look again, I'm the one who posted this information. I could've kept my mouth shut. I WANT the Army community to know that this is happening. I'm doing this through SDN anonymously (isn't that why it's here?) for a reason.

Please do not kill the mailman for delivering the bill...

 

[BigNavyPedsGuy]

Alright, fair enough. The screen name made me think you were a recruiting arm. Thanks for informing.

 

[Gastrapathy]

It IS bad news though. Coupled with the CCC, this is a place where the services seem to be starting to diverge

 

[ak44]

BNPG:

As stated earlier, the pilot for this is 2016 a grand total of 25 whole seats! WOW! The HPSP office is looking to fill these with mostly dental students. Start is for DCC is 2017 and it won't be mandatory for at least one and possibly two years past that. ak44 will not have to do this nor will have to later. But, again as stated earlier, it's best to knock out BOLC early in the HPSP. If you do this nobody gets screwed by a late start.

Hoping you could clarify this further for me. I'm currently a first year medical student and will be graduating in 2018. By then, won't I have to complete both DCC sign and BOLC according to your timeline? I agree with you that it would be great to get it over with early this summer, and spoke with my recruiter. The pre-enrollment process you mentioned seems to consist of filling out 3 forms, which I won't sign off on until I'm commissioned anyways. As helpful as you have been, I'm still not clear on what I can work on at this point to expedit the process. So let me phrase my question as directly as I can:

Can I sign up for/reserve a BOLC spot prior to commissioning?
When is the deadline to sign up for the June-July BOLC this year?
Exactly how screwed am I if I have to complete these trainings post-graduation? (Because so far you've only mentionted that I won't be if I complete them early, which I don't think I can)

Thank you.

 

[USArmyHPSP]

I'll not be available to answer my email today - but PM me and I'll get back to you tomorrow

 

[USArmyHPSP]

It IS bad news though. Coupled with the CCC, this is a place where the services seem to be starting to diverge

Don't be too sure of this. Air Force is LOOKING at additional training too. They just aren't this far down the road...

 

[BigNavyPedsGuy]

Don't be too sure of this. Air Force is LOOKING at additional training too. They just aren't this far down the road...

So the services might not be diverging, but this still IS bad news.

 

[HighPriest]

I dunno, guys. I look around my crumbling, devestated, shell of a hospital, and I look at the budget defecits, the constant pressure to increase production regardless of safety issues, the inflated, unwarranted responsibilities of civilian, non-clinical staff who have made it their personal position to strike down any smug, active-duty physician who glances in their general direction, the diverging incentives to increase clinical load while at the same time threatening to punish anyone who isn't willing to rearrange their clinical schedule to attend unrelated military training, the SOP of having clinical providers spend 20-50% of their time as an office manager, the constant misinterpretation of Joint Commision requirements, and the bimonthly UAs, and I think to myself: you know what would fix all of this? A few more weeks of leadership training....

In all seriousness, however, our consultant has indicated that there is a movement in the upper branches of the MEDCOM forest to encourage physicians to take on leadership positions specifically because they are seeing global failure with non-physician leadership. Many of the top producing hospitals in the country are lead by physicians who still maintain some semblence of a practice, and that is apparently what the Army has indicated it wants in the future. I know, I know, I don't believe anything the Army indicates either. But it is at least a reasonable thought that is being poured into his ear like sweet, sweet poison. Of course, a few weeks of additional leadership courses will in no way help this to happen. I don't remember half of what I did at BOLC at this point.

 

[ARMYDOCWIFE]

The "leaders" of the AMEDD should have to take the 4 week leadership training.

 

[HighPriest]

The "leaders" of the AMEDD should have to take the 4 week leadership training.

Clearly you are unfamiliar with the MEDCOM policy of leading from behind.

 

[BigNavyPedsGuy]

I dunno, guys. I look around my crumbling, devestated, shell of a hospital, and I look at the budget defecits, the constant pressure to increase production regardless of safety issues, the inflated, unwarranted responsibilities of civilian, non-clinical staff who have made it their personal position to strike down any smug, active-duty physician who glances in their general direction, the diverging incentives to increase clinical load while at the same time threatening to punish anyone who isn't willing to rearrange their clinical schedule to attend unrelated military training, the SOP of having clinical providers spend 20-50% of their time as an office manager, the constant misinterpretation of Joint Commision requirements, and the bimonthly UAs, and I think to myself: you know what would fix all of this? A few more weeks of leadership training....

LOLIRL (Laughed Out Loud In Real Life)

 

[pgg]

In all seriousness, however, our consultant has indicated that there is a movement in the upper branches of the MEDCOM forest to encourage physicians to take on leadership positions specifically because they are seeing global failure with non-physician leadership.

Well, step one of finding a solution is admitting there's a problem. I'm not sure non-physician leadership is the primary culprit though.

(On the whole, I do of course prefer physician leadership, or at least clinician leadership, because they tend to be more clueful about how bad policy can harm patient care.)

Many of the top producing hospitals in the country are lead by physicians who still maintain some semblence of a practice,

Here's where I have to raise an eyebrow though, and where that MEDCOM forest seems to be missing the trees. Civilian hospitals are overwhelmingly led by people with business degrees, who are in their 50s or 60s, who have been working in healthcare management for a decade or three. Sure, some of them were doctors first, but then they became business experts, and over many years they competed with other business experts, before taking charge of the business of those hospitals.

The failure of medical leadership in the military has more to do with the facts that
1) our leaders are there for a year or two before being moved ("top producing hospitals" in the civilian world don't do this!)
2) our leaders aren't business people who moved up in the business world after being successful at business
3) many of our leaders take their leadership positions because they are looking for a fitrep bullet to get promoted, and never intend to permanently shift into such positions (their "finish line" is the O5 or O6 retirement, not long term business success)

These are not good ways to get GOOD leaders in place, regardless of the individuals' backgrounds.

It works out, sometimes. Sometimes the perfect storm of talent and skill and greatness winds up in command of your hospital.

But the killer is, even when it does work out ... in two years that person gets replaced with someone who's a boot! Our leaders, even the best ones, are always always ALWAYS on the steep part of the learning curve.

Back in the days when all a military hospital CO had to do was let his people work and preside over NJPs for 20-year-olds who got in bar fights, it worked. Now that the money is drying up and the beans have to be counted, their lack of business training and experience is exposed.

 

[HighPriest]

Well, step one of finding a solution is admitting there's a problem. I'm not sure non-physician leadership is the primary culprit though.

(On the whole, I do of course prefer physician leadership, or at least clinician leadership, because they tend to be more clueful about how bad policy can harm patient care.)




Here's where I have to raise an eyebrow though, and where that MEDCOM forest seems to be missing the trees. Civilian hospitals are overwhelmingly led by people with business degrees, who are in their 50s or 60s, who have been working in healthcare management for a decade or three. Sure, some of them were doctors first, but then they became business experts, and over many years they competed with other business experts, before taking charge of the business of those hospitals.

The failure of medical leadership in the military has more to do with the facts that
1) our leaders are there for a year or two before being moved ("top producing hospitals" in the civilian world don't do this!)
2) our leaders aren't business people who moved up in the business world after being successful at business
3) many of our leaders take their leadership positions because they are looking for a fitrep bullet to get promoted, and never intend to permanently shift into such positions (their "finish line" is the O5 or O6 retirement, not long term business success)

These are not good ways to get GOOD leaders in place, regardless of the individuals' backgrounds.

It works out, sometimes. Sometimes the perfect storm of talent and skill and greatness winds up in command of your hospital.

But the killer is, even when it does work out ... in two years that person gets replaced with someone who's a boot! Our leaders, even the best ones, are always always ALWAYS on the steep part of the learning curve.

Back in the days when all a military hospital CO had to do was let his people work and preside over NJPs for 20-year-olds who got in bar fights, it worked. Now that the money is drying up and the beans have to be counted, their lack of business training and experience is exposed.

You're absolutely correct. It isn't just about physician leadership. I do personally believe that leadership by a non-physician is worse than the alternative, but I 100% agree with everything else you've said. I'd agree 110%, but only idiots do that. Part of the "initiative" is to send more interested MD and DO providers to get an MBA, MPH, or what-have-you. Long-term leadership is just something that doesn't work in the military - not, at least, in the sense that it does in the civilian sector - simply because no one is going to stick around for 40 years just to develop the experience required to properly lead. So there will always be a grain of salt. And as you say, promotions for senior leadership in MEDCOM seem to be solely about padding the OER...

 

[denali]

In all seriousness, however, our consultant has indicated that there is a movement in the upper branches of the MEDCOM forest to encourage physicians to take on leadership positions specifically because they are seeing global failure with non-physician leadership. Many of the top producing hospitals in the country are lead by physicians who still maintain some semblence of a practice, and that is apparently what the Army has indicated it wants in the future. I know, I know, I don't believe anything the Army indicates either. But it is at least a reasonable thought that is being poured into his ear like sweet, sweet poison. Of course, a few weeks of additional leadership courses will in no way help this to happen. I don't remember half of what I did at BOLC at this point.

Ah, now this makes a little more sense. As I said in that other thread, I find this move interesting because I would have expected the Army to double-down on branch-immaterial and Nurse Corps TSGs. However, this new "leadership" training is still bass-ackwards; who would want to "lead" an organization they don't even want to be a part of. When you treat me like $#!4, I'm not going to invest in the organization and will be counting the seconds till my ADSO expires and deleting please-help-us-recruit-more-doctors emails from HRC . Only a select (possibly pathologic) few will aspire to lead vs. finding a better organization to belong to. "Leadership" indoctrination is not the way; treating your professional staff right and giving them a reason to stick around and grow with the organization needs to happen first.

 

[BigNavyPedsGuy]

Well, step one of finding a solution is admitting there's a problem. I'm not sure non-physician leadership is the primary culprit though.

(On the whole, I do of course prefer physician leadership, or at least clinician leadership, because they tend to be more clueful about how bad policy can harm patient care.)

Here's where I have to raise an eyebrow though, and where that MEDCOM forest seems to be missing the trees. Civilian hospitals are overwhelmingly led by people with business degrees, who are in their 50s or 60s, who have been working in healthcare management for a decade or three. Sure, some of them were doctors first, but then they became business experts, and over many years they competed with other business experts, before taking charge of the business of those hospitals.

The failure of medical leadership in the military has more to do with the facts that
1) our leaders are there for a year or two before being moved ("top producing hospitals" in the civilian world don't do this!)
2) our leaders aren't business people who moved up in the business world after being successful at business
3) many of our leaders take their leadership positions because they are looking for a fitrep bullet to get promoted, and never intend to permanently shift into such positions (their "finish line" is the O5 or O6 retirement, not long term business success)

These are not good ways to get GOOD leaders in place, regardless of the individuals' backgrounds.

It works out, sometimes. Sometimes the perfect storm of talent and skill and greatness winds up in command of your hospital.

But the killer is, even when it does work out ... in two years that person gets replaced with someone who's a boot! Our leaders, even the best ones, are always always ALWAYS on the steep part of the learning curve.

Back in the days when all a military hospital CO had to do was let his people work and preside over NJPs for 20-year-olds who got in bar fights, it worked. Now that the money is drying up and the beans have to be counted, their lack of business training and experience is exposed.

Great post! After leaving the military I joined a rural hospital. The CEO at the time of my interview had been there 12 years. He actually moved on to a higher regional job in the network of hospitals. His replacement has lived in this community for 25 years and worked in the hospital for more than a decade! Neither are physicians and nobody cares because they are/were the right person for the job and they are both invested in the community, the long-term improvement of the organization and how it serves the community. They also let the doctors be doctors and understand that we all have our roles to help us succeed. You just can't get that long-term sustained commitment when you recycle your leadership every 2 years.

 

[pgg]

The other problem, of course, is that our leaders have been given a task with highly mobile goalposts and a shrinking budget ... and we're not really a healthcare organization in the first place.

We're a kill-people-and-break-things-overseas organization that happens to need some healthcare on the side.

It's foolish and unrealistic to demand the same kind of dollar value for healthcare that civilian institutions achieve under these circumstances; Congress and the public should simply ACCEPT the fact that there are financial inefficiencies inherent to being the healthcare branch of a warfighting machine. We're not Kaiser. I'm not suggesting we should be wasteful. We owe the public responsibility and diligence, and we should try to be good stewards of public funds. But we can never match civilian healthcare dollar : outcome values ... and pressure from above to achieve this just grinds down the people attempting to do more with less.

Kaiser can't do what we do. They can't deploy worldwide tomorrow and provide modern state of the art care with a global network for CASEVAC and supply. Why on earth does Congress think we can do that, AND do everything Kaiser does, AND do GME, AND do it for the same or less money?

 

[deuist]

Kaiser can't do what we do.

No, but I think that Doctors Without Borders could. The major problem with military medicine is that the leadership does not have a vested interest in watching the product grow. If your boss is only in town for three years and has no other goals beyond getting bullet points, then the hospital is going to suffer. The whole physician versus non-physician argument is a moot point if your commander micromanages – yet does a terrible job doing so, is a hypocrite when enforcing rules, and has never deployed in 20 years.

 

[pgg]

No, but I think that Doctors Without Borders could.

Nah. MSF left Afghanistan because it was too dangerous. I remember it vividly because they gave a public middle finger to us as they departed.

 

[deleted480308]

Nah. MSF left Afghanistan because it was too dangerous. I remember it vividly because they gave a public middle finger to us as they departed.

Our docs can only do what we do there because we are surrounded by other soldiers with guns. There are regions of the world where american/european charity groups can't function because they get killed without the ability to shoot back

 

[colbgw02]

Physical security is necessary, but not sufficient, for what military medicine does in the deployed environment. There are lots of logistical and administrative issues that the .mil is actually relatively good at with respect to this particular issue, mostly because we have the requisite institutional experience.

 

[BigNavyPedsGuy]

Physical security is necessary, but not sufficient, for what military medicine does in the deployed environment. There are lots of logistical and administrative issues that the .mil is actually relatively good at with respect to this particular issue, mostly because we have the requisite institutional experience.

I agree. Having done Humaitarian work with NGOs and the military. The military has the logistics and resources to make your jaw drop. Give a Doctors without Borders team an LHA with full medical component, a helo squadron and logistic support and the ebola epeidemic in Africa would've been several months shorter.

Thankfully the Navy's scheduled humanitarian missions focus more on PR than impact. During PP12 we were in Cambodia when there was an outbreak of Enterovirus D68 (the one that killed kids in the states last fall). Our insturctions as pediatricians were not to engage or treat any kids we thought might have the illness.

Wow, when you actually type that out...it's just...wow

 

[deleted480308]

Wow, when you actually type that out...it's just...wow

They deploy you under a banner of "helping address the crisis" and literally said to not treat anyone with the disease?

 

[j4pac]

Milmed should focus its efforts on what they do well...operational medicine and triage of war casualties at the major MTFs. Everything else should be shut down because it is bad business.

Extraordinary efforts have been made in proving the cost-effectiveness of military hospitals...and the solution? Less time spent face to face with patients...and more admin performed by physicians. If the solution to the problem is inferior healthcare...then we are failing.

 

[deleted480308]

Milmed should focus its efforts on what they do well...operational medicine and triage of war casualties at the major MTFs. Everything else should be shut down because it is bad business.

Extraordinary efforts have been made in proving the cost-effectiveness of military hospitals...and the solution? Less time spent face to face with patients...and more admin performed by physicians. If the solution to the problem is inferior healthcare...then we are failing.

I've long since thought that we should just fund insurance properly and let veterans choose their own providers stateside as opposed to trying to distribute a completely distinct care network across the whole country

 

[BigNavyPedsGuy]

They deploy you under a banner of "helping address the crisis" and literally said to not treat anyone with the disease?

"Pacific Partnership, the largest annual humanitarian and civic assistance mission in the Asia-Pacific region, ensures that the international community is better prepared to synchronize and function together as a coordinated force when disaster strikes."

That's from the website. It was a PR mission. We happened to be there when the disease was. They didn't want us to render care and then have to stop because what kids needed was beyond the remote clinic capabilities. "We're only here for 2 weeks, we can't start life support and then pull the plug"

There is some merit to it, but to instruct us not to even engage felt defeating.

My point: if you could combine the dedication of a good NGO with the logistics of the military, one could change the world. Literally.

 

[notdeadyet]

I've long since thought that we should just fund insurance properly and let veterans choose their own providers stateside as opposed to trying to distribute a completely distinct care network across the whole country

That would be not good for many specialties when focusing on veteran-specific issues.

At least on my side (psych), there will typically be a big drop in mindshare and quality of service going from the VA to the community for much of our stuff for combat veterans. Yesterday I evaluated someone at the Access Center at the VA for complaints of "depression." He actually suffered from PTSD and heavy ETOH use. By the end of a 60 minute appointment, I was able to refer him to a PTSD 360 clinic where he will get medication management and evaluation by a psychologist for readiness for trauma-focused CBT vs. PE or CPT (the latter two are first-line evidence-based modalities for PTSD that very, very few non-VA/military practitioners have any proficiency in). I was able to also get him hooked up with a SUPT group that is made up of veterans with issues with both PTSD and substance abuse (PTSD + substance use is a common and challenging thing because the PTSD exacerbates the substance use which exacerbates the avoidance which exacerbates the PTSD... etc.). I was also able to refer him to a TBI clinic since he had a bad one that likely was the criterion A for the PTSD but also has been producing some cognitive difficulties.

There is nothing like this in the community. I've heard the same said for prosthetics and other departments focusing on combat issues. I realize the same is not true for diabetes, hypertension, etc.

The republicans love the idea of privatizing all this stuff, but you'll get a drop in quality for veterans. So we can either see about reducing wait time at the VA through better management or we can maybe carve out combat-veterans vs. non-combat veterans. Maybe as a comprimise, non-combat veterans can be given Tricare and fend for themselves trying to find providers and the VA can be focused purely on combat veterans.

 

[notdeadyet]

My point: if you could combine the dedication of a good NGO with the logistics of the military, one could change the world. Literally.

Out of curiosity, how much of this do you think is pure logistics vs how much is having essentially an unlimited budget. I'd be curious to see the military launch a humanity mission on an NGO budget and see the results. Maybe quite favorable, but I wonder.

 

[Shikima]

That would be not good for many specialties when focusing on veteran-specific issues.

At least on my side (psych), there will typically be a big drop in mindshare and quality of service going from the VA to the community for much of our stuff for combat veterans. Yesterday I evaluated someone at the Access Center at the VA for complaints of "depression." He actually suffered from PTSD and heavy ETOH use. By the end of a 60 minute appointment, I was able to refer him to a PTSD 360 clinic where he will get medication management and evaluation by a psychologist for readiness for trauma-focused CBT vs. PE or CPT (the latter two are first-line evidence-based modalities for PTSD that very, very few non-VA/military practitioners have any proficiency in). I was able to also get him hooked up with a SUPT group that is made up of veterans with issues with both PTSD and substance abuse (PTSD + substance use is a common and challenging thing because the PTSD exacerbates the substance use which exacerbates the avoidance which exacerbates the PTSD... etc.). I was also able to refer him to a TBI clinic since he had a bad one that likely was the criterion A for the PTSD but also has been producing some cognitive difficulties.

There is nothing like this in the community. I've heard the same said for prosthetics and other departments focusing on combat issues. I realize the same is not true for diabetes, hypertension, etc.

The republicans love the idea of privatizing all this stuff, but you'll get a drop in quality for veterans. So we can either see about reducing wait time at the VA through better management or we can maybe carve out combat-veterans vs. non-combat veterans. Maybe as a comprimise, non-combat veterans can be given Tricare and fend for themselves trying to find providers and the VA can be focused purely on combat veterans.

What about aborbing Mil.med into the VA and create 2 branches of service from a single entity? Less bureaucratic BS, get the same 'wrap around' care which effect would be 'cradle to grave' and wouldn't have gaps in coverage when DoD charts aren't imported into the VA system.

 

[deleted480308]

That would be not good for many specialties when focusing on veteran-specific issues.

At least on my side (psych), there will typically be a big drop in mindshare and quality of service going from the VA to the community for much of our stuff for combat veterans. Yesterday I evaluated someone at the Access Center at the VA for complaints of "depression." He actually suffered from PTSD and heavy ETOH use. By the end of a 60 minute appointment, I was able to refer him to a PTSD 360 clinic where he will get medication management and evaluation by a psychologist for readiness for trauma-focused CBT vs. PE or CPT (the latter two are first-line evidence-based modalities for PTSD that very, very few non-VA/military practitioners have any proficiency in). I was able to also get him hooked up with a SUPT group that is made up of veterans with issues with both PTSD and substance abuse (PTSD + substance use is a common and challenging thing because the PTSD exacerbates the substance use which exacerbates the avoidance which exacerbates the PTSD... etc.). I was also able to refer him to a TBI clinic since he had a bad one that likely was the criterion A for the PTSD but also has been producing some cognitive difficulties.

There is nothing like this in the community. I've heard the same said for prosthetics and other departments focusing on combat issues. I realize the same is not true for diabetes, hypertension, etc.

The republicans love the idea of privatizing all this stuff, but you'll get a drop in quality for veterans. So we can either see about reducing wait time at the VA through better management or we can maybe carve out combat-veterans vs. non-combat veterans. Maybe as a comprimise, non-combat veterans can be given Tricare and fend for themselves trying to find providers and the VA can be focused purely on combat veterans.

Or give veterans the option. geographic distribution is an issue. If I think I need someone specializing in veteran care, I live near a VA hospital....if I'm fine with standard civilian care, I live elsewhere and the VA pays my bills via a properly funded tricare

 

[HighPriest]

That would be not good for many specialties when focusing on veteran-specific issues.

At least on my side (psych), there will typically be a big drop in mindshare and quality of service going from the VA to the community for much of our stuff for combat veterans. Yesterday I evaluated someone at the Access Center at the VA for complaints of "depression." He actually suffered from PTSD and heavy ETOH use. By the end of a 60 minute appointment, I was able to refer him to a PTSD 360 clinic where he will get medication management and evaluation by a psychologist for readiness for trauma-focused CBT vs. PE or CPT (the latter two are first-line evidence-based modalities for PTSD that very, very few non-VA/military practitioners have any proficiency in). I was able to also get him hooked up with a SUPT group that is made up of veterans with issues with both PTSD and substance abuse (PTSD + substance use is a common and challenging thing because the PTSD exacerbates the substance use which exacerbates the avoidance which exacerbates the PTSD... etc.). I was also able to refer him to a TBI clinic since he had a bad one that likely was the criterion A for the PTSD but also has been producing some cognitive difficulties.

There is nothing like this in the community. I've heard the same said for prosthetics and other departments focusing on combat issues. I realize the same is not true for diabetes, hypertension, etc.

The republicans love the idea of privatizing all this stuff, but you'll get a drop in quality for veterans. So we can either see about reducing wait time at the VA through better management or we can maybe carve out combat-veterans vs. non-combat veterans. Maybe as a comprimise, non-combat veterans can be given Tricare and fend for themselves trying to find providers and the VA can be focused purely on combat veterans.

Agreed that it would be worse for some specialties, but for others it would be greatly beneficial. That also depends upon what facility we're discussing. I can say with certainty that soldiers would get better treatment in the community where I am stationed simply because I do not have the support that I need to do many cases, and I barely have the support that I need to do some of the things that I do tackle. Accompany that with the fact that my command doesn't understand how our facility is drastically different (and not in a good way) from the surrounding hospitals, and you get pressure to do things that you shouldn't be doing. So at least in my case, soldiers and families would be better off seeking care outside of the Army system for many of the reasons they come to see me.

The answer is, contrary to everything the Army understands, not to have a one-size-fits-all solution to the problem.

 

[BigNavyPedsGuy]

Out of curiosity, how much of this do you think is pure logistics vs how much is having essentially an unlimited budget. I'd be curious to see the military launch a humanity mission on an NGO budget and see the results. Maybe quite favorable, but I wonder.

The USNS MERCY (TAH-19) spent $10K/day in fuel. I'm fairly certain the big budgets enable the logistics. Helos and ships cost a lot of money. I'm willing to guess that one LHA/LHD approaches or exceed teh entire anual budget for Doctors Without Borders - which is one of the best funded NGOs.

I might do a little homework...

 

[BigNavyPedsGuy]

Total budget for MSF (Doctors Withous Borders) for 2013 was $171million. I looked over their year end summary. It is impressive! One could argue that they do WAY more than military healthcare with much, much less.

DOD healthcare had a budget of ~$480 billion per the CBO. Obviously, these numbers are apples and oranges.

The estimated cost of PP11 was ~$4Million dolars/port visit. When you look at MSF spending per country, most are ~$1million and the impact is much greater and longer lasting.

I think on the efficiency front, NGO>military for making a budget last.

I know this was a rabbit trail, but this stuff really interests me.

source
source
source

 

[deuist]

Our docs can only do what we do there because we are surrounded by other soldiers with guns. There are regions of the world where american/european charity groups can't function because they get killed without the ability to shoot back

Take a look at this map. Doctors Without Borders is located all over the world – including in many war zones. The reason they don't get shot at is because the organization takes a neutral stance on politics. The US military, on the other hand, will gladly show up and start telling the local governments how to operate.

 

[deuist]

One could argue that they do WAY more than military healthcare with much, much less.

They probably go to places where the need is the greatest and the doctors can work the most. The US military is all too happy to set up a full MTF in a deployed location, complete with surgeons, anesthesiologists, emergency physicians, dentists, social workers, and the list goes on… all for the ability to perform one surgical operation per week.

 

[ProudMD]

I'll be heading to USUHS in the fall, and I'll be attending Army BOLC this June. Apparently, the Army has already reserved a spot for me.

My question is that if this extra leadership course becomes mandatory in the next 2-3 years, will I and other USUHS Army students (who have already completed BOLC by then) have to "make up" the new course retroactively? As far as I know, the USUHS academic and military schedule is jammed packed, so I don't see how 1/3 of the class can squeeze out 4 weeks to attending the new course.

 

[USArmyHPSP]

I'll be heading to USUHS in the fall, and I'll be attending Army BOLC this June. Apparently, the Army has already reserved a spot for me.

My question is that if this extra leadership course becomes mandatory in the next 2-3 years, will I and other USUHS Army students (who have already completed BOLC by then) have to "make up" the new course retroactively? As far as I know, the USUHS academic and military schedule is jammed packed, so I don't see how 1/3 of the class can squeeze out 4 weeks to attending the new course.

No. They are working on a "Grandfather" plan of some sort. It's not finalized, but the idea is that start with the class matriculating in the summer of X (some future date) it is from that point on that it will become not only mandatory, but a prerequisite to BOLC.

 

[deleted480308]

Take a look at this map. Doctors Without Borders is located all over the world – including in many war zones. The reason they don't get shot at is because the organization takes a neutral stance on politics. The US military, on the other hand, will gladly show up and start telling the local governments how to operate.

http://www.doctorswithoutborders.or...t-borders-shocked-killing-5-staff-afghanistan

much like honey badger, extremists don't give a s%^&

 

[j4pac]

Take a look at this map. Doctors Without Borders is located all over the world – including in many war zones. The reason they don't get shot at is because the organization takes a neutral stance on politics. The US military, on the other hand, will gladly show up and start telling the local governments how to operate.

That's a reach.

 

[BigNavyPedsGuy]

That's a reach.

It might have been worded strongly, but it's clear to see that Doctor Wihtout Borders is accepted because they are neutral and apolitical while the US is rejected becasue of a political agenda. That's fairly obvious.

 

[HighPriest]

WTF are we even talking about anymore? Doctors Without Borders might be able to lay down some sick surgery, but can their surgeons qualify with an M-9? Do they know how many layers of clothing are appropriate in cold weather? Do they know what the RACE acronym stands for? I think we can all agree based upon these answers who the superior medical corps is...

 

[deuist]

WTF are we even talking about anymore? Doctors Without Borders might be able to lay down some sick surgery, but can their surgeons qualify with an M-9? Do they know how many layers of clothing are appropriate in cold weather? Do they know what the RACE acronym stands for? I think we can all agree based upon these answers who the superior medical corps is...

The real qualification is the driver's safety course for 30-year-olds.

 

[BigNavyPedsGuy]

I'm sure Doctors Without Borders blocks clinic before every holiday weekend for mandatory safety stand downs, right?

 

[Shikima]

I'm sure Doctors Without Borders blocks clinic before every holiday weekend for mandatory safety stand downs, right?

That's ok, Doctors Without Borders (Tri) Care insurance will cover them in the interim.