Put yet another way...here as a civdoc, I am the "pilot of the plane" and in the milmed system the doc is the "engine". (and many time we are the engine put at full tilt while admin has the brakes on, the wings missing, etc...and being blamed by admin that the plane just wont get airborne.)
just another article showing how short the USAF is in providing the people to take care of our troops.
I especially agree with the last paragraph stating that it is especially the "day to day" chronic undermanning that is the hardest on staff.
http://www.airforceots.com/portal/modules.php?name=News&file=article&sid=143
War-zone deployments mean longer waits, more Tricare referrals at stateside hospitals
By Erik Holmes - Staff writer
Posted : January 29, 2007
Continuing personnel shortages and ramped up deployments have the Air Force medical corps stretched thin.
With no quick fix on the horizon, airmen and their families seeking medical care are finding longer waits for appointments at base medical centers and more referrals to civilian providers for routine care.
For medical personnel trying to keep up with a steady flow of patients, the crunch means longer hours and more stress.
Leaders at base hospitals and in the Air Force surgeon generals office admit the medical system is strained, but they insist that good management and new recruiting programs in the works will allow them to meet their deployment obligations while continuing to provide airmen a high level of care.
Were stretched, said Brig. Gen. (Dr.) David Young, commander of the 59th Medical Wing at Wilford Hall Medical Center in San Antonio. This is a tough business were in. ... [But] our team has pulled together to constantly, daily rebalance what we do to meet our missions [of] being the Air Forces flagship medical center, being constantly deploying ... and to provide health care.
The medical staffing shortage is not new, but it has become more acute than in years past.
The most pressing shortage across the Air Force is in nursing. In fiscal 2006, 463 or 12 percent of the Air Forces 3,855 authorized nursing positions were unfilled, according to the Air Force Surgeon Generals office.
As recently as 2003, the shortfall was 4 percent.
This shortage could have a direct effect on the quality of care patients receive, said Edward Brooks, a public health professor at the University of North Carolina at Chapel Hill.
A shortage of nurses means fewer people on the front line, fewer people checking to make sure everything is running the way it ought to be, he said. The lack of nurses then translates into ... potentially poorer quality of care.
The Air Force is trying to reduce the shortage by offering loan repayment and other benefits to nurses who join, but competition from the civilian side is fierce.
There just arent enough of them nationwide to go around, said Col. Joanne McPherson, commander of the 377th Medical Group at Kirtland Air Force Base, N.M. Youre ... fighting for the same group of people that the other hospitals are fighting for.
The National Center for Health Workforce Analysis estimates that the civilian sector is 8 percent short on nurses, and the Bureau of Labor Statistics projects that the nation will face a shortfall of more than 1 million nurses by the end of the decade.
The Air Force is at a competitive disadvantage in recruiting nurses because civilian hospitals can pay them significantly more than the military can, especially in the early years of their careers.
The medical service also faces a shortage of primary-care providers, such as family practice physicians, flight surgeons, physicians assistants and nurse practitioners. The shortage in these areas is particularly severe at small bases, said Maj. Gen. (Dr.) Tom Loftus, operations director of the Air Force Medical Service.
But while most of those professions can be hired as civilian contractors, the shortage of flight surgeons family doctors for aviators and their families presents a unique problem.
The Air Forces shortage of flight surgeons stands at more than 15 percent, according to the surgeon generals office. And the service cannot draw on civilian contractors to fill this gap because few civilian physicians possess the skill and knowledge to care for aviators, Loftus said.
Clearly, thats not a specialty that you go out onto the street and contract for, he said, so were trying to take some of our family practice docs in the blue suits and get them trained so we can shift them into flight medicine, and then we can contract for [civilian] family physicians.
Finally, there is a critical shortage of dentists. That shortage stood at 10 percent in fiscal 2006.
Further complicating matters for the Air Force Medical Service are deployment requirements for operations Iraqi Freedom and Enduring Freedom, which are going to increase by 20 percent beginning in the next couple of months.
On Jan. 15, the Air Force took over operational control and most of the staffing responsibility for the new combat support hospital at Bagram Air Base, Afghanistan.
The number of medical personnel deployed at any time has remained consistent at about 1,000 for the past few years, but staffing the Bagram hospital will require about another 200.
Clearly, it stretches us a little bit further, although we certainly feel like we can handle it, Loftus said. [We are] not stretched to the breaking point. ... Taking over Bagram supports the war effort, and thats our No. 1 issue.
Large medical facilities such as Wilford Hall have filled the bulk of the Air Forces medical deployments, but the service will likely start drawing more heavily on smaller facilities as large facilities reach their limits.
Young, the commander at Wilford Hall, said his hospital cannot shoulder the added burden alone.
We are going to be reaching out to fill [Bagram] through ... tapping into other places that havent been tapped yet, he said. Weve taken the brunt of it so far, and ... itll be tough for me to go much further. Individuals, yes, but very large numbers I dont think I can go much further.
Wilford Hall provides about 300 medical personnel at all times to the Air Force Theater Hospital at Balad Air Base, Iraq, and up to 200 additional staff may be deployed to other locations during a heavy deployment cycle, Young said. That amounts to 9 percent of the hospitals staff of about 5,500.
Still, all the medical leaders who spoke to Air Force Times said the service will be able to continue the additional deployments for as long as necessary by shuffling personnel and hiring civilians to fill gaps.
Quality trumps quantity
But staffing shortages and deployments do affect medical care for airmen and their families back home.
Perhaps the most significant and visible effect is the longer wait time for those seeking routine appointments at base facilities.
Medical commanders and personnel at several bases reported longer wait times for patients. While they can keep up with the flow of critical cases and emergencies, airmen who have routine ailments or who want a checkup will find appointments harder to come by.
I can get emergencies in, I can get urgents in, Young said. Its the elective operation or the routine case that ... gets stretched out a bit. So where Id like to get them in in seven days, maybe its nine or 10 days [for] the next appointment.
McPherson said shortages at Kirtland particularly of nurses force her to choose between longer wait times for routine appointments and decreasing the quality of care.
When you have a constant nursing shortage, the patient [wait] times go up quite a bit, she said. Our primary focus is making sure we maintain the quality. If we have to sacrifice the number of appointments that we have available in order to assure that theres quality care, thats a no-brainer. Well just do that.
More beneficiaries are also finding that base facilities cant see them fast enough, so Tricare is farming them out to civilian providers.
Military health care providers are required to see patients within 24 hours for acute care, seven days for routine appointments, 14 days for checkups and 30 days for specialty appointments.
If the base facility cannot meet these timelines, the patient can choose to wait longer to see a military provider or be referred to a civilian doctor through Tricare.
The Air Force surgeon generals office was unable to provide statistics on Tricare referrals, but medical personnel at several bases said they are sending more patients to civilian providers.
At Wilford Hall, which sees more than 6,000 patients daily, about 9 percent of eligible patients are referred to civilian doctors through Tricare, Young said.
I resist like crazy trying to send a patient downtown, he said. I sometimes just cant meet the ... standard, and then its up to the patients. Do you want to wait, or do you want to go downtown?
Joyce Raezer, director of government relations for the National Military Family Association, said some families seeking care are simply being turned away and sent to civilian doctors because base facilities are overwhelmed.
What we hear from families is that, in a lot of cases, families arent offered the choice of going out, she said. Theyre just basically being told, Suck it up [because] we just cant get you in right now.
The situation is particularly bad for retirees, who are the lowest priority when it comes to scheduling appointments.
Active-duty airmen are the highest priority, followed by families enrolled in Tricare Prime and then retirees enrolled in Tricare Prime.
There is a sense among the retirees, especially the over-65 retirees, that they are getting squeezed out, Young said. I feel very bad about that. ... At least they get health care, but they dont always get it at Wilford Hall or Brooke Army Medical Center [at Fort Sam Houston, Texas].
While the care offered by civilian providers through Tricare is as good as that on base, many airmen, retirees and their families prefer to receive care in the military system.
Besides the convenience of not leaving base for an appointment, Air Force medical personnel are also more flexible and attuned to airmens needs, said Capt. Michael McCarter, a physician assistant with the 377th Medical Group at Kirtland.
A majority of them prefer to get their care with the military system, he said. They get used to the number of issues that they can bring up compared to [with] our civilian counterparts. Generally speaking, if you get seen by a civilian provider outside our facility, its a one-complaint system and ... if you have additional things you have to make follow-up appointments.
This is particularly problematic for retirees who must pay a co-pay to see civilian providers, McCarter said.
A greater sense of comfort comes along with the blue suit, McPherson said.
Theres a huge sense of loyalty there, she said. Its kind of your home. Its a sense of family. We wrap our arms around you, and were going to take care of you.
Raezer said the biggest problem with referring patients through Tricare is that they often find themselves bouncing between military and civilian doctors.
The continuity-of-care issue is a concern if youve got a beneficiary going back and forth, she said.
A patient in such a situation may not be able to establish a relationship with an individual doctor for ongoing needs, Raezer said, and medical records dont always flow back and forth between civilian and military providers as efficiently as they should.
Staffing shortages lead to longer hours and a more hectic pace for medical personnel as base facilities struggle to keep up with patient loads, several medical airmen said.
At Eglin Air Force Base, Fla., the base hospitals family medicine residency clinic was short three or four of its 14 medical technicians until filling the holes recently with civilian contractors.
It can be a little bit more stressful, said Senior Airman Fawn Hill, a medical technician in the clinic who is assigned to the 96th Medical Operations Squadron. Sometimes wed double up with two different doctors ... so were just constantly running around taking care of both doctors needs. Its more work obviously, but it gets done.
Hill said she often would cut her lunch break short or work longer hours to keep up with the workload.
Staff Sgt. Jason Grott, a reservist and medical technician with the 349th Aeromedical Staging Squadron at Travis Air Force Base, Calif., said his unit has been hit hard by increased deployments during the past couple of years, leaving those remaining stateside to pick up the slack.
Instead of leaving at 5 oclock, well end up staying till 7, 8, 9 oclock or even later, he said. Additionally ... a lot of the people are finding themselves doing more duties, [so] theyll end up coming in additional days. ... It can be trying at times, [but] it is a grin-and-bear-it thing.
Despite the enlisted airmens upbeat attitudes, McPherson said the workload does wear down her units personnel.
Theres no doubt that when youre short, everybody has to pull a bit harder and work a bit longer to make up for it, she said. I dont think anybody minds if its a deployment, [but] when its the day-to-day constant shortage of nursing, that starts to wear on you.
