AVOID MILITARY MEDICINE if possible

[USAFdoc]

[

QUOTE=gastrodoc;5302755]Great article. Now if the SG's would act on it we'd be moving in the right direction. Anyone know what % of the Trycare budget goes to profits for Humana and the other companies?

[/QUOTE]

It is a great article and paints an accurate broad description of how the milmed portrait got "grafittied" by TRICARE over the past decade.

The SGs have to know exactly what the article states, and they have failed to make the necessary changes, and in fact, have continued to head down the same road that has made things this bad to begin with.

---

Members don't see this ad.

 

[Galo]

another article (from the ARMY TIMES)
good read.http://www.armytimes.com/community/opinion/navy_opinions_welling_070430/

Privatization problems

Civilians in military medical jobs make more money, lower troop morale
By David R. Welling


It is refreshing to read that the surgeons general are fighting to keep more active-duty medics instead of allowing them to be replaced with civilians.

Civilianizing our medics is not a new idea. This march toward mediocrity began more than 10 years ago with the institution of Tricare. Gradually, the folks running things are dismantling a proud and effective system and replacing it with what one of my patients called “mangled care.” Before these rocket scientists drive our train completely over the cliff, it would be educational to consider the reasons we have a medical corps and some of its advantages.

The present system was not dreamed up in a vacuum. It was the product of some bad years and some bad medicine. At various times, the medical corps has been caught unprepared to respond when we needed to go to war. At other times, we have had poorly trained doctors, doctors who fled malpractice claims by coming into the military, or doctors who could not make it in civilian practice because of a variety of inadequacies — strangers to excellence. Military medical care suffered; patients paid a price.

In 1978, when I reported to Eglin Air Force Base, Fla., some doctors couldn’t speak English. Some were graduates of questionable medical schools in strange foreign countries. And we had dissatisfied patients who were getting shoddy care.

About that time, some of our leaders decided we could create a better system. We would acquire a core group of leaders in the medical world. We would eliminate the bad apples. We would offer scholarships to medical students at the world’s best medical schools, and those students would incur a military obligation in return. We would also begin a military medical school of our own in Bethesda, Md.

Our medical centers would be staffed by the very best minds in the business. We would establish training programs for specialists. We would grow our own world-class doctors who could seek full careers in the military.

By about 1990, we had everything in place and working beautifully. Traditions were established. Important research was accomplished. Centers of excellence were springing up within the military.

Then came Tricare, which has nibbled away at the system we had until we today are looking at the collapse of a national treasure. Tricare was supposed to save us money. Instead, we have sacrificed excellence for mediocrity, and we are paying huge bucks for the privilege. Tricare has emptied our hospitals and left many active-duty doctors without enough to do. Thus, it has perversely worked to make us less ready to go to war. It has made lots of business folks very rich.

This new plan will not attract the best and the brightest civilians into military medicine, but it will eliminate a generation of physicians who wear the uniform proudly, who have served with distinction and who are needed.

We lose command and control when we civilianize. We demoralize the active-duty medics, who take call, get deployed and do all the heavy lifting while civilians sometimes get two to three times as much pay.

We need to keep a “full-service bank” going in the military. Surgeons need pediatricians, who need internists, who need pathologists. Once destroyed, our medical corps will take much blood and treasure to recreate.


The writer, a retired colonel, was a surgeon in the Air Force for 30 years. His e-mail address is [email protected].

This is not the first time Dr. Welling has made his views known. About 4-5 yrs ago he published a similar truth specifically about the inability for surgeons to stay current within a system that sent everything out. At the time he had just taken a job at USHUS, as a professor. He is a colorectal surgeon by training. He is also a patriot for speaking the truth. He is one of the one's I have a hard time understanding. How they can deal in a system that totally SUCKS, yet they bang their heads against the wall to try to make a difference in their immediate vacinity. It burns me up to think of the A-HOLES I know who are now in positions of command in the AF hierarchy, who have TOTALLY sold out for purely their own benefit. I hope they get their cumuppins some time.

 

[alpha62]

This is not the first time Dr. Welling has made his views known. About 4-5 yrs ago he published a similar truth specifically about the inability for surgeons to stay current within a system that sent everything out. At the time he had just taken a job at USHUS, as a professor. He is a colorectal surgeon by training. He is also a patriot for speaking the truth. He is one of the one's I have a hard time understanding. How they can deal in a system that totally SUCKS, yet they bang their heads against the wall to try to make a difference in their immediate vacinity. It burns me up to think of the A-HOLES I know who are now in positions of command in the AF hierarchy, who have TOTALLY sold out for purely their own benefit. I hope they get their cumuppins some time.

We would have been out of Iraq 18 months ago with a draftee army. The whole freaken goat rope is being painfully sustained by everbody biting off on the pension and career derby.

Somebody would have said something by now if they weren't worried about their next promotion or making their 20. Why would Military Medicine be any different ?

Growing a pair of retirement balls and speaking out is the name of the self serving game

 

[USAFdoc]

FYI: another very informative article (actually the minutes from the most recent Society of Medical Consultants to the Armed Forces). For your reading pleasure and displeasure.thumbup:

http://www.smcaf.org/NewsletterJune 2007.pdf

below are some of the "highlights"

From The President
Military Medicine has found itself much in the news since our meeting last fall and the exposure was not good. We know our medics are doing a great job in caring for our sick and wounded, just as they have always done. But a problem was found at Walter Reed, you all know about it, so no need to re-hash it here.
If you have read some of the follow-on articles in the main stream media you find statements that the quality of care our sick and injured have received is second to none. The special commissions convened to look at military medicine in the wake of the "discoveries" at Walter Reed have all said that. We already knew it.


MINUTES FROM THE SPRING COUNCIL MEETING OF THE
SOCIETY OF MEDICAL CONSULTANTS TO THE ARMED FORCES

Major General Gale Pollock, acting Surgeon General of the Army, gave an overview of the status of the Army Medical Corps. She emphasized the present wars in Iraq and Afghanistan have been long and there has been a steady flow of injured soldiers. There are more soldiers surviving their injuries in these wars because of the excellent field medical care afforded.
The large number of injured soldiers and the extended duration of the war have stressed the Army medical system. This was reflected to some extent in the situation at Walter Reed. The Army Medical Corps has been under funded therefore capital improvements and physical plan upgrades have been delayed. She mentioned that the lay Press has criticized the Army medical system for being ill prepared to handle casualties and especially the rehabilitation needs of injured soldiers. General Pollock said this criticism was in some respects a positive commentary because it indicated how many of our soldiers were surviving their injuries compared to previous wars. She also countered criticism concerning the lack of continuity of care. She mentioned problems did exist in transferring injured soldiers from the Army medical system into the Veterans Administration system. The Army is providing some rehabilitation prior to transfer to the VA.
It should be mentioned that General Pollock had recently taken her position when General Kiley stepped down as the Surgeon General of the Army. General Kiley had given the Army Surgeon General’s report to SMCAF last year.
General Pollock mentioned that there was a movement in the Army Medical Corps for privatization of services similar to the other military services. She mentioned that Walter Reed Hospital would be closing and much of Walter Reed’s function would be transferred to Bethesda Medical Center, which would become a joint- service hospital. She mentioned that if further funding is not received, the Army Medical Corps will not be able to make payroll by June 2007. Supplemental funding is expected, however.
General Pollock mentioned there was a problem with information being leaked to the press. There were also problems with low morale and low retention (do ya think ) rates in the Army Medical Corps. She said shortages were especially acute in the Army Nurse Corps, which has a 40% shortage at present. Some of the medical specialties also have shortages. She is calling for a revamping of the needs of the Army Medical Corps with elimination of some specialties and possibly addition of a few new specialties. She felt that there would be a new full time Army Surgeon General in place by Labor Day of 2007. She also mentioned that a good deal of Army medical care is being transferred to Fort Belvoir which is farther from Washington, D.C. and offers better security.
Deputy Surgeon General Pollock fielded several questions and comments especially concerning privatization. SMCAF members felt there was a need to reverse privatization.
The term used was “military to civilian conversion of medical facilities”. Recruiting was discussed and SMCAF members emphasized that multi-service recruiting should be performed rather than single service. Dr. Mason Ahearn, President-elect of SMCAF, mentioned the HPSP (Health Profession Scholarship Program). He felt that the application for HPSP should be standardized for all three services.
The second guest speaker was Major General Brice Green, Deputy Surgeon General of the Air Force. General Green gave an overview of the present status of the Medical Corps of the Air Force. He stressed the outstanding record the Air Force had in transporting casualties from war zones around the world and the staffing hospitals. He mentioned that no injured soldier had died during air transport. He mentioned the average age of an active duty Air Force soldier was 27 years while the average age for an Air Force reservist was 32 years of age. He, like General Pollock, mentioned that transitioning from the active military medical care to the VA continued to be a problem. He was disappointed with the disability ratings performed by the VA. He mentioned that the VA concentrated on disability whereas the Air Force medical system concentrated on return to duty.
Many of the Air Force’s medical staff are now being assigned to 120 day rotations, which facilitate the planning and aided with retention. Nursing and primary care were the most difficult recruiting areas for the Air Force. Bonuses were helpful. Also, he felt the “sustained benefit program” needed upgrading in the Air Force.

There was a good deal of military to civilian conversion in the Air Force and he mentioned that the Air Force was gradually losing its graduate medical education programs. He was especially concerned about the loss of Wilfred Hall, which is consolidating with the BAMC (Brooke Army Medical Center) in San Antonio. He was concerned that in many cases, the Veterans Administration does not cover families of injured soldiers, as does the military. He outlined how the Air Force is making major advancement in affiliating their graduate medical education with adjacent university medical schools and residency programs. He felt the association with university medical schools was vital for continuation of the Air Force’s graduate medical education.
The next reporting Surgeon General was Admiral John Mateczun, the Deputy Surgeon General of the Navy. Like his associates, he was concerned about the transition to the Veterans Administration following naval medical care. He felt that rehabilitation in most cases should be done at the Veterans Hospitals rather that in the Navy medical system. He mentioned an interesting fact that the junior officers in the Navy have been mobilized for war on multiple occasions whereas most of the senior leadership in the Navy had never been mobilized. He emphasized the quality of the medical centers within the Navy, especially San Diego and Portsmouth. He mentioned that smaller Navy medical centers would probably be downgraded and possibly phased out. In the future, probably only two or three major Naval medical centers would exist. Admiral Mateczun was concerned about the lack of authorization to mobilize the naval reserves, which he felt was needed. He mentioned with pride the recent very successful trip of the hospital ship Mercy to Indonesia. This was extremely positive mission for promoting American-Indonesian relations. Surveys have shown the
mission was well received by the Indonesian people. The hospital ship Mercy may be sent to South America on a goodwill mission next year. He further mentioned the Navy had been assisting in the global war on terrorism and that more funding was needed for this particular mission. Admiral Mateczun agreed that joint-service provision of care was coming in the future. He termed this “integration of services”. He mentioned that the Navy has had far fewer casualties than the other services in our present wars. He, similar to the other Surgeon Generals, was concerned with the rehabilitation of injured sailors. Camp Pendleton and Camp Lejeune presently offer rehabilitation services. A great deal of medical care within the navy is being transferred to the private sector. He said possibly only the District of Columbia, Portsmouthand San Diego will be left to provide Navy health care in the future. Admiral Mateczun was somewhat uncertain about the appropriateness of joint-service hospitals. He felt that they were being forced upon the system.

 

[USAFdoc]

Below is an article from the SAVANNAH, GA newspaper (June 24th, 2007)talking about the problems a 1/3 shortage of docs caused at thier clinics. Not to say that wasn't a challenge but at my USAF Primary Clinic we were missing 50-80% of our docs. For those of you in milmed primary care (docs, staff and patients); best wishes.


http://savannahnow.com/node/310958


Army hospital recovering from doctor shortage
1A | Bryan / Liberty | Intown | Local News
Sean Harder | Sunday, June 24, 2007 at 12:30 am | (see enhanced version)

Certified nurse assistant Elvie Humphrey works on her computer as non-commissioned officer in charge Sgt. Cory Surla makes notes in the pediatric clinic at Winn Army Community Hospital, Fort Stewart. (Photo: John Carrington)

Winn Army Community Hospital, Fort Stewart. (Photo: John Carrington)

Amber Felder holds the attention of her daughter Abigail as Dr. Dennis Brown examines the 5-month-old infant at Winn Army Community Hospital, Fort Stewart. (Photo: John Carrington)

Amber Felder talks to her 5-month-old daughter Abigail at Winn Army Community Hospital, Fort Stewart, as head nurse Constance Hamilton stands in the doorway of her pediatric clinic examination room. (Photo: John Carrington)

(Photo: Savannah Morning News)



FORT STEWART

At one point this spring, more than 20 soldiers and family members a day were complaining about service at Winn Army Community Hospital.

Now, following a spike in complaints that reached four times the normal level, the hospital is recovering from an eight-month shortage of doctors that sparked much of the discontent.

"Everybody needs to be seen and seen now," said Col. Scott Goodrich, the hospital's commander. "When you call and ask for your provider, and they don't have an opening, people become unhappy."

The hospital's staff of 41 civilian and uniformed doctors began to dwindle by nearly one-third late last summer because of combat deployments, new assignments and competition from the private sector.

At its worst point, the hospital was short 16 physicians, Goodrich said.

The shortage created a logjam in the hospital's internal medicine, pediatrics and family-care clinics. Patients complained they could not get care within a reasonable time. Many ended up going to the emergency room for routine care or were referred to outside providers.

In March, the number of patient complaints hit a high of 616 - about four times the normal monthly level.

Recovery from the staff shortage has been difficult, Goodrich said, and the situation has had ill effects on the hospital as a whole.

"When providers leave and you can't get them back, the demand increases and the stress on the entire organization increases. That is indeed what happened here," he said. "We were understaffed for such a long period of time, cracks started to show in morale and in the willingness to work as a team no matter the cost."

Winn's recovery, however, has begun. Patient complaints dropped significantly in April as physician vacancies were filled.

As of June 1, the hospital was down five doctors. Two more hires were on the way, Goodrich said, but two other Army doctors are about to deploy to Iraq.

"We're starting to rebuild our basic health-care machinery here," Goodrich said. "We've had to work very hard to dig ourselves out, and I think we're just about there."


Patients frustrated

When one of Sharon Konvicka's three daughters got sick earlier this year, she called Winn's Family Medical Clinic and was told it would be several weeks before she could get an appointment.

With her husband, Sgt. Michael Konvicka, serving his third tour in Iraq, Sharon Konvicka was frustrated.

"I just kept calling back and calling back, knowing someone was eventually going to cancel," she said.

The approach worked, and after several tries she was able to secure an appointment.

More discouraging, she said, was her attempt to schedule a family therapy session to talk through some of the issues surrounding her husband's 15-month deployment. When she called the hospital's behavioral health clinic, she was told appointments were backed up for as long as eight months.

"It would be nice to have a family meeting, just so we don't turn into a flaming basket case while he's gone," she said. "But I don't think anyone is calling to cancel those appointments these days, so we're just relying on each other and opening new lines of communication."

Linda King, the hospital's patient representative since 1990, said Winn recorded more monthly complaints than ever from August to March. Three out of four were complaints about access to hospital care and appointment delays.

"The demands are greater because our population is growing, and the hospital is not growing as fast as the demand," King said. "From August until school is out, we stay busy with demands of people needing their families to be seen.

"The key will be if we can sustain the staff we have into this August, when families return and school is in session."


Problems Army-wide

Such problems aren't limited to Fort Stewart.

The Army operates 36 medical facilities worldwide. Last year, 17 - or nearly half - failed to meet Pentagon standards for providing a doctor within seven days for routine care, said Margaret Tippy, spokeswoman for the U.S. Army Medical Command.

That was an improvement, however, from the 21 facilities that fell below the standard in 2006 and the 23 like them in 2005.

Since 2005, Tippy said, 84 percent of routine care was provided within the seven-day standard across the Army.

The Army also is relying more on doctors in nearby communities. A recent USA Today investigation found that payments for outside referrals jumped from $200 million in 2000 to nearly $1 billion last year.


Budget, space lacking

Since Winn was opened in 1983, its potential patient population has grown 40 percent to 74,000 people. That's in large part because soldiers and families are being moved to Fort Stewart from other closed or reorganized bases.

As a result of increased demand, space and personnel have fallen short. Reconfiguring and expanding the 333,000-square-foot facility has become necessary, Goodrich said.

"It's squeezed everyone into a facility that was not built for a community this size," he said.

Services such as alcohol and substance -abuse prevention and medical boards have been moved outside the hospital into temporary buildings. Soon, the behavioral health services that Sharon Konvicka struggled to access also will be moved to a temporary space to make way for a new laser eye-surgery center.

Winn's master plan does call for expansion, but funding and a target date for completion have not been set.

The hospital's $72 million budget also has been an issue.

The hospital often receives "just-in-time funding" or "marginally adequate funding" based on sometimes incorrect projections about service demands, Goodrich said. He said he has worked to stabilize those estimates despite a patient population at Fort Stewart that continues to fluctuate with deployments.

"It's not sufficient to grow an organization or recover from a catastrophic shortage of staff," Goodrich said.


Doctors on the move

All Army physicians, from pediatricians to dermatologists, serve one-year rotations into Iraq as frontline trauma doctors. When they're not deployed, they tend to remain at Winn only three years before moving on to a new assignment.

As a result, patients rarely see the same doctor over time. Goodrich acknowledges Winn offers "no continuity of care" to its patients.

The best hope for consistency lies with the hospital's civilian doctors, but even they tend to move on to new jobs every three to four years.

Multiple combat deployments have only exacerbated the situation. Doctors are proud to serve fellow soldiers in combat, Goodrich said, but each deployment leaves one more vacant position to fill.

"Those taskings come from the Army's medical command," he said. "Their request at that point is 'They're going to leave. We know it's going to hurt. Go hire someone.'

"Immediately, there is a hole you drop into."

That sends Uncle Sam out to the open market, seeking medical workers already in high demand nationwide.

Compounding the situation, Goodrich said, has been the lack of competitive salaries and the speed at which hiring decisions are made - a process that can drag out as long as six months.

"We're in fierce competition with the rest of the civilian world, especially Savannah's Memorial and St.Joseph/Candler hospitals," he said. "They can offer people a lot more money and can hire people very, very quickly."

The Center for Naval Analyses, an in-house military consulting operation, was commissioned by Congress in 2001 to conduct a comparison between civilian and military physician pay.

The study found the pay gap varies widely by speciality - 13 to 63 percent for doctors with seven years of experience.

That gap was wider for specialists, such as surgeons, than it was for primary care physicians who provide routine care.


Learning to compete

The access-to-care issues at Winn were "truly a perfect storm, a confluence of events," said Jeff Glenn, the military legislative assistant for U.S. Rep. Jack Kingston, R-Georgia.

Glenn visited the facility this past spring along with U.S. Rep. John Murtha, D-Pa., who has been outspoken about shortcomings of the Army medical system.

The Pentagon has begun revamping its hiring practices to offer higher salaries and streamline its hiring process, Glenn said. The feeling from the spring visit was that Winn's staffing problems were being resolved.

"Everyone is paying attention to it, but it hasn't re-emerged as a problem," he said.

The Army's new hiring rules likely will take effect at Winn sometime in 2008.

"The hope is the system is changing enough so we can offer incentives and speedy hires that will attract the providers we need," Goodrich said. "As we've gotten more providers in, wait times have gone down,and satisfaction has increased.

"I feel we're on the right track."


--------------------------------------------------------------------------------


WOUNDED SOLDIER, FAMILY HOTLINE

Earlier this year, the Army launched a Wounded Soldier and Family hotline. It encourages service members and families who need assistance with medical concerns to call.

CALL: 800-984-8523.

WHEN: Open Monday-Friday, 7 a.m.-7 p.m.

Report on wounded soldier care due out soon

BY SEAN HARDER

912-652-0496 [email protected]

After reports about poor conditions at Walter Reed Army Medical Center in Washington, the spotlight turned to Army hospitals across the nation, including Winn Army Community Hospital.

In April, Fort Stewart's hospital was one of 11 facilities in seven states that underwent so-called "tiger team" inspections. It's part of an Army effort to study outpatient care and ensure that such poor conditions are not the norm.

Fort Stewart made the list because of the high concentration of troops and specifically the number of soldiers on medical hold and medical holdovers.

A medical hold is when active-duty soldiers await additional treatment or processing by a medical examination board. Medical holdovers are for National Guard members and reservists in need of treatment or further medical board processing.

As of Friday, Fort Stewart had 24 soldiers on medical hold and 53 on medical holdover, said Winn spokeswoman Ann Erickson.

An additional 168 soldiers from the 3rd Infantry Division were held back from this year's deployments and are awaiting additional medical screening.

The inspection teams spent a day and a half at each facility and delivered a report to top Army brass in May that is yet to be released to the public.

That report should be available soon, said Margaret Tippy, spokeswoman for the Army's medical command.

Col. Scott Goodrich, Winn's commander, said his hospital fared better than most in the inspections. He said the conditions and bureaucratic delays found at Walter Reed tend not to be issues at smaller hospitals.

"There are delays in the process, but that is not something unique to this organization," Goodrich said. "We had fewer delays than most locations. It's something that is very bureaucratic and organizational."

 

[USAFdoc]

recent interview discussing Walter Reed Panel recent recommendations. FYI

http://www.washingtonpost.com/wp-dyn/content/discussion/2007/07/25/DI2007072501469.html

Commission Calls for Changes to Military Health System
Dana Priest and Anne V. Hull
Thursday, July 26, 2007; 11:00 AM


The President's Commission on Care for America's Returning Wounded Warriors called for "fundamental changes" in the management of the military's health care and disability system, according to a draft report released on Wednesday.

Washington Post reporters Dana Priest and Anne V. Hull were online Thursday, July 26, at 11 a.m. ET to discuss the commission's recommendations for overhauling the military health care system.





Over the past few months Priest and Hull have investigated the care and treatment of service members returning from the wars in Iraq and Afghanistan in the Post's series, " Walter Reed and Beyond."

The transcript follows:

____________________

Anne V. Hull: Hello everyone. Thanks for joining us. Let's begin.

_______________________

North Bethesda, Md.: The recommendations mostly seem to emphasize supporting the care to veterans and their families, something you would have thought the system already covered. Is this just an example of typical government bureaucracy that led to the failure of not doing this already? Can it be blamed on the Bush administration or does this go back much further?

Anne V. Hull: You would have thunk. The problems have existed forever, certainly during the Vietnam War. We haven't had a sustained combat environment since then, so that's probably why you're hearing about it now. Also, the country wants to support wounded service members now and isn't putting up with all the excuses. Yes, to some extent this is a typical bureaucratic set of problems -- times ten -- and to some extent it is the fault of the country's leadership, who are responsible for making sure the bureaucracy does what is important to do, like care for these people.

_______________________

Arlington, Va.: If the proposals are enacted, how long will it take for them to be enforced?

Anne V. Hull: The report gives them 12 months; but of course, it has no inherent power, so that's just a little kick and nothing more. The "how long" question is really a political one. How long can they get away with NOT fixing it.

_______________________

Ann Arbor, Mich.: Nicholson has said he's leaving, but I've seen nothing about a successor. What does the commission report imply for what characteristics a new Secretary should have?

Anne V. Hull: Someone who can effectively take on a lot more work; a lot bigger responsibility vis a vis the evaluation of wounded soldiers and the health care of their families.

_______________________

Tucson, Ariz.: What are you going to do to be more fair to people whose injury or disability is not so visible and has therefore often been downgraded when in fact it is very disabling on a day to day basis, for example pain?

Anne V. Hull: Well, the commission has a specific recommendation on post traumatic stress disorder. The Army is supposed to be quicker at determining fitness for duty using a uniform exam and the VA, which is better equipped anyway, is supposed to more quickly evaluate a soldier and they historically have been more generous with disability compensation than the services.

_______________________

Northeast Washington, D.C.: With all the reporting you have done on this subject, after examining the recommendations do you think, if implemented, they would help those real people you have interviewed and those like them?

Anne V. Hull: Yes. But we're a little skeptical of the Recovery Coordinators. Sounds like another layer of managers on top of a system that doesn't really function right now. After the hearing, Sec. Shalala told us she thought they would need are 24 of them. That was a shocking number. There are 28,000 wounded so far, thousands seriously. 24 seems way low.

_______________________

Alexandria, Va.: First of all - thanks again to the Washington Post for holding a flame to the administration's feet. My brother was seriously wounded in Iraq and, though his care at Bethesda and Brooke AMC were excellent, it was apparent that neither facility was up to the same level.

My question, however, is whether this report covered the absurd lack of care given to reservists and guardsmen wounded in Iraq? These men and women are being called up to serve in the same warzone for years on end, but then find their healthcare cut off after 2 years.

Anne V. Hull: The commission says only that service members (including guard and reserve) found unfit because of combat-related injuries should receive lifetime health care coverage for themselves and their dependent through TRICARE. Now, that will be very expensive, and it has to be approved in legislation, so we'll see.

_______________________

Charlotte, N.C.: Can you sum up what the recommendations were? T hanks

Anne V. Hull: here's the link. the commission report is not long, 29 pages: Recommendations

_______________________

Boston, Mass.: Congratulations on your reporting on soldier care. I do get cynical when I hear Bush "will look at" recommendations from bipartisan study groups and he sets up photo ops with affected people. Which of the recommendations do you think Bush will not implement?

Anne V. Hull: Yes, we were surprised at his tone as well. The report, on the whole, used diplomatic language, in contrast to the report commissioned by Defense Secretary Gates which was quite openly critical of the system. So, the proof, as they say, is in the pudding. We'll have to wait and see how the president follows up.

_______________________

Washington, D.C.: Living in DC and reporting on this subject in depth you might be aware of how difficult it is for community members to volunteer their time with Walter Reed. Despite all the talk about 'supporting our troops', when we actually try to do so, the hospital gives us the cold shoulder. Is anything being done to tap into the large and willing pool of local support?

Anne V. Hull: This is a problem. We are deluged with readers who call asking, how can we help? The generosity is overwhelming, from someone in the Midwest wanting to donate a billiards table to a cadre of local mental health counselors who want to provide services to an Army with a severe shortage of counselors and psychologists.

Walter Reed either does not return their phone calls or says it needs no help. Gen. Schoomaker, the CG at WR, is aware of this problem and says he is trying to coordinate efforts better. But we've seen no improvement yet.

_______________________

Washington, D.C.: I have 2 points...first off the Commission didn't report on the qualities needed for a new VA secretary. That was not what they were commissioned to do.

Secondly...the coordinators would be for seriously injured patients...they cover the definition in the report...and that number is between 2,000 to 3,000 servicemembers if I remember correctly.

People would be well served to read the report and make their own opinions based on the information that was collected.

Anne V. Hull: Right, the commission made no suggestions about the qualities the new VA secretary should possess. But the proposals are massive, particularly the data sharing aspects between DOD and VA. No small undertaking. So whoever gets the job has to cut out for overhauling some key areas of care.

We gave the total number of seriously wounded from Iraq and Afgahnistan. The current number hovers just under 3,000.

_______________________

Raleigh, N.C.: There has been a suggestion of Private Sources for these healthcare initiatives. Is this another effort for privatization? It is my understanding that one underlying cause of the problems at Walter Reed was this movement to privatize sources.

Anne V. Hull: One of the proposals, the Recovery Care Plan that calls for Recovery Care coordinators to give personal and longterm care to each seriously wounded soldier, will draw employees from the U.S. Department of Public Health and the Department of Health and Human Services.

With severe shortages in, for instance, mental health care, the Army will go outside to boost its ranks of providers. It has done this for years but the problem is more critical now.

_______________________

Washington, D.C.: So, Walter Reed can't even coordinate volunteers and donations, but we are expected to believe they can adequately treat wounded soldiers?! Sigh.

Anne V. Hull: Walter Reed would argue that it is focused on providing the best medical care it can to the soliders. Docs and nurses are working 24-7 and are often deployed themselves for months at a time. It has been an extremely exhaustive chapter in the lives of the staff.

But things fall the cracks when the soldiers leave the hospital beds.

_______________________

Rockville, Md.: My friend's husband is a marine who recently returned from Iraq. He is experiencing symptoms of PTSD and although he is eligible for treatment, the marine culture has inhibited his ability to receive services. Any ideas on if/how these new measures could make it easier for marines returning from combat to receive psychological treatment without facing stigma/backlash from superiors?

Anne V. Hull:"Stigma" was addressed in the report released yesterday. "Both departments (DOD and VA) must work aggressively to reduse the stigma of PTSD." Some say the military culture of "suck it up" and "drive on" are the greatest obstacles to troops asking for and getting help. What's needed are top commanders speaking openly about the need for good mental health care; not those at the Surgeon General's office but those in theater.

_______________________

Chesterfield, S.C.: Hey Dana, and Ann:

After listening to the news and reading about the findings by Ms. Shalala and Mr Dole, I have a question. According to Mr Snow, "White House press secretary Tony Snow initially told reporters yesterday that Bush would not act immediately on the panel's advice. 'He's not going to be making recommendations; he's not going to be issuing calls for actions,' Snow said."

If nothing is going to be done, then why do the homework????

These guys need everything now, not years down the road.

When will all this end, and what should the soldiers and their families do in the mean time?

Ms. Shalala made the comment: "It isn't fair for a family member to lose their job to take care of their injured soldier, it is their job to take care of him", but with things the way they were, how do you even think about allowing the Army to take care of a family member????

Thank you Annette McLeod

Anne V. Hull: Annette is the wife of wounded Spc. Wendell McLeod, who was hit in head with a steel door on the Iraq border. They spent more than a year at Walter Reed. Now they are coping with the aftermath of the injury at home in South Carolina.

Holding Pattern at Mologne House

_______________________

Arlington, Va.: I've an idea to get Walter Reed to accept help from Americans: EVERYONE who wants to help in whatever way, all need to gather at the gates of Walter Reed, with trucks, cars, mobs of people, and, of course, camera crews from ABC, CBS, NBC, and CNN. Bring along a few congresscritters as well, both R and D, and then let's see the brass at Walter Reed fail to return phone calls from volunteers.

Anne V. Hull: Seems like that is what it might take. Walter Reed has not been good at taking advantage of all the people who want to volunteer.

_______________________

Washington, D.C.: I think that earlier reader was a little nasty - yes, we can read the report for ourselves, but, as a layperson who is not immersed in this topic via reporting, it helps to have the perspective of reporters like Anne and Dana.

Also, whether or not the commission was tasked with listing a job description for a new sec'y, I, too, think the new VA sec'y will need to come with a plan for how to overhaul this situation. The reporting has revealed it to the masses and now people want to see change.

Anne V. Hull: just passing on

_______________________

More Walter Reed series?: Is that over?

washingtonpost.com: Walter Reed and Beyond

Anne V. Hull: That's classified.

_______________________

Baltimore, Md.: Are you planning to do more stories in your Walter Reed series?

Anne V. Hull: Why? Do you have a tip?

_______________________

Santa Barbara, Calif.: Just wanted to say "thank you" for breaking this story, and the follow-ups. Your articles made me write, for the first time in my franchised life, to my senators, urging them to action to correct this. Please keep up the excellent work.

Anne V. Hull: What we found is that the public pressure, like yours, has kept the issue alive.

_______________________

Still outraged....: OK, what can we do to get this beyond the administration, "taking it under advisement"?

Anne V. Hull: All of the recommendations could be implemented by Congress, although many of them would only take action by the executive (the prez). So, I suppose, if Bush decides not to do a thing (unlikely), Congress could take it upon themselves.

_______________________

Washington, D.C.: Are the people working to make this situation better military personnel or contractors? If contractors, what is the company name?

Anne V. Hull: There are more and more contractors being used and you can expect that to continue. The commission asks DOD to partner with the private sector on mental health.

_______________________

Washington, D.C.: In my experiences, there are many organizations that help directly at Walter Reed such as the Wounded Warrior Project, DSUSA, and the Yellow Ribbon Foundation. Maybe people can check out these reputable groups which already are connected with the hospital? It is much easier than going in as an individual. People have to remember that Walter Reed is not only a hospital but a military facility as well and is secured that way.

Anne V. Hull: You are right. Go to www.washingtonpost.com/WalterReed and we've listed a few of the organizations that help.

 

[USAFdoc]

Below is a nice article on military medicine: retention issues, costs to the DoD, HPSP vs Academy etc. It is about 10 years old but very professionally done and gives some background numbers on costs etc and sheds some light on what the SG might have been dreaming about 10 years ago.


http://www.gao.gov/archive/1995/he95244.pdf

 

[BomberDoc]

Just a random experience to let perspective mil docs know what kind of BS they're in for...

Everybody in the AF has to have Self Aid Buddy Care. There is probably a different name for it in each service. It is the basic, barest material on how to treat injuries. Stop bleeding by elevation, direct pressure, pressure points, tourniquet, etc. Recently we have a deployment readiness inspection. I sit for hours and finally get to go through the inspection line... dog tags, check... shot record, check... currencies... hmmmm. The 19.5 year old 2 stripe airman notices that I'm not current on Self Aid Buddy Care. My readiness guys told me docs don't have to do that. Duh, makes sense, right? Well, this young hard charging airman doesn't believe me. I whip out my license to practice medicine. A1C Snuffy says it doesn't count. I tell him that I teach SABC. It doesn't count. Rather than throttle this little dips#it, I just press on through the line. As it turns out, the writeup makes it to the Group Commander. So I'm a criminal because yesterday instead of clicking through a Powerpoint presentation to get my SABC certificate, I was treating the guy who walked in with distal extremity paresthesias, tremors, and a K+ of 7.2! The hyperkalemia guy is doing fine, but I'm still in trouble for my "misguided" priorities and saving a life instead of punching a currency. Management would rather have a fatality than a writeup on the inspection.

Get me the Hell out of here!

 

[USAFdoc]

Just a random experience to let perspective mil docs know what kind of BS they're in for...

Everybody in the AF has to have Self Aid Buddy Care. There is probably a different name for it in each service. It is the basic, barest material on how to treat injuries. Stop bleeding by elevation, direct pressure, pressure points, tourniquet, etc. Recently we have a deployment readiness inspection. I sit for hours and finally get to go through the inspection line... dog tags, check... shot record, check... currencies... hmmmm. The 19.5 year old 2 stripe airman notices that I'm not current on Self Aid Buddy Care. My readiness guys told me docs don't have to do that. Duh, makes sense, right? Well, this young hard charging airman doesn't believe me. I whip out my license to practice medicine. A1C Snuffy says it doesn't count. I tell him that I teach SABC. It doesn't count. Rather than throttle this little dips#it, I just press on through the line. As it turns out, the writeup makes it to the Group Commander. So I'm a criminal because yesterday instead of clicking through a Powerpoint presentation to get my SABC certificate, I was treating the guy who walked in with distal extremity paresthesias, tremors, and a K+ of 7.2! The hyperkalemia guy is doing fine, but I'm still in trouble for my "misguided" priorities and saving a life instead of punching a currency. Management would rather have a fatality than a writeup on the inspection.

Get me the Hell out of here!

there is NOTHING that surprises me anymore in milmed. I understand why "A1C" needs to do his job, at the same time, somebody above him needs to do thier job and realize that the doc doesn't need to be trained to do first aid.

what you describe is just one of numerous examples I could give in which the top heavy beuracracy is just "driving the car blindfolded."

Civilian medicine has its beuracracy as well, but the vast majority of the idiotic stuff won't fly because the docs wont let it fly....and if admin insists on it, well they can do it and begin looking for new docs as well, cause they would leave.

My "favorite" idiotic happening at my base was the fire alarms/drills.
At times, more than once a week, for weeks on end, they would practice firedrills (emptying the clinic) and at time just test the alarms to see if they were working. And ALWAYS right in the middle of clinic hours. My working through the Chain of Command on this issue found NOBODY with a good answer as to why this was happening, and why they could not at least do the "testing only" after hours.

With my last communications with my staff at my last base I was told things were even worse then when I was there. SAD

 

[USAFdoc]

FYI: latest issue of the USAFP:


http://www.usafp.org/Word_PDF_Files/2007-Summer-Newsletter.pdf

 

[a1qwerty55]

USAF shines again

I read the above link to the USAFP newsletter and one thing was striking.

How unbelievably useless the USAF Consultants Corner letter was.

I'm pretty accustomed to admin mumbo jumbo but this guy takes the cake - not one concrete thing in the letter but plenty of platitudes, slogans, and baloney.

At least the Army and USN ones had tangible info contained within. Below is my favorite excerpt:

It has become apparent that the orientation and training
of our clinic personnel needs a longitudinal, strategic focus to create healthy "microsystems" of care. Secondly,
fostering strong, longitudinal continuity of provider/patient relationships and provider/support staff relationships will
drive many of the outcomes desired in outstanding health systems.

Code speak for nothing will change,

 

[Galo]

USAF shines again

I read the above link to the USAFP newsletter and one thing was striking.

How unbelievably useless the USAF Consultants Corner letter was.

I'm pretty accustomed to admin mumbo jumbo but this guy takes the cake - not one concrete thing in the letter but plenty of platitudes, slogans, and baloney.

At least the Army and USN ones had tangible info contained within. Below is my favorite excerpt:

It has become apparent that the orientation and training
of our clinic personnel needs a longitudinal, strategic focus to create healthy "microsystems" of care. Secondly,
fostering strong, longitudinal continuity of provider/patient relationships and provider/support staff relationships will
drive many of the outcomes desired in outstanding health systems.

Code speak for nothing will change, I'm going to get a star, suckers.

Will the AF just give up already?

Not that I mind you pointing out alot of the truths we've been trying to expose, like the ridiculous leadership that physicians have to put up with, but you make it sound like the Army and Navy are not that bad. Please remember Walter Reed, and many of the equally inept medical leaders all over the DoD. The decline in military medicine is by no means isolated to the AF. It is a widespread chronic failure of leadership, support, and mentality that is not likely to change anytime soon. More than likely things will continue to get worse before they get better.

 

[USAFdoc]

USAF shines again

I read the above link to the USAFP newsletter and one thing was striking.

How unbelievably useless the USAF Consultants Corner letter was.

I'm pretty accustomed to admin mumbo jumbo but this guy takes the cake - not one concrete thing in the letter but plenty of platitudes, slogans, and baloney.

I have spoken with the USAF reps (all of em) over the past several years.
Col Haynes is just taking the advice that "if you don't have anything good to say, don't say anything."

He basically decided to just say nothing.

 

[Gastrapathy]

I have spoken with the USAF reps (all of em) over the past several years.
Col Haynes is just taking the advice that "if you don't have anything good to say, don't say anything."

He basically decided to just say nothing.

Thats a kind assessment. I'd say that advice doesn't apply to a "leader." More appropriate would be "if you don't have anything to say (good or otherwise), go see some damn patients and wait for ahlta to load with the rest of us."

 

[DiveMD]

USAF shines again

I read the above link to the USAFP newsletter and one thing was striking.

How unbelievably useless the USAF Consultants Corner letter was.

I'm pretty accustomed to admin mumbo jumbo but this guy takes the cake - not one concrete thing in the letter but plenty of platitudes, slogans, and baloney.

At least the Army and USN ones had tangible info contained within. Below is my favorite excerpt:

It has become apparent that the orientation and training
of our clinic personnel needs a longitudinal, strategic focus to create healthy "microsystems" of care. Secondly,
fostering strong, longitudinal continuity of provider/patient relationships and provider/support staff relationships will
drive many of the outcomes desired in outstanding health systems.

Code speak for nothing will change, I'm going to get a star, suckers.

Will the AF just give up already?

HAHAHA! I don't' know what my GMO life would be without this forum. Great post!

 

[a1qwerty55]

Not that I mind you pointing out alot of the truths we've been trying to expose, like the ridiculous leadership that physicians have to put up with, but you make it sound like the Army and Navy are not that bad.

The Army and Navy are not AS bad. The USAF has the smallest medical service yet the majority of negative posts come from USAF docs. I frankly am just tired of the USAF. -My friends in their medical corps get treated far worse than I or my colleagues do (exception being deployments), there is this apparent tendency for the USAF to draw and retain technocrats who are inflexible to degrees I've never seen. The USAF actually has MORE military specific crap.

Luckily for USAF beneficiaries they often is a USN or Army base near by to offer the subspecialty support, pharmacy services etc. that the USAF has opted out of supplying.

 

[Galo]

The Army and Navy are not AS bad. The USAF has the smallest medical service yet the majority of negative posts come from USAF docs. I frankly am just tired of the USAF. -My friends in their medical corps get treated far worse than I or my colleagues do (exception being deployments), there is this apparent tendency for the USAF to draw and retain technocrats who are inflexible to degrees I've never seen. The USAF actually has MORE military specific crap, and by the way, the care stinks.

Luckily for USAF beneficiaries they often is a USN or Army base near by to offer the subspecialty support, pharmacy services etc. that the USAF has opted out of supplying. They can't even run the air evac system. The horrible experiences that I, my colleagues and more importantly the patients experience are indefensible.

My solution - privatize the A/E system at least for Conus and Oconus travel - actually in many deployed locations (not including Iraq/Afghanistan) a French company International SOS is the first choice for evacuation because they can actually show up on time and with necessary equipment.

I really don't like the USAF medical establishment. I'd like obviously for AF personnel to get great care, but since there isn't buy in at the Flag officer level, maybe the USAF is right in getting out of the business and letting the two more robust medical departments just take it over.

I will never fight with you on trying to defend the AF milmed system. However, I think you are giving the army and the navy WAY too much credit in being anything near ideal in taking care of patients. You have to remember its all a part of the DoD, and I certainly do not want prospective students getting the wrong idea that army/navy would be a "good" place to practice medicine. It seems that your experience is something of an anomaly that you have created for yourself, but then again, you probably did not have the issues of GME, deployment, and ability to choose specialty, like the problems that currently exist DoD wide. Military medicine is rotten right now, and seems to be getting worse all the time. Once again,I point out Walter Reed, and all the other places of complacency that have permeated militiary medicine.

 

[a1qwerty55]

I don't really disagree that much with the above post. I wouldn't describe any of the services as a "good" place to practice medicine. Instead I would say they can be "OK" and that the many many downsides are somewhat offset by the service to country, and soldiers/airmen/sailors.

I just crack up when I see these premeds usually with no military experience referring to how they are going to apply for an AF HPSP "scholarship", under the impression that the AF has less military specific crap, and the quality of life is so good. It's as if they aren't reading your posts. I totally can't figure out why the USAF isn't having trouble filling their HPSP slots.

Honestly, who here feels that training opportunities, and the overall support of the medical community is better in the USAF over the Army or Navy? Anyone?

 

[LauraDO]

This whole thread, this whole forum is so sad to me. I was interested in the 'scholarship' less for the scholarship itself and more for the chance to serve. I grew up an army brat. I lived on bases from the time I was born until I was about 12 when my Dad retired. Being part of the Army was something I was proud of and enjoyed. Both my Father and my Grandfather graduated from West Point, it is a blood thing I think.

When my father retired I was so disappointed that I was too young to join. When it was time to go to college my father refused to let me go to West Point (something about me being too stubborn and controling) When I decided to go to medical school I thought this would finally be my chance to continue to the bloodline.

Why am I going into all of this, just because it shows how sad a state of affairs it is, how can military medicine ever get better when it scares off people, like myself, who have loved the military their whole lives

It;s just sad. Our soilders deserve better

 

[Mirror Form]

I will never fight with you on trying to defend the AF milmed system. However, I think you are giving the army and the navy WAY too much credit in being anything near ideal in taking care of patients. You have to remember its all a part of the DoD, and I certainly do not want prospective students getting the wrong idea that army/navy would be a "good" place to practice medicine. It seems that your experience is something of an anomaly that you have created for yourself, but then again, you probably did not have the issues of GME, deployment, and ability to choose specialty, like the problems that currently exist DoD wide. Military medicine is rotten right now, and seems to be getting worse all the time. Once again,I point out Walter Reed, and all the other places of complacency that have permeated militiary medicine.

And what problems are you pointing out again? It's bad enough that I have to deal w/ laymen who only read headlines and don't bother reading any articles, but I'm not going to put up w/ that from other physicians.

Walter Reed has a huge number of problems, and is a pretty crappy place to work overall. But the OIF patients get great "HEALTH" care. Every washington post article could only find examples of people who didn't like their barracks or didn't show up to their follow up appointments.

 

[Galo]

And what problems are you pointing out again? It's bad enough that I have to deal w/ laymen who only read headlines and don't bother reading any articles, but I'm not going to put up w/ that from other physicians.

Walter Reed has a huge number of problems, and is a pretty crappy place to work overall. But the OIF patients get great "HEALTH" care. Every washington post article could only find examples of people who didn't like their barracks or didn't show up to their follow up appointments.

My experience is with the AF, and common to all health care facilities where I have physician friends that work. Don't get off telling me that wherever in the Army you work, you are isolated from the crap that is happening to all of military medicine. As a resident you do not have the responsibility of an attending, and till its your ass on the line, you will not understand where I am coming from. As surgical residents, our residents met their numbers ONLY because they were in a combined civilian program, and did 90% of their training at civilian hospitals. I defy any fully military program to even stand up to the lowliest of civilian programs, (well, maybe the absolute lowliest). So dont spew crap here that the layman who found people who "didn't like the barracks or didn't show up for their follow up appointments", and published it in the Washington Post, was just out to smear the army for no good reason. When you as an active duty resident physician can downplay the horrible care that some (maybe most?) soldiers are receiving, you have bought totally into the crap, and you should be looking for your next promotion, because medicine and taking care of people just became your last priority above military crap.

 

[a1qwerty55]

Wow what an over reaction!

I hate the break the news to you but the Washington Post article was 100% about discrediting Bush, and Walter Reed was the vehicle.

No one, absolutely no was has been critical of the inpatient care, the outpatient prosthetic care (the best in the world). The issues were with an off campus facility which had "mold" in some rooms, much like my dorm room in college, or like most enlisted troops bathrooms in their private homes. What was never disclosed in the rush to discredit Army medicine was that the soldiers all were offered alternate lodging and DECLINED. Yes there were mice in the building,, have you ever been to DC the whole place is a rat trap, Georgetown included.

The real problem which thankfully will hopefully change was the totally screwed up medical board process which makes it very difficult to get a final disposition for the soldier, not to mention that the soldier can work the system and so long as he gets a "new" problem near the end of his board process, like maybe headaches, or back pain, or sleep apnea whatever, the whold board process gets derailled.

Sorry Galo, you are wrong about the care at WRAMC. The facility is old, the civilian staff lethargic, but despite this, the care is amazingly good thanks to very dedicated and idealistic physician and nursing staff.

 

[IgD]

Walter Reed has a huge number of problems, and is a pretty crappy place to work overall. But the OIF patients get great "HEALTH" care. Every washington post article could only find examples of people who didn't like their barracks or didn't show up to their follow up appointments.

Do you think the fact that you work at WRAMC is clouding your judgment a little on this issue

 

[USAFdoc]

I hate the break the news to you but the Washington Post article was 100% about discrediting Bush, and Walter Reed was the vehicle.

No one, absolutely no was has been critical of the inpatient care, the outpatient prosthetic care (the best in the world). The issues were with an off campus facility which had "mold" in some rooms, much like my dorm room in college, or like most enlisted troops bathrooms in their private homes. What was never disclosed in the rush to discredit Army medicine was that the soldiers all were offered alternate lodging and DECLINED. Yes there were mice in the building,, have you ever been to DC the whole place is a rat trap, Georgetown included.

The real problem which thankfully will hopefully change was the totally screwed up medical board process which makes it very difficult to get a final disposition for the soldier, not to mention that the soldier can work the system and so long as he gets a "new" problem near the end of his board process, like maybe headaches, or back pain, or sleep apnea whatever, the whold board process gets derailled.

Sorry Galo, you are wrong about the care at WRAMC. The facility is old, the civilian staff lethargic, but despite this, the care is amazingly good thanks to very dedicated and idealistic physician and nursing staff.

1. I think this site works best when people generally stick to what they know first hand. That probably means that med students should not be telling the milmed docs that milmed is wonderful, and that I should not be the final word on WRAMC.

2. I think you could find alot of dedicated/idealistic physician and nursing staff around the military. The problem is that, in my experience, the majority leave asap because of the poor leadership, manning, and excessive beuracracy. WRAMC sure sounds like a good example of death by red tape "stangulation". And when these idealistic docs and nurses leave, that leaves the door wide open for those non-idealistic docs and nurses to fill the leadership void, to the pain of us all.

3. You can go back to the early entries of this thread to get details of my first hand experience in USAF primary care. My conversations with people still at the base informed me that things are worse than ever.

4. For those of you heading into milmed, just be prepared for the worst; hope and pray for the best, and when you are in a couple months and already counting down the days until your DOS, at least you can know that you are doing a great service for the troops, their families and our country...even though your leadership many times is doing a disservice to those same people and you.

5. And I do NOT believe the washington post article was 100% about discrediting BUSH. Now am am not so thick as to completely discount any political agenda with the post, but I believe they became aware of some serious problems there, and reported them. And thankfully they did, because we have seen more action for improvment since they did. The previous ARMY Surgeon General knew about these things for years and did squat, and got promoted to the SG position based on his ability to "SQUAT."

 

[Mirror Form]

My experience is with the AF, and common to all health care facilities where I have physician friends that work. Don't get off telling me that wherever in the Army you work, you are isolated from the crap that is happening to all of military medicine.

And guess what, you didn't provide any examples. Can't say I'm surprised. OIF patients at WR get treated like VIP's and don't have any of the issues that your average 90 year old vet gets at your air force clinics. If any OIF patient calls a clinic and asks for an appointment (regardless of whether they have a referral) they're supposed to be seen within 72 hours (and that was before the wash post BS).

As a resident you do not have the responsibility of an attending, and till its your ass on the line, you will not understand where I am coming from.

You'd be surprised. If I don't staff my cases, and there is a HUGE amount of pressure from my staff not to, then it is my ass on the line. Of course I always have the option to staff if needed, but my staff can always just refer out too.

As surgical residents, our residents met their numbers ONLY because they were in a combined civilian program, and did 90% of their training at civilian hospitals. I defy any fully military program to even stand up to the lowliest of civilian programs, (well, maybe the absolute lowliest).

No doubt that many of the military gen surg programs are abysmal. The hospital I did my internship at had a 100% horrendous gen surg program that was scary to even think about. Fortunatley Walter Reed never kicked out the over 65 population like AF (and some army and navy hospitals) did. As a result, my program makes all of its numbers, and gets better numbers then several of the surrounding civilian programs (and since I'm in a surgical subspecialty they're all a lot more competitive then your average gen surg program).

So dont spew crap here that the layman who found people who "didn't like the barracks or didn't show up for their follow up appointments", and published it in the Washington Post, was just out to smear the army for no good reason.

So I guess you didn't read the articles? They used evidence like "a beer can was found outside the barracks" and whatnot. There's no doubt it was partially politically movitated. The primary motive was money of course. Always lucrative to create a scandal.

When you as an active duty resident physician can downplay the horrible care that some (maybe most?) soldiers are receiving, you have bought totally into the crap, and you should be looking for your next promotion, because medicine and taking care of people just became your last priority above military crap.

And once again, no examples. Yes, you're FOS. I know of a few examples where mistakes were made on soldiers. One guy lost a leg from getting aspergilosis. But overall the OIF guys get ridiculously good care compared to what your average Kaiser or medicare patient gets.

 

[Mirror Form]

Do you think the fact that you work at WRAMC is clouding your judgment a little on this issue

Are you kdding me? I despise the death star and can't wait to get far away from it. The place is a sh*thole. However, the only good thing about it is that we really do work our a$$es off to take care of the OIF soldiers. So to hear ingnorant outsiders spewing garbage about how they're all getting crappy care is pretty F'ing annoying.

 

[Tired]

I know of a few examples where mistakes were made on soldiers. One guy lost a leg from getting aspergilosis. But overall the OIF guys get ridiculously good care compared to what your average Kaiser or medicare patient gets.

Ditto. We go to town on these guys too (NNMC). 72hrs for a clinic visit. Front-of-the-line priority in the OR, regardless of procedure. Automatic consultations with psychiatry, neuropsych, audiology, dental, social work, case management. Top-of-the-line prosthetics courtesy of the WRAMC guys. The major complaint I hear is, "Why can't I just go home and get followup there?" We love these guys. We do everything for them, sometimes in cases where maybe we shouldn't.

 

[USAFdoc]

Ditto. We go to town on these guys too (NNMC). 72hrs for a clinic visit. Front-of-the-line priority in the OR, regardless of procedure. Automatic consultations with psychiatry, neuropsych, audiology, dental, social work, case management. Top-of-the-line prosthetics courtesy of the WRAMC guys. The major complaint I hear is, "Why can't I just go home and get followup there?" We love these guys. We do everything for them, sometimes in cases where maybe we shouldn't.

the best thing milmed has going for it is its docs and nurses down in the trenches doing the day to day care for the troops and the families. The worse thing milmed has going for it is the beuracracy/admin and friendly fire aimed at those same docs,nurses, troops, and their families.

 

[Galo]

I am willing to concede that since I have no first hand experience with these army/navy places, is plausible I could have overreacted, but the reaction is based on what I lived and experienced for 6 years as an active duty doc. One of the hallmarks is would you be a patient there for a major procedure?

No matter how hard you guys have to work, the point is you are doing double or triple for what should be a nearly effortless ability to take care of patients. The mil red tape is and will always be one of the reasons mil med will always bog down, and be a burden to properly take care of patients.

My original point was that army navy milmed CANNOT be any better than what I have described the disaster that AF mil med is. They are the same beast in different color pants. The same mentallity, the same ignorance, the same disrupted sense of order that only a non-physician, or one that has so turned hie/her back on medicine, that they have become a manager bean counter that will continue to burden the ability to care for patients. So Take the knot out of your panties. It is the acceptace of mediocracy or the acceptance of some military crap being more important that medical care of a patient that leads to problems in all of mil med.

Incidently, I just finished reading the book recommended by Idg, Oath Betrayed, about how complicit medical personell were in the systematic torture of POW's in Iraq, Afganistan, and the other secret prisons the U.S. has across the world. Its that indifference, inability, or fear of speaking out against what you know is wrong, that lead physicians to what the military wants, an officer first, and a physician much later.

I highly recommend the book to those who have an minimum interest in yet another dark chapter in military medicine.

 

[a1qwerty55]

One of the hallmarks is would you be a patient there for a major procedure? Yes, me twice as well as several family members - I could have opted out and did not b/c the care was better in my facility than in the civilian community.

No matter how hard you guys have to work, the point is you are doing double or triple for what should be a nearly effortless ability to take care of patients. Maybe but does that equate to worse care? No


My original point was that army navy milmed CANNOT be any better than what I have described the disaster that AF mil med is. They are the same beast in different color pants.

I totally disagree. There are very big cultural differences between the USAF, Army and USN. This extends to their medical departments as well. Of the three and having worked with all three personally, the USAF is clearly failing to a greater degree than the other two

 

[USAFdoc]

I totally disagree. There are very big cultural differences between the USAF, Army and USN. This extends to their medical departments as well. Of the three and having worked with all three personally, the USAF is clearly failing to a greater degree than the other two

there are more than cultural differences.

during a "open access" seminar several years ago, attended by 7-8 bases, all of them USAF clinics except one USN base clinic represented. The USN clinic was the ONLY one that seemed to be functioning decently. They had 2 things going for them that the USAF clinics didnt.

1) The usaf Primary care clinics were running with panels sizes of more than 1500 pts per doc, while the USN was at 700 pt per doc.

2) The USN had a civilian experienced office manager. Our USAF base had a succession of several brand new/inexperienced military office managers that although were nice people, really had no clue (and more importantly, no autonomy themselves...basically pawns of more senior admin).

 

[a1qwerty55]

there are more than cultural differences.

during a "open access" seminar several years ago, attended by 7-8 bases, all of them USAF clinics except one USN base clinic represented. The USN clinic was the ONLY one that seemed to be functioning decently. They had 2 things going for them that the USAF clinics didnt.

1) The usaf Primary care clinics were running with panels sizes of more than 1500 pts per doc, while the USN was at 700 pt per doc.

2) The USN had a civilian experienced office manager. Our USAF base had a succession of several brand new/inexperienced military office managers that although were nice people, really had no clue (and more importantly, no autonomy themselves...basically pawns of more senior admin).

I think you just made my point for me.

 

[USAFdoc]

I think you just made my point for me.

it makes no significant difference who has the "best" or "worst" culture out of the services. They all have issues. I have stressed the value that we all try to speak from experience and every service is represented on this site in terms of bad experiences (perhaps the USAF more)

the crux of the problem is that medicine is under tremendous strain nowadays, and in the military, that strain is compounded by having a medical system in which the doctors and nurses actually seeing patients and responsible for care, have near zero "power" within the system, and those weilding the "power" have repeatedly shown that their Priorities are different from those of us seeing patients. Congress has for years been told "half-truths" about the state of milmed by Surgeon Generals that likely get appointed for their "politics" over their committment to patients and staff.

if this all sounds like a "toxic" brew......you would be right.

 

[Galo]

Posted by A1qwerty55:

I totally disagree. There are very big cultural differences between the USAF, Army and USN. This extends to their medical departments as well. Of the three and having worked with all three personally, the USAF is clearly failing to a greater degree than the other two



At least we are in full agreemend that they are ALL FAILING. I don't care if you think the AF is failing to a greater degree. All the services have many of the same problems. USAF docs post above is a great explanation.

That's what people trying to learn about whether or not they should be going into military medicine need to know. ITS A FAILED SYSTEM.

 

[USAFdoc]

Posted by A1qwerty55:


That's what people trying to learn about whether or not they should be going into military medicine need to know. ITS A FAILED SYSTEM.

another recent newspaper article. Best quote the very last sentence.


http://www.signonsandiego.com/uniontrib/20070328/news_1n28vets.html

Funds aren't there to hire staff, top Army physician says

By Hope Yen
ASSOCIATED PRESS

March 28, 2007

WASHINGTON – The Army's new acting surgeon general said yesterday she is concerned about long-term morale because the military lacks money to hire enough nurses and mental health specialists to treat thousands of troops coming home from Iraq and Afghanistan.


"When the original plans were made, we did not take into consideration we could be in a long war," said Maj. Gen. Gale Pollock. She became surgeon general earlier this month after Kevin Kiley was forced to resign in a scandal over poor treatment of the war-wounded at Walter Reed Army Medical Center.
"We have not been able to do the hiring," Pollock told a House Armed Services subcommittee.

She testified at the first of two congressional hearings yesterday on veterans care during which lawmakers expressed impatience with the Bush administration's efforts. They said years of communication gaps between the Defense and Veterans Affairs departments have yet to be fixed.

Testimony from officials from the two departments highlighted the difficulties that lie ahead for the Bush administration in fixing problems after reports of shoddy outpatient treatment and bureaucratic delays at Walter Reed, one of the Army's premier facilities for treating the injured.

Since the disclosures last month, three high-level Pentagon officials have been forced to step down. Some Democrats also have questioned whether VA Secretary Jim Nicholson, a former Republican National Committee chairman, is up to the job of revitalizing the veterans care system.

Bush has appointed a presidential task force to study the problems and a slew of reviews are under way by the Pentagon, VA and several congressional committees. But troops and veterans say many of the issues are well-known and have long been in need of response.

Among the complaints are the difficulties troops and veterans have in navigating the health care system, including moving from military hospitals to the VA's vast network of 1,400 clinics and treatment facilities, which provide supplementary care and rehabilitation to 5.8 million veterans.

Speaking before a Senate panel, Michael Kussman, executive-in-charge of the Veterans Health Administration, and Ellen Embrey, deputy assistant secretary of defense for health affairs, defended their efforts to improve coordination that would speed health care to injured troops and veterans.

Embrey said the departments had taken steps to strengthen joint committees and place each other's personnel in Pentagon and VA-run facilities.

That drew an angry response from Sen. Richard Burr, R-N.C., who noted that the Government Accountability Office earlier this month reported the two departments still fail to share health records electronically despite years of warnings and recommendations.

"We're now in the fifth year of this armed conflict," said Burr, a member of the Senate Veterans Affairs Committee. "At what point do we actually look at what's going on and implement changes?

How many real-life experiences do we have to listen to?"

 

[fnr]

http://www.dfas.mil/more/legislativeaffairs/fy07legislation/FY07SA617.pdf

They are all hurting because of all stated above.....and now will have doc making different amounts of money working next to each other.....great for morale

FNR

 

[The White Coat Investor]

and now will have doc making different amounts of money working next to each other.....great for morale

FNR

This isn't any different than it is now. My orthopod buddy makes more than me, my IM buddy makes less. The contractors I work with make more than all of us. If you can't handle making less than the guy you work next to, you need to go find a union job.

 

[USAFdoc]

This isn't any different than it is now. My orthopod buddy makes more than me, my IM buddy makes less. The contractors I work with make more than all of us. If you can't handle making less than the guy you work next to, you need to go find a union job.

I have to admit the fact that the civilian docs working our clinic (at more pay, less hours, no "USAF milmed duties" and no call) had NO BEARING on how I felt about working in the USAF clinic. I wouldn't want their job either (and neither did they as 8 of 9 left in 2 years).

 

[bricktamland]

I posted this in another tread, but thought that it was also very appropriate for the theme of this one. Here is another reason to avoid military medicine:

In the military, incompetent leaders aren't fired, they just get reassigned, and then wreak havoc and spread misery elsewhere:

I'd like to share with you a little anecdote. When I was deployed as a Battalion Surgeon with a Marine infantry unit to Iraq, we had this complete psycho of a Regiment Surgeon overseeing us. I've never met anybody like him before. This guy was the most ego-maniacal, power hungry freak of nature I've ever encountered.

We're in the middle of a war zone, and all this guy cares about is bolstering his numbers so he can advance his career. He makes up some arbitrary rule about HIV readiness, making our entire battalion's HIV status out-of-date. Somehow, he convices the Regimental CO that Marines will be dying left and right if we don't get their HIV status current. So my CO gets super pissed, chews me out with all sorts of F-bombs, and orders us to get blood draws on the entire battalion. Remember, we're in the middle of a war zone, with Marines spread out all over the AO. Obviously, the military medical system in Iraq wasn't designed with the intention of doing HIV draws.

The whole thing was a tremendous fiasco. First off, we had to beg for extra medical supplies from other units, pissing them off in the process. Next, we risked many peoples lives--mainly the Corpsmen--sending them over IED-laden roads to remote outposts just so they could draw an HIV sample. Eventually, through unbelievable efforts, we collected the HIV for every single person in the whole battalion. We sent the samples off to the lab. Guess what happened? The transit time from the middle of Iraq all the way to a lab in the US was way too long, and over 90% of the samples had to be destroyed. Lives risked, time wasted, money wasted. All for one person's selfish gain.

Higher ups in the medical system heard about this and got pissed. There was an investigation. But guess what the fallout was? Nothing. This Regimental Surgeon, who actually has a real medical degree (believe it or not), suffered no repercussions. He was merely transferred to another billet.

What pisses me off the most, is that he put people's lives at risk for his own selfish gain. Clearly, he wanted to put on his Fit Rep that all the BAS's under his supervision went from 0-100% medical readiness due to his superior leadership. We were in a combat zone!!! He could have done something useful, like taught airway managment to the Corpsmen. But instead, we spent the entire 7-month deployment dealing with that crap.

Sadly, people like him are all too prevelent in the military. Often, they are the career military folks whose only concern is picking up rank. They could care less who they have to stab in the back to get there, and seem to take a perverse pleasure in wasting resources.

That being said, I have met plenty of kind, selfless career military doctors who are genuine heros. They are truly inspirational. But unfortunately, they seem to be in the minority.

For anybody reading this and considering a career as a military doctor, please realize you will have plenty of colleagues like this guy. And no matter how ruthless and incompetent they are, they just seem to continue climbing the ladder.

 

[Galo]

I posted this in another tread, but thought that it was also very appropriate for the theme of this one. Here is another reason to avoid military medicine:

In the military, incompetent leaders aren't fired, they just get reassigned, and then wreak havoc and spread misery elsewhere:

I'd like to share with you a little anecdote. When I was deployed as a Battalion Surgeon with a Marine infantry unit to Iraq, we had this complete psycho of a Regiment Surgeon overseeing us. I've never met anybody like him before. This guy was the most ego-maniacal, power hungry freak of nature I've ever encountered.

We're in the middle of a war zone, and all this guy cares about is bolstering his numbers so he can advance his career. He makes up some arbitrary rule about HIV readiness, making our entire battalion's HIV status out-of-date. Somehow, he convices the Regimental CO that Marines will be dying left and right if we don't get their HIV status current. So my CO gets super pissed, chews me out with all sorts of F-bombs, and orders us to get blood draws on the entire battalion. Remember, we're in the middle of a war zone, with Marines spread out all over the AO. Obviously, the military medical system in Iraq wasn't designed with the intention of doing HIV draws.

The whole thing was a tremendous fiasco. First off, we had to beg for extra medical supplies from other units, pissing them off in the process. Next, we risked many peoples lives--mainly the Corpsmen--sending them over IED-laden roads to remote outposts just so they could draw an HIV sample. Eventually, through unbelievable efforts, we collected the HIV for every single person in the whole battalion. We sent the samples off to the lab. Guess what happened? The transit time from the middle of Iraq all the way to a lab in the US was way too long, and over 90% of the samples had to be destroyed. Lives risked, time wasted, money wasted. All for one person's selfish gain.

Higher ups in the medical system heard about this and got pissed. There was an investigation. But guess what the fallout was? Nothing. This Regimental Surgeon, who actually has a real medical degree (believe it or not), suffered no repercussions. He was merely transferred to another billet.

What pisses me off the most, is that he put people's lives at risk for his own selfish gain. Clearly, he wanted to put on his Fit Rep that all the BAS's under his supervision went from 0-100% medical readiness due to his superior leadership. We were in a combat zone!!! He could have done something useful, like taught airway managment to the Corpsmen. But instead, we spent the entire 7-month deployment dealing with that crap.

Sadly, people like him are all too prevelent in the military. Often, they are the career military folks whose only concern is picking up rank. They could care less who they have to stab in the back to get there, and seem to take a perverse pleasure in wasting resources.

That being said, I have met plenty of kind, selfless career military doctors who are genuine heros. They are truly inspirational. But unfortunately, they seem to be in the minority.

For anybody reading this and considering a career as a military doctor, please realize you will have plenty of colleagues like this guy. And no matter how ruthless and incompetent they are, they just seem to continue climbing the ladder.

Unfortunately this is all too common a scenario that continues and will continue to happen unabated in a system that rewards mediocrity and punishes speaking out against it.

I have posted before about my experience with a very similar AS&HOLE who was hated throughout the AF, but was totally protected because of his rank. His infamy still known today, but the most poignant example is when he took an 80 year old veteran with a 10 CM abdominal aortic aneurysm, and MURDERED him on the table when he had 7 days of active duty left. Now murder is probably a harsh word, and not accurate, but not far off. Since he began to operate at that base the number of vascular cases dropped significantly because of his poor outcomes. He was investigated twice for poor outcomes at two different bases, but instead of not allowing him continue to operate, they said it was the hospital that could not support the cases. He had ENOURMOUS power, and was literally untouchable. He was not even a board certified vascular surgeon, but one of the guys who did one year at a VA in Missisippi, and was considered by the AF a vascular/thoracic surgeon. My hospital commander actually told me she would allow her father to be operated on by him, and this was after the death of that veteran. It's almost incomprehensible to me how intelligent people in the military can be so easily bamboozled. This lady was even a physician, though one who practiced behind a desk and was primarily an administrator. What is also amazing is how many people realize the idiocy of these Frank Burns types, but do nothing about it. They can truly make your military experience a horrendous one. Although its best to stay away from them, they will pop up in places where you have no say and have to watch conditions deteriorate, and patients suffer.

There are many who will not find these people, but I would venture to say there are more that will. Certainly a great reason to not go into military medicine. Though more important than this, it is highly likely that you will not be able to train in what you want, and that the training you get will not be the best you can get. I'm sure some army docs will argue this and say its specific to the AF, but dont be fooled, this is a Dod wide problem. Stay away from milmed!!

 

[alpha62]

Ditto here and the same thing goes for all the MEDCOM dinguses that went along with this geriatric contractor scam. Getting killed in the process of evacing a 65 y/o greedy civilian bastard for a locked up prostate, CAD, a blue foot, or any other disease of aging in the middle of a war zone is a freakin crime.

Unfortunately this is all too common a scenario that continues and will continue to happen unabated in a system that rewards mediocrity and punishes speaking out against it.

I have posted before about my experience with a very similar AS&HOLE who was hated throughout the AF, but was totally protected because of his rank. His infamy still known today, but the most poignant example is when he took an 80 year old veteran with a 10 CM abdominal aortic aneurysm, and MURDERED him on the table when he had 7 days of active duty left. Now murder is probably a harsh word, and not accurate, but not far off. Since he began to operate at that base the number of vascular cases dropped significantly because of his poor outcomes. He was investigated twice for poor outcomes at two different bases, but instead of not allowing him continue to operate, they said it was the hospital that could not support the cases. He had ENOURMOUS power, and was literally untouchable. He was not even a board certified vascular surgeon, but one of the guys who did one year at a VA in Missisippi, and was considered by the AF a vascular/thoracic surgeon. My hospital commander actually told me she would allow her father to be operated on by him, and this was after the death of that veteran. It's almost incomprehensible to me how intelligent people in the military can be so easily bamboozled. This lady was even a physician, though one who practiced behind a desk and was primarily an administrator. What is also amazing is how many people realize the idiocy of these Frank Burns types, but do nothing about it. They can truly make your military experience a horrendous one. Although its best to stay away from them, they will pop up in places where you have no say and have to watch conditions deteriorate, and patients suffer.

There are many who will not find these people, but I would venture to say there are more that will. Certainly a great reason to not go into military medicine. Though more important than this, it is highly likely that you will not be able to train in what you want, and that the training you get will not be the best you can get. I'm sure some army docs will argue this and say its specific to the AF, but dont be fooled, this is a Dod wide problem. Stay away from milmed!!

 

[USAFdoc]

What pisses me off the most, is that he put people's lives at risk for his own selfish gain. Clearly, he wanted to put on his Fit Rep that all the BAS's under his supervision went from 0-100% medical readiness due to his superior leadership. We were in a combat zone!!! He could have done something useful, like taught airway managment to the Corpsmen. But instead, we spent the entire 7-month deployment dealing with that crap.

Sadly, people like him are all too prevelent in the military. Often, they are the career military folks whose only concern is picking up rank. They could care less who they have to stab in the back to get there, and seem to take a perverse pleasure in wasting resources.

That being said, I have met plenty of kind, selfless career military doctors who are genuine heros. They are truly inspirational. But unfortunately, they seem to be in the minority.

For anybody reading this and considering a career as a military doctor, please realize you will have plenty of colleagues like this guy. And no matter how ruthless and incompetent they are, they just seem to continue climbing the ladder.

the design of the military admin system promoted/enables that type of thing. This is what one would expect to happen with this design, and unfortunately, until the design is changed, the outcomes like this will continue. I hate to think what civilian medicine would be like with milmed "rules".

 

[USAFdoc]

The below article states what I believe to be one of the major hurdles for milmed: if the primary purpose of the military is to defend the country, what happens when medical care in the military begins to cost so much that defending the country becomes compromised?

now this is not to say that the medical care for our military is not one of the functions, but it is not the primary.

and now to the heart of the matter....with medical cost spiralling out of control (civilian and military), what do we all think the military response internally will be?

Does anybody really believe it will be anything other than "DO MORE and MORE with LESS and LESS"?


that is what I witnesses first hand with 20% manned clinics, increasing TRICARE enrollments, restricted CME, restricted leave, PAs replacing doc slots in FP and IM clinics etc.

any thoughts? article below.

Wall Street Journal, January 25, 2005

As Benefits For Veterans Climb, Military Spending Feels Squeeze Congress's Generosity May Hurt Weapons, Other Programs; Lobby Group's Power Grows

By Greg Jaffe, greg.jaffe@... Staff Reporter Of The Wall Street Journal

WASHINGTON -- With the wars in Iraq and Afghanistan badly straining its forces, the Pentagon is facing an awkward problem: Military retirees and their families are absorbing billions of dollars that military leaders would rather use to help troops fighting today.

Congress, pressured by veterans groups, has in recent years boosted military pensions, health insurance and benefits for widows of retirees. Internal Pentagon documents forecast that the lawmakers' generosity since 1999 will force the federal government to find about $100 billion over the next six years to cover the new benefits.

"The amounts have gotten to the point where they are hurtful. They are
taking away from the nation's ability to defend itself," says David Chu, the Pentagon's undersecretary for personnel and readiness.

Rising veterans' benefits are a big factor behind the billions of dollars in weapons cuts to be proposed when President Bush unveils next year's budget blueprint early next month. New retiree entitlements also are crimping the Pentagon's ability to increase incentives for enlistment at a time of dangerous, yearlong Iraq deployments.

The military's budget woes are similar to the broader problem facing the U.S. government, as spending on aging baby boomers -- in the form of Social Security and Medicare -- squeezes out funds for other programs, from health care for the poor to scientific research. The pinch is exacerbated by Mr. Bush's campaign promise not to raise taxes. The private sector, particularly auto makers and the steel industry, is being similarly squeezed. Many companies are holding the line and in some cases cutting spending on pensions and health care for future retirees.

The Pentagon, which faces an increasingly aggressive and effective veterans lobby, doesn't have that luxury. The main force among veterans groups has been the Military Officers Association of America, an Alexandria, Va.-based group boasting about 400,000 dues-paying members and a board packed with retired generals and admirals.

MOAA has an ambitious agenda for 2005, listing on its Web site 16 goals for further expanding retiree and survivor benefits. Earlier this month, its members flooded Capitol Hill with about 16,000 brown bags with hand-written messages urging lawmakers to exempt World War II and Korean War retirees from Medicare premium payments. The message: Veterans were being treated like old paper bags to be discarded after use.

"We in the military have long had pay scales below our civilian counterparts," says retired Vice Adm. Norb Ryan, the MOAA's president. In exchange, the military offered troops a generous retirement and health-care package. "Now some in the Pentagon want to walk away from that. That is a very dangerous thing," Adm. Ryan says.

The politics of veterans benefits, meanwhile, are roiling the Republican Congressional majority. Earlier this month, the House Republican leadership took the unusual step of stripping New Jersey Rep. Christopher Smith of his chairmanship of the Veterans Affairs Committee. Mr. Smith had irked House leaders when he pushed so aggressively for veterans benefits that he at times threatened to oppose their spending plans -- and President Bush's -- unless more retiree benefits were included.

Big Shift

The rise of the veterans lobby marks a dramatic shift in modern military spending. "If you look back to the history of the all-volunteer force going back to 1973, the Congress has in general deferred to the executive branch on major pay and benefit changes," says Dr. Chu.

That began to change in the late 1990s, when veterans groups charged that the federal government was reneging on promises made by recruiters in the 1940s and '50s to provide free cradle-to-grave medical care to military retirees who served a 20-year career. They took out ads on the radio and flooded newspapers with letters to the editor saying the military was letting down the "Greatest Generation."

"There was tremendous emotion. These groups were highly organized," says retired Gen. Jack Keane, who was on active duty at the time. Senior military officers worried the widespread allegations of broken promises from veterans groups were hurting military recruiting, recalls Gen. Keane. Many officers, including Gen. Keane himself, sympathized with the retirees.

Over the objections of the Clinton Pentagon, but with the support of then-Joint Chiefs Chairman Gen. Henry Shelton, Congress in 2000 opened the military's generous health-care program to over-65 retirees who in the past had been forced to rely solely on Medicare. The change will cost the federal government more than $8 billion for this fiscal year ending Sept. 30, the Pentagon says. Lawmakers also changed the military retirement system to allow troops with 20 years of service to collect 50% military pay upon retirement instead of 40%.

Almost every year since then Congress has pushed through billion-dollar increases in personnel benefits. The projected growth in retiree benefits of the next six years dwarfs the $55 billion in cuts to new fighter jet, ship and submarine programs proposed by the Bush administration in December and spread out over the same six-year period.

The largesse has grown with the wars in Iraq and Afghanistan, which mark the first time in the past century that the U.S. has had to wage sustained combat with an all-volunteer force. Members of Congress use any opportunity to see off soldiers or welcome them home. "The first question the lawmakers ask is, 'What can we do for you?' Then they do it," says one senior Army official.

The sharp reductions in the number of World War II, Korea and Vietnam veterans serving in Congress and in the top ranks of government may help explain some of the veterans groups' influence. Lawmakers who didn't serve in the military are more apt to be intimidated by veterans groups, says Tom Philpott, an expert on military benefits who writes a syndicated column on the subject for several military Web sites and newspapers. "I think there is a guilty conscience among those who didn't serve. They say to themselves, 'I didn't serve. But I am sure as heck not going to short-sheet those who have,' " he says.

In each of the 2003, 2004, and 2005 budgets, Congress passed a series of laws allowing severely disabled retirees to collect both their retirement and disability pay. In the past, retirement pay was reduced, dollar for dollar, by disability compensation. The benefit change will cost about $700 million in 2006 and will rise to about $3 billion a year in 2013, the
Pentagon says.

In the 2005 budget passed last fall, lawmakers came to the aid of 250,000 military widows like 70-year-old Betty Wells, at a 10-year cost of about $7.5 billion.

Because Ms. Wells's husband made regular payments into the Pentagon's survivor benefit program, she thought she would receive about 55% of his retirement check after he died. Upon her husband's death in 2002 she was shocked to learn that because she already received Social Security she was entitled to a smaller share. Instead of $2,000 a month, she received about $1,300. "My goodness, all of a sudden I had to get...back to work," says the Ocala, Fla., real-estate agent. Other widows have testified before Congress that they had to turn to local charities to make up the difference when their checks were reduced.

Veterans claimed that participants in the program weren't adequately told about the Social Security offset when they signed up. Congress ordered the Pentagon in the 2005 defense budget to pay widows the full 55% starting in 2008.

Also in the 2005 budget, lawmakers opened up the military health-care system to reservists who recently served on active duty. For every 90 days deployed overseas, reservists can now buy at a steep discount a year's worth of health insurance, provided they remain in the reserves.

New Obligations

Beyond lawmakers' additions, the private sector's push to trim benefits for employees is in some cases forcing the Pentagon to assume new and unexpected costs. As private-sector firms ask employees to pay larger health-care premiums, a growing number of younger veterans are opting for military health insurance.

The military's health-insurance system, Tricare, has charged families the same $38 monthly premium since 1995. Over the same period of time, private-sector premiums for families who buy health insurance through an employer have surged 70% to about $210 a month.

Michael Lynch retired as a Marine Corps lieutenant colonel earlier this month and took a job with a government contractor. He compared the cost of buying health insurance through his employer with the cost of Tricare and chose the government plan. "Tricare's benefits were very similar to my employers. But the cost was much, much less," says Col. Lynch, who is
married with two daughters.

Today retirees account for about 50% of all Tricare beneficiaries, up from 40% in 2000. To cover the cost of these new enrollees, the Pentagon has had to shift about $2 billion a year into its health-care accounts primarily from new weapons-program accounts. "It is quite painful to reallocate that money," says Dr. Chu.

Pentagon officials estimate that by decade's end, new legislation passed by Congress or pending on Capitol Hill will increase the amount of money going to U.S. troops and military retirees by about $28.6 billion a year. By comparison, new legislation added by Congress boosted the Pentagon's $100 billion personnel budget by less than $1 billion in each of the years 2001 and 2002.

Dr. Chu says the military could recruit more troops for less money if it slowed the growth of deferred benefits and paid more cash. About 60% of military pay is tied up in noncash compensation, like pensions, generous health-care benefits, subsidized food and housing.

"I'd like to believe 19-year-olds paid attention to their annuity package," says Dr. Chu. But they don't. "Nineteen-year-olds want cash to buy a pickup truck," he says.

To boost recruiting, the Defense Department recently tripled re-enlistment bonuses for reservists and national guardsmen to $15,000 from $5,000. It also raised the amount of money that deployed troops get for serving away from their family in a war zone to $475 a month from $125 a month.

As personnel benefits continue to grow, former Pentagon budget chief Dov Zakheim, who stepped down last year, says the Pentagon increasingly finds itself "caught in a vise." Congress won't allow the Pentagon to cut benefits to retirees and deficit pressures make it unlikely that the Pentagon will continue to see its overall budget grow.

Pentagon officials say that with the country at war, cutting maintenance and training isn't an option either. "The only place you can cut is acquisition and research and development," Dr. Zakheim says. Amid this standoff, Pentagon officials say that further cuts to big-ticket weapons systems, like ships, fighter jets and the replacement to the current Army battle tank, are inevitable.

Meanwhile, the military is bracing for more fights in the coming Congress over benefits. There's the brown-bag push to exempt retirees from monthly Medicare Part B premium payments. The payments, which amount to about $80 a month, cover the cost primarily of doctor visits and are required even if veterans are covered by the military health-care system. Veterans groups insist these World War II and Korean War vets were promised free health care for their service. "This is a matter of principle for these guys," says Adm. Ryan.

MOAA is also pressing lawmakers to repeal a law that reduces the pensions of widows who receive a $1,000-a-month check because their husbands died of a service-related cause. The cost: about $400 million a year. And it's trying to lower the age at which reservists can begin collecting their military pensions to 55 from 60.

Reservists say that change is needed to compensate them for their time on active duty. Lt. Col. Doug Trogstad, who pilots a cargo plane in the Air Force Reserve and also works for Northwest Airlines, has spent the past two years flying missions into Iraq for the Air Force. "I have been deployed more than most active-duty troops," he says. While on active duty he has
taken a substantial pay cut and has been unable to contribute to his retirement fund. "I never believed the government was fair. But it should at least be equitable," he says.

Pentagon officials say that change comes with a $1 billion-a-year bill and will do little to help with recruiting or retention problems. In fact, Dr. Chu says, the change would lead about 25,000 older reservists to retire early. "We would pay $1 billion a year and get negative retention. It is a caricature of what is going on," he says.

http://online.wsj.com/article_email/0,,SB110661195353434665-IRjgINmlaR4nZ2qaHyIb\
amDm4,00.html






As Thomas D. Segel, a columnist from GOPUSA stated:

Since taking his DoD post, David Chu has served as the designated "attack dog" for the administration. He has testified before Congress, given speeches and written articles for the media on numerous occasions. If the topic relates to veterans' issues, retired military personnel or military dependents benefits his approach has repeatedly been negative. In fact, some of his public comments have actually displayed distain for those who, in the past, served their country with honor. He has been particularly vicious in arguing against expenditures for veteran and retiree health care. At the same time it should be noted he will receive a federal pension and medical benefits when he retires from federal service. Some say these are even more generous benefits than are awarded to military retirees.

Major General Earl G. Peck, USAF (Ret) has some serious observations about Dr. Chu's conduct. He says, "The point Dr. Chu misses is that honoring the solemn obligations of our nation to veterans makes a direct contribution to national security even if he chooses to ignore the moral strictures that bind us to promises. Having served more than 36 years on active duty and with 6 sons who have served or are serving in the armed forces, I can testify that every failure to honor those obligations diminishes the value of a military career to those who are serving and those who might serve in the future. If through misguided parsimony we are no longer able to attract the right people, we can't provide for the security of the nation."


(and doesn't that last paragraph say it right !!!!!!!!!!)

 

[USAFdoc]

Below is the article introducing the NEW US NAVY Surgeon General, Vice Adm, Dr. Robinson. How fitting that a Surgeon General's office now manned with a rectal surgeon. No doubt that much of milmed is in need of a rectal !

September 2007
Robinson Becomes Navy's New Top Doc - Sandra Basu


Dr. Robinson
WASHINGTON-Vice Adm. Adam M. Robinson, Jr., MC, USN, became the Navy's new chief of BUMED (Bureau of Medicine and Surgery) and the Navy Surgeon General last month, replacing outgoing BUMED chief and Navy Surgeon General Vice Adm. Donald Arthur, MC, USN. Dr. Arthur served as surgeon general from 2004 until August of 2007. Dr. Robinson was confirmed by the Senate on Aug. 1, and assumed his new position on Aug. 27.

"I am excited for the challenges that lay ahead," said Dr. Robinson, after he was nominated for the position, according to the National Naval Medical Center (NNMC) in Bethesda. ''Navy Medicine remains committed to not only Force Health Protection, but also excellence in research and development and the establishment of a world class, fully integrated military treatment facility here on the [NNMC] Bethesda campus. We need to ensure that science and technology keep up with the needs of clinical care."

Dr. Robinson most recently was the commander of NNMC in Bethesda, Md., a position that he held from 2004 to 2007. His tenure took place during the early phases of the implementation of the 2005 Base Realignment and Closure (BRAC) plan that entails the integration of NNMC and the Walter Reed Army Medical Center in Washington, D.C., into one medical facility by 2011. That facility will be located on the campus of NNMC and will be called the Walter Reed National Military Medical Center.

Prior to taking his position at NNMC, Dr. Robinson held a variety of leadership positions in the military. Dr. Robinson served as the deputy chief of the Navy Bureau of Medicine and Surgery for Medical Operations Support and the acting chief of the Navy Medical Corps before his appointment as head of NNMC in Bethesda.

In addition, in August 1999, Dr. Robinson became BUMED director of readiness and was selected as the principal director of clinical and program policy in the Office of the Assistant Secretary of Defense for Health Affairs in September 2000, where he also served as the acting deputy assistant secretary of defense for health affairs, clinical and program policy.

Dr. Robinson's first Navy medical assignment was as a general medical officer at the Branch Medical Clinic in Fort Allen, Puerto Rico, before reporting to NNMC in Bethesda, Md., in 1978 to complete a residency in general surgery.

After completing a fellowship in Colon and Rectal Surgery at Carle Foundation Hospital in the University of Illinois School of Medicine in 1985, Dr. Robinson served as the Head of the Colon and Rectal Surgery Division at NNMC in Bethesda. Dr. Robinson went to Naval Medical Center, Portsmouth, Va., in 1990 to serve as the head of the general surgery department and director of the general surgery residency program. He was appointed acting medical director for the facility in 1994. While at Naval Medical Center Portsmouth, Dr. Robinson earned a master's degree in Business Administration from the University of South Florida.

In 1997, Dr. Robinson served as the Executive Officer of the naval hospital in Jacksonville, Fla. In January 1999, as Fleet Hospital Jacksonville Commanding Officer, Dr. Robinson commanded a detachment of the hospital as a medical con-tingent to Joint Task Force Haiti.

Dr. Robinson is a native of Louisville, Ky., and entered the naval service in 1977. He holds a Doctor of Med-icine degree from the Indiana Uni-versity School of Medicine in Indi-anapolis through the Armed Forces Health Professions Scholarship Program.

Dr. Robinson holds fellowships in the American College of Surgeons and the American Society of Colon and Rectal Surgery. He is a member of Le Societe Internationale de Chirurgie, the Society of Black Academic Surgeons, and the National Business School Scholastic Society, Beta Gamma Sigma.

Dr. Robinson's personal decorations include the Legion of Merit (two awards), the Defense Meritorious Service Medal (two awards), the Meritorious Service Medal (three awards), the Navy Commendation Medal, the Joint Service Achievement Medal, the Navy Achievement Medal and various service and campaign awards.

 

[USAFdoc]

Most recent edition of the Uniformed Family Physician hot off the presses. Link below. Some good info on the USN GMO situation. Most of the editor letters are the same ol' "best healthcare system in the world" mixed with the regular "we have big problems but we are supremely confident we will solve them all" verbage.
I have GREAT respect for those still doing thier best to keep milmed afloat working their behinds off down on the "front lines" (stateside clinics) and those deployed.
I have less respect for those in senior leadership positions that have basically lied about the real state of milmed in many areas, and for allowing things to degrade to their current state.

happy reading

http://www.usafp.org/Word_PDF_Files/2007-Fall-Newsletter.pdf

 

[USAFdoc]

Link to the Military Medical Student Association below.

Possibly some good info for those of you already in the HPSP or USUHS pipeline. I believe you need to register to get to any of the "good stuff".


http://www.militarymedicine.org/

bump

 

[USAFdoc]

Link to the Military Medical Student Association below.

Possibly some good info for those of you already in the HPSP or USUHS pipeline. I believe you need to register to get to any of the "good stuff".


http://www.militarymedicine.org/

bump

bump
go Mizou

 

[USAFdoc]

For the second year in a row “transitional year” is the most popular specialty in the Air Force.

I count 284 MS IV’s in the match and 70 of them matched into some type of PGY1-only training (transitional year with no follow-on, Gen Surg PG1, IM PG1, etc.). In the Air Force, this means that they will be doing GMO/flight surgery for at least two years before they can re-apply to residency. So in the Air Force, 25% of the MS IV’s will end up as GMO’s. Do not let anyone tell you that the AF does not force people to do GMO’s. I find it very hard to believe that 70 medical students did not want to do a residency.

I also count 75 MS IV’s who matched into non-primary care specialties. Assuming that most of the transitional-year folks wanted to do something other than primary care (likely true), that means MS IV’s have a roughly 50% chance of matching if they want to do something other than primary care. Not good odds, folks…not good at all.

Frankly, I can’t believe that the AF continues to post the match results for all to see—it’s an embarrassment and could be a serious recruiting problem.

Well, the above is just another reason that people entering the HPSP pipeline should think twice, and "look before they leap". If you want to serve no matter what, just realize what the "current" definition of "NO MATTER WHAT" is according to the USAF nowadays.

For those still willing to leap into the potential cesspool, below is a link and some info.

http://webcampus.drexelmed.edu/osa/careeradvising/AirForceTips.htm


Tips for the Air Force Military Match



This information is provided for students with an HPSP Air Force scholarship who would like information about the military match. It will give basic information, points of contact, web site links and other information invaluable to the Air Force match process.



First of all, the one person who has most AF match answers (or who can direct you to those who have the answers) is Ms. Sharon Restivo at HQ AFPC/DPAME (Physician Education) at Randolph AFB, TX. Her phone number is (800) 531-5800. When all else fails, call her. In fact, I would suggest you call her to introduce yourself so that it will be easier to call her in the future. The web site which has all the information you need is: http://ci.afit.edu/CIM/CIMJ/cimj.asp I will be referring to various links in this website through the rest of this “tip sheet.”



The best way to ensure a successful outcome to the military match is by starting early (Jan-Feb of your 3rd year). At this time, you should start having an idea of what specialty you prefer to enter. Once you’ve decided upon a specialty, click on the “4th year students” button on http://ci.afit.edu/CIM/CIMJ/cimj.asp and go to “Approved Training Starts for AY03.” This will give you a rough idea of where the residency in which you are interested is located in the Air Force and how many spots are available for this training. In May, a board convenes and figures out how many spots will be available for each specialty in the Air Force. At that time, the site should change to “Approved Training Starts for AY04 (and so on…)” to give you the actual number of spots in a specialty for the upcoming year. For the time being, though, you can use the previous approved training slots to get a rough idea of what’s available and where. You can also go to the JSGME page and look under the “Specialties” table to see where clerkships are available. Do not be deterred because a specialty looks like it has too few spots. Remember that the pool of applicants is much smaller than the civilian match so a program with 8 slots in the military is not unattainable.
Once you’ve found a residency in a location that you desire, you will dramatically increase your odds of obtaining a residency spot if you do an “away” rotation at that spot. To do this, you need to contact the coordinator no later than the end of February to get a spot. The list of clerkship coordinators can be found at: http://ci.afit.edu/CIM/CIMJ/Active Duty Tours/Points of Contact (POCs) for ADTs.htm You preferably want to aim for a rotation during blocks 2-4 of your 4th year as these blocks will be completed before all final paperwork for the military match must be in. You can also use this opportunity to get a letter of recommendation from a military doctor. Most military residency directors will tell you that it doesn’t matter if the letters are from military or civilians but I am of the belief that at least one of your two letters should be from a military doctor to maximize your chances of matching favorably. Call the coordinator and set up a date. Remember, this is the “rate limiting step.” If you feel pretty sure about a specialty, set up an “away” month. If anything changes, you can always cancel it later but make sure you aren’t left without an away month. If for some reason, you change your mind, call the clerkship director and cancel your rotation right away to allow other students the opportunity to get a position in the clerkship.
After you have verbally set up the month through the AF clerkship coordinator, go to the Queen Lane campus and fill out a DREXEL MED “away” rotation form. A link to this site is: http://webcampus.med.drexel.edu/clinicaleducation/Awayelectiveform4.htm Information from DREXEL MED about “away” rotations can be found at http://webcampus.med.drexel.edu/clinicaleducation/AwayRotations4.htm As with all paperwork during your 4th year, you must ensure that this paperwork ends up in the right hands (in this case, the clinical education office). The best way to do this is by hand-delivering it to the office. If that is not possible, you should call the office to make sure that they received the paperwork. If they haven’t, this could become a problem because they will think that you took the month off instead of doing an actual rotation. In effect, this could delay your graduation because the office will think that you have not completed the required rotations for 4th year.
As far as scheduling the “away” rotation in your DREXEL MED 4th year schedule– you may want to consider using a “vacation” block to ensure that the desired block is not filled automatically by the DREXEL MED “lottery” computer. Alternatively, you can take your chances and leave the block open. If, by some strange twist of fate, you happen to have your “away” block filled with an unwanted clerkship, do everything in your power to open that block up by trading the clerkship or canceling it and applying for the newly-cancelled clerkship somewhere else. If all else fails, talk to the clinical education office and explain your predicament. They may be able to help you. Note: the only clerkships that are usually scheduled against your wishes are the neurology and medicine sub-I blocks because they are required of all students. It would behoove you to give multiple options on your “lottery” worksheet for these clerkships to avoid the above catastrophe. By doing this, you will not have to waste a coveted block on “vacation.” The clinical education office will give you an evaluation to give to your evaluator at the base to be filled out and returned. If they don’t give you one before you leave, ensure they have the address of your evaluator so that they can send it to him/her. If it does not get filled out and returned, you may be in jeopardy of not having the clerkship count.
After you have completed DREXEL MED’s paperwork requirements, you need to fill out an ADT worksheet. A link to this is: http://ci.afit.edu/CIM/CIMJ/Forms/ADT Request Form.htm The worksheet is self-explanatory. If you have any problems with it, contact the clerkship coordinator to whom you are sending it and he/she will help you. Again, ensure that the paperwork gets in to the hands of the person who needs it to make your clerkship happen. The best way to do this is via fax with a follow-up phone call. If you have not received confirmation within a couple of weeks, call the coordinator and politely ask about your status. If something falls through the cracks, do not freak out. In the military, more than in civilian life, an ounce of sugar will get you much farther than a pound of salt.
Take STEP 2 no later than the end of August so that your results are back in time for the military match. You will have to photocopy your results and send them in your application package as the NMBE will not send them to the AF board directly. The AF board uses a nebulous grading scheme to determine who will match and who won’t match. Among the criteria are: school standing, research, publications, board scores (STEP 1 and 2), letters of recommendation, clerkship grades (including AF clerkships), AOA status (which you will find out right before the board meets and, if granted membership, you will have to send a new copy of the DoD application portion with the updated information right away) and the all-important “fudge factor.” The “fudge factor,” which most directors will not admit exists, is in place to ensure that students that “fit in” and are well-liked but who may not have the strongest other credentials, will get a spot. If you don’t think civilian programs have the same thing, you’re kidding yourself. If you are missing STEP 2 scores or any other portion of your application, it could mean the difference between getting a much-coveted AF spot and not even being deferred in the specialty of your choice. This is why it is important to take STEP 2 and have the results for the board. Furthermore, people usually do better on STEP 2 than on STEP 1 and that will only help you in the process.
If you do not receive your orders a month before you are supposed to show up for your clerkship, call and find out where they are. Once you receive your orders (about a month beforehand), call billeting at the base you are going and ensure you have a room reserved. Many people assume because they have orders, they will have a room. THIS IS NOT THE CASE and you could find yourself staying in a real sorry looking hotel far away from base instead of a cushy VOQ on base with all of the amenities of home.
Of the many items you should bring with you when doing your clerkship, a few are vital. If you have a laptop with internet access or can borrow one, it will definitely help you. HPSP provides $250 per semester for rental fees for a laptop. You will be hard-pressed to find a laptop you can rent for a month for that amount. You will use the laptop to research presentations, e-mail Marie Hartman and the clinical education office and for preparation of your application/personal statement/CV. While preparing your AF application, you must also complete your ERAS application. Your laptop will help you do that as well. Most bases have computer facilities but they are not always easily accessible and you may not have the energy after a long shift to go find a computer. It’s much easier to have one in your VOQ. Also, bring the correct uniform. You should bring not only your blues, but also a couple of sets of BDUs and, above all, your service dress. Make sure all fit you well and are clean and starched. Military bearing and appearance is noted during clerkships and when you interview, you will be expected to be in your service dress. Get your hair cut within regs before you arrive. When you get on base, things will be moving quickly and you don’t want to worry about getting your hair cut when you have to check in to billeting and learn where everything on base is. Also, make sure that you have a copy of your vaccination records, which you can get from employee/student health at MCP or Hahnemann (allow one month) and bring the records with you to in-processing.
Upon signing in to base on the first morning of your rotation, ask to set up a physical examination. It is required for your GME application. If you do not get it done during your clerkship, you will have to make an appointment and drive to Fort Dix/McGuire AFB in NJ to get it done. This is no easy task. Save yourself the hassle and get it done while completing your clerkship.
As far as the application goes, call Sharon Restivo to get the link to the template/instructions. The core application is due to Sharon Restivo’s office in mid-September. It includes the DoD application, CV, Second Choice, PG1 Only, Statement of Understanding, Weight Statement, Race/Ethnic Voluntary Disclosure, Education Summary and Personal Essay. Here is a note about each.
DoD application: pretty self-explanatory. When you come to item #23 (training preferences), make sure you list all places you are willing to go. You can rank Navy and Army programs as well (although you probably won’t get them). If anything, by ranking Navy and Army programs, you show your sincere desire to do a military residency. If you do not want to do a military residency, you should choose “deferred” and nothing else.

CV: The format for the CV is in the GME application. You must follow the format as it is written, meaning each category must be on your CV and in the same order as the format specifies. What you put in each category is up to you. Give as much information about yourself in the CV as possible without changing the format.

Second Choice: self explanatory. Do not put down a second choice unless you are sure you would be willing to do a residency in that specialty because you just may get it.

PG1 Only: until a couple of years ago, it was encouraged to do a PGY1 year if you were interested in a difficult specialty. This would give you some exposure to the program directors and help you “beef” up your application before applying the next year for the specialty. Many programs are now viewing a PG1 year as a bad thing. Before you sign up for a PGY1 year, talk to the program director in the specialty of your choice to see what his/her views are.

Statement of Understanding: self-explanatory

Weight Statement: on day 1 during in-processing, bring the form with you and have the person who weighs you fill out the sheet. It will save you a hassle down the road.

Race/Ethnic Voluntary Disclosure: self-explanatory

Education Summary: self-explanatory

Personal Essay: very different from your personal statement for ERAS. It should be in 4-paragraph military style, double-spaced and no more or less than 10 point font. First paragraph should say why you want to go into military medicine. Second paragraph should explain why you are choosing your specialty. Third paragraph should explain why you are choosing the location to do your specialty. Fourth paragraph should be a summary. There are, of course, variations on this. I urge you to have a military doctor review your personal statement and give you feedback before you submit it.

By mid-October, all other documents should be sent to Sharon Restivo, except your official transcript and the Dean’s Letter. In effect, this means copies of your board scores (STEP 1 and 2) should be sent by you to her. Again, NBME will not send the results directly to her (this may change in the near future so check with NBME to see if they are able to send the results directly to Sharon). Also, letters of recommendations should be sent to her. The first two letters she gets are the two that will go in your file. You must send the originals. Unlike ERAS, you are not penalized for seeing the letter before you send it. Ask your letter writers to send you the original which you will forward to Sharon Restivo. Make copies for your records before you send the letters. As always, call Sharon to make sure she received everything and ask her if your file is complete. She will send you a letter at some point telling you what you have in your file and what is missing. After mid-October, the only thing missing should be your official transcript and the Dean’s letter.
Have a copy of all of your information to give to your interviewers when you go for your interview. This includes a copy of your unofficial transcript (which you can get from the registrars office before you leave – give them at least 2 weeks notice), your complete application, your personal letter, your CV and your clerkship evaluations from DREXEL MED and any military evaluations (this may be the only time they get to see those evaluations). An in-person interview is much stronger than a telephone interview. Even if you don’t succeed in lining up an “away” rotation in the clerkship of your choice, you may want to consider paying out-of-pocket to fly to the base to do an in-person interview. Call the program and ask when they have an opening for you to interview. You are guaranteed an interview. Most programs also have days for phone interviews. Again, these are not as strong as in-person interviews but you may want to consider them for programs that are not your top choice.
It is your responsibility to make sure that the official transcript gets sent to the correct military people by Nov 1. You should wait until mid-October to have your transcript sent to ensure it is as up-to-date as possible. Go to the Registrar’s office and fill out the necessary forms to have it sent where it needs to go. There are two places. Both, with addresses, can be found at: http://ci.afit.edu/CIM/CIMJ/Forms/transcriptltr.htm
As final advice, I will go back to the beginning. If you run into any problems or have any questions, call Sharon Restivo. Do not hesitate. Continually call to ensure that the right people have the information they need. Try not to stress. 97% of all Air Force applicants traditionally get one of their top two choices in specialty so the odds are in your favor. Having noted that, the difference between getting the specialty in the place you want versus the place you don’t want is attention to detail. Stay on top of things!!!

 

[USAFdoc]

December 27th article on the INCREASED milmed budget for 2008

while this does not provide a "fix" to the broken system, at least it may enable a chance for improvment.


http://www.usmedicine.com/dailyNews.cfm?dailyID=354




Congress Passes Bill To Increase Defense Health Program Budget
By Sandra Basu
Posted: 27-December-2007

WASHINGTON—With an eye on military health care, Congress passed the 2008 National Defense Authorization Act last month, adopting provisions designed to rectify the bureaucratic tangles that wounded servicemembers were encountering in navigating the health care process. The $696.4 billion bill was awaiting the President’s signature as of mid-December.

The bill would authorize $23.08 billion in appropriations for the Defense Health Program, an increase over the $21.2 Defense Health Program budget for FY 2007. The bill adopts provisions from the Senate and House passed versions of the Wounded Warrior Act that would help injured servicemembers navigate the health care system. In addition, the bill barred the Department of Defense (DoD) from raising TRICARE fees and pharmacy copays for FY 2008, flying in the face of efforts that the Administration has been pushing Congress to support. The bill authorized a 3.5 per cent across-the-board pay increase for all servicemembers.

"This bill provides a 3.5 per cent military pay raise, prevents fee increases for health care, and includes the Wounded Warrior Act to ensure that our injured forces receive the best care we can provide," Rep. Ike Skelton (D., Missouri) said last month in a statement after the House had adopted the conference report for the bill.


Recovery Of The Wounded
The Department of Defense and the Veterans Administration (VA) had been scrambling last year to improve the processes that wounded soldiers undergo as they transition from DoD care to the VA, even before the passage of the bill.

Among the provisions of the bill is a directive for DoD to establish a Wounded Warrior Resource Center to serve as a single point of contact for service-members, their families and primary caregivers to report issues with facilities, obtain health care and receive benefits information.

In response to substandard living conditions that outpatients were living in at Walter Reed Army Medical Center (WRAMC) in Washington, D.C., that were revealed by the press earlier this year, the bill would require semi-annual inspections of housing facilities at MTFs for recovering service members.

Traumatic Brain Injury (TBI) and Post- Traumatic Stress Disorder (PTSD) have been growing concerns as servicemembers return from Iraq and Afghanistan with these injuries. The bill would require that a comprehensive policy be formulated to address TBI and PTSD and other mental health conditions, as well as military eye injuries. In addition, the bill would require that centers of excellence be established to focus on these conditions.

The bill would also require that a comprehensive policy for care, management and transition of wounded servicemembers be developed by July 1, 2008. This bill directs DoD and VA to jointly formulate a plan for the medical evaluation and disability evaluation of recovering servicemembers. DoD is directed in the bill to use the VA schedule for rating disabilities, rather than using its own as it has been. In addition, DoD and VA must submit a report to Congress on the feasibility of consolidating the disability evaluation systems of the military and VA.

National Association for Uniformed Services (NAUS) Legislative Director Rick Jones said that his organization was pleased that the NDAA is addressing the disability rating issues.

"In so many instances, those folks [servicemembers] who have received a certain benefit rating from the military receive a higher rating from VA. We know there is a difference," Jones told U.S. MEDICINE last month.

The bill would require the development of uniform standards and procedures for formulating a comprehensive recovery plan for each recovering service member, as well as policy that will establish a uniform program for recovery care coordinators at the military treatment facilities that will oversee and assist the wounded servicemembers throughout their recovery.

In addition, the bill would increase, from two to five years, the period during which recently separated combat veterans may seek care from the VA.

The bill would also prohibit military to civilian conversions of military physicians and dentists, an initiative that associations said would be beneficial to beneficiaries.

"We like the provision that bars them from civilianizing any more military physicians," Military Officers Association of America Director of Government Relations Steve Stobridge told U.S. MEDICINE last month. "We think that is really important. We are having trouble finding doctors in the civilian community in some places who will take care of TRICARE beneficiaries and that only gets worse if some of the military providers go away."

Association of Military Osteopathic Physicians and Surgeons Executive Director Jim Yonts said that his organization, which represents osteopathic physicians in the uniformed services, also supports such an initiative to bolster military physicians.

"It isn’t that a physician in an emergency room can’t do [the job] if they are not in uniform, but that if you wear the uniform of the population you are serving you have a feel for all of the other things that go on that impact health care beyond that," Yonts told U.S. MEDICINE last month.

Associations representing beneficiaries were particularly pleased that Congress barred TRICARE fees and pharmacy copays from being increased, an initiative that they had been working to prevent.

"We had been working for the last two years to quiet the aggressive steep increases that the Pentagon was planning for those who had earned a TRICARE benefit…this year the NDAA extended the moratorium on the Pentagon’s ability under law to increase those fees. We are pleased by that," said NAUS Legislative Director Rick Jones.

 

[deuist]

I'm all for more pay raises. However, this article mentioned co-pays for pharmaceuticals. I didn't think military members paid anything for drugs. Do the soldiers have a co-pay with TRICARE?