Does the military save any money with their "sign your life away" scholarships?

[PostLessOne]

So, the military offers various scholarships and incentives where they pay for the costs of medical training in return for a certain number of years of service. In return for paying money up front to train a doctor, basically they get that person to work for them at a pay rate significantly less than a civilian attending would typically earn.

The problem is, does this policy even accomplishes what the government intends? A lot of the posters here complain that military hospitals are badly mismanaged because the hospital has plenty of doctors but not enough assistants or good computers or equipment. And so the government blows tons of money on getting those doctors in uniform on the one hand, and yet scrimps on the support needed to help them work efficiently on the other.

I'm not saying that this is the case at every military medical facility, just observing that this seems to be the general trend.

Civilian hospitals generally do this a lot better because the free market price for a physician's time is high enough that they have every incentive not to waste it. The military sees no problem in making it's expensive assets go to PT and sexual harassment and EPW training every year instead.

Also, this indentured servitude program creates lots of disgruntled employees who tend to act out in various ways, generally by complaining. It also means the military can't get rid of employees who would not be able to retain a job in many civilian institutions.

There does seem to be one key reason to have doctors in uniform : in an actual war zone, you have to pay civilian contractors a ridiculous premium to get them to show up. In a real shooting war, many civilian physicians would refuse to go unless drafted.

The solution seems self evident : stop running these wasteful indentured servitude/scholarship programs. Run military hospitals more like civilian institutions, mostly staffed by contractors. Offer lesser incentives to get doctors to sign up for reserve military spots, so that you have people that can be sent to a war zone.

Do have a limited number of physician/officers who entered the military after residency. These individuals would be groomed for leadership roles and would be paid appropriately. (since you do need a few physicians as leaders to organize big military medical efforts and to set policy)

Thoughts?

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[Gastrapathy]

The solution seems self evident : stop running these wasteful indentured servitude/scholarship programs. Run military hospitals more like civilian institutions, mostly staffed by contractors. Offer lesser incentives to get doctors to sign up for reserve military spots, so that you have people that can be sent to a war zone.

Thoughts?

Everything you say boils down to the assumption that reservists would sign up in this scenario. Why would they? The reserves are more disruptive to life than AD service. Set up a practice, hire folks who depend on you and then disappear for 6-15 months. The "lesser" incentives would have to be huge.

 

[IgD]

I think the DoD analysts would love your post. They see military health care professionals as a resource drain that takes away from bombs and guns. They would much rather have contractors then have to pay retirement pensions of officers.

I think the problem is that medical officers really are needed and that requires a robust graduate medical education pipeline. I think if you want to quit you should be able to at any point but have to pay a steep penalty on your loans.

 

[pgg]

Civilian hospitals generally do this a lot better because the free market price for a physician's time is high enough that they have every incentive not to waste it.

I think any discussion of military vs civilian health economics really needs to keep one fundamental difference firmly in mind:

Civilian physicians create income and wealth for themselves and their hospitals with every patient they see and every procedure they do. They are the life blood of their organizations and are valued accordingly.

Military physicians cost their hospitals money with every patient they see and every procedure they do. We're necessary evils. Half of the line wants us gone completely, and there are more than a few admin weenies within our own ranks who favor outsourcing, downsizing, and creative accounting to save money.

We may have the same job, but we're working on different planets.