I am a former USAF PA x 4 years and now a GMO Flight doc. I was prior enlisted x 10 years in the medical field, so, I have seen both worlds. There is no easy solution. In 1995, the USAF had 470 or so PA's and thru "right sizing" there are now approximately 300.
Problem was: manning looks at a FTE slot as the workhorse for RVU's/access
and 10 years ago some doctor/nurse O-6 or above came up with the "bright idea" that all slots would be "better served to have docs if a doc = PA in terms of FTE provider terms". In fact, I was told personally by several O-6 nurses who were "helping" solve this manning problem--- "if 1 slot is equal, i'm sure all patients would rather see a physician so we are going to convert these slots and it is a win/win situation".
Hello---- try and find/recruit/retain that many FP docs with the current status of the USAF primary care situation + deployments (frankly, it's not going to happen).
So what happened? Well, many medical groups took this "advice" and changed PA slots to Doc slots. Sounds logical, but understand this... a PA isn't usually on any medical group committees/additional duty and PA's/NP's are nothing but massive number crunchers for the clinic's patient count. Example, my load was 28-35 + per day and I had clinic 4.5 days every week, and did 1 shift on weekend in ER for fast track type patients. I typically saw 400-500 patients a month and the closest physician # were in the 250-300 range.
So our problem today is, there are not many PA's, we can't get enough docs = stressed USAF primary care (can't comment on USA/USN). Those in the trenches get whipped, thus, worse FP retention! (see USAFdoc (ex's) experiences). Morale suffers, retention worsens and the vicious circle keeps swirling. Same thing occurs with surgeons/specialists in the USAF--- no cases = disgrunteled docs = poor morale = NO retention.
Nothing against docs, but a seasoned doc, especially one who is a Major or above is usually tasked to do something else besides being a "FTE" and they typically have 3 days or less at times of clinic due to TDY's/training/CME/committee's and such. Also, there is no way the military is going to ever recruit enough docs to fill these converted billets. The USAF now is 100+ slots open for FP's that will essentially never fill due to attrition and such. The fix now is to "convert" these slots to Civilian FP's. Problem is--- pay is not super attractive and most I have seen can't stand the BS/extra paperwork and the added admininstrative crap that they rarely stay longer than their 1 year (if that).
Our current med group has 8 slots for FP civilians now, only 2 are filled and the other two docs they had stayed 2 months and quit. They haven't even interviewed any prospective docs for these slots in the last 2 months. Pay is certainly an issue, but alot of it is word of mouth.
There is not a "magical mix" of either. But 1/3 docs and 2/3 PA's/NP's actually would make more sense in most primary care clinics from an RVU/meeting daily needs standpoint.
Recruiting PA's is also difficult. One reason is, pay is NO longer attractive. In 1995 a PA graduate started at 38-42 K, now they come out in the 55-65 K range. With a few years experience, it isn't uncommon for a PA to make 80-100 K, especially if they are a specialty PA (ENT, ortho, Cardio, Derm). A military PA's salary is less, they get only 166 dollars monthly for board certification pay and there are NO other bonuses to make it attractive for them to stay or come in, also, they have terrible promotion rates (BSC corps) b/c they compete with Pharmacists/P.T./optometry and others and the promotion to Major is long and about 75% if you have everything including PME and such. They don't have "stellar OPR's" due to their use-- as a number machine and not as clinic chief/additional duty person.
I am going to echo USAFdoc's concerns about primary care, because I saw them on a daily basis as well. It still is ongoing and I don't know if there is an easy solution. But, since the decision makers never seem to "ask" the people who are in dealing with this problem (the FP docs, PA's, NP's) and NOT the nurses or some administrative MSC or out of touch O-6.
In my military medical experience, I have had only 1 physician (just 1 year ago) come by and do an anonymous survey about this-- he asked my concerns and I had him for 1.5 hours and he looked "stunned" to hear this from a lowly Captain. He was from HQ AFMSA position doing some site surveys, but was "concerned" about the retention problem and he was investigating for an upcoming committee meeting on this problem. Oddly enough, I never heard back from him and the other docs/PA's in the medical group were either too scared or too busy to take the time to give him feedback. Likely, I was written off as a "crazy disgruntled dude" but , I ended my talk with him letting him know that I love the USAF, was a career man, and was planning on another 10 years of service.
I think this was a great topic for this forum, but again, unlikely any of us here can "fix" this. But, one thing we can do is-- speak up professionally at meetings / committee's/ with peer's and such to state our cases and get our point of view heard... This must be done tactfully and takes some guts to do-- but it is the right thing to do!
One caveat though, do it professionally. I haven't sufferred any adverse actions-- but I have seen some others get beat down for this, especially if they aren't professional, don't have a "fix/alternative" solution or are disrespectful. I don't consider myself a rebel, but if I don't agree with something, I always let it be known and offer an alternative solution. At the end of the day, I salute and follow what my commander or clinic chief directs me to. I guess that's why I am still active duty and trying my best to keep my standards high and provide the best patient care I can (despite the obstacles).
I understand some can't play that game, but if you plan on a long military career, it is unfortunately an unwritten requirement to have!
Thanks for listening and hope I did impart some insight for some on this forum. I don't claim to be an expert, but again, I do have some experience with this particular topic.
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