In the now mature combat theater of Iraq, Navy medical assets continue to be poorly staffed and used. Despite advanced levels of care rapidly available from Air Force and Army facilities, top Marine Corps line officers are unwilling to divest themselves of the rapidly mobile but less capable Navy units used during the attack phase. These units, which have no data to support their effectiveness during the maneuver phases of combat, are now clearly inferior to the higher echelons of care currently available in theater.
Unfortunately, the cost of manning these surgical units has come in the form of poor retention and recruitment of critical wartime medical specialties. Navy physicians, dentists, nurses, and corpsmen are voting with their feet, and no amount of bonus money will correct the true underlying probleman absolute lack of leadership and planning on the part of Navy Medicine. Combine this with the inability of the recruiting command to attract and award the Health Professions Scholarships to incoming medical students, and the Navys ability to support combat medical operations in the future is clearly in question. (Quote from USNI Proceedings Dec. 2005)
This is not just a problem in the Navythe issues are identical in the Army and Air Force. The problem is that the line officers, who know nothing about medical capabilities, control the medical assets. In the case of surgical services, this disconnect results in a gross waste of surgical talent. In the Air Force, for instance, the base commanders demand surgical capability at every single small base in the Middle East, regardless if it is needed, or how close the nearest Army Combat Support Hospital is. Commanders like to have surgeons around Just in case something happens.
So in my case, during my civilian general surgery residency I took care of critically ill and severely injured trauma patients every day. But when I finished residency, and deployed to the war zone, I sat around and did NOTHINGzero surgical cases in four months. Once my commander noticed that I had no surgical cases, I was assigned other duties: working as a GMO, passing out Motrin, inventorying supplies, etc. I was even assigned (I swear I am not making this up) to police the compound and pick up the cigarette butts. Only the Military would assign a board-certified General Surgeon to pick up trash.
I think some students who are interested in surgery join the military with romantic notions of taking care of hundreds of shot-up soldiers during a deploymentlike in an episode of M*A*S*H. The reality is that a surgeon in the Air Force (and maybe the Army and Navy too based on the article) is far more likely to be sitting around doing nothing, or doing PA-level work, or picking up trash than doing surgery (the busy AF hospital at Balad, Iraq is the exception not the rule). Surgeons should not join the military with the expectation that they will take care of lots of wartime penetrating traumathey will very likely be disappointed.
