All Branch Topic (ABT) USUHS in the cross hairs....again

[militaryPHYS]

If you are a USUHS grad you likely got an e-mail today from the current president, Dr. Thomas. He included documents outlining the defense of the University during another round of budget cuts with USUHS on the chopping block again.

One of the documents was the Institute for Defense Analyses "Analysis of DoD Accession Alternatives for Military Physicians: Readiness Value and Cost".

Long story short: USUHS has higher accession cost ($1 million USUHS vs. $400k HPSP). But it also has higher retention (USUHS avg years served 15.2 vs. HPSP 9.21). Therefore they conclude USUHS is the overall better value to the government. USUHS students also deploy more (700 days vs. 250 days).

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[Detective SnowBucket]

I have a friend at USUHS right now, does this mean anything for current students?

 

[militaryPHYS]

It shouldn't. It would likely be a grandfathered in situation (i.e. phase it out).

This comes up every year just about. The new 126 page IDA report is new though.

 

[Matthew9Thirtyfive]

I’m a current USUHS student and got the email too. A bit disconcerting to say the least. Apparently in 1997 they got pretty close to closing it down with something even passing the house. It had a provision that current students would be grandfathered in.

Honestly as a first year student I don’t really know anything, but I have been in the military long enough to have witnessed it go for the short term gain at the cost of a more significant long term loss, so I would not be surprised if this goes through. I’m praying it doesn’t obviously and that worst case scenario they grandfather us in if it does.

 

[Gastrapathy]

wheres Al Gore nowadays?

Doesn’t sound FOUO. Post it please

This feels like a Q1R

 

[pgg]

If you are a USUHS grad you likely got an e-mail today from the current president, Dr. Thomas. He included documents outlining the defense of the University during another round of budget cuts with USUHS on the chopping block again.

One of the documents was the Institute for Defense Analyses "Analysis of DoD Accession Alternatives for Military Physicians: Readiness Value and Cost".

Long story short: USUHS has higher accession cost ($1 million USUHS vs. $400k HPSP). But it also has higher retention (USUHS avg years served 15.2 vs. HPSP 9.21). Therefore they conclude USUHS is the overall better value to the government. USUHS students also deploy more (700 days vs. 250 days).

Do they discuss retirement costs? USUHS grads are far, far more likely to stay for 20 and retire. Pension costs are extremely expensive.

An honest analysis of accession costs has got to at least acknowledge the tail. If that $1M figure doesn't account for lifetime costs including pension, it seems to me that the cost difference is likely a LOT more.

 

[Barrel Proof]

I caught a pessimistic tone in reading that email. I know there has been chatter behind the closing of USUHS several times in the past. Hopefully this ends up being more of the same. At the end of the day USUHS is a great school and has a proven, valuable role in military medicine.

 

[Matthew9Thirtyfive]

I caught a pessimistic tone in reading that email. I know there has been chatter behind the closing of USUHS several times in the past. Hopefully this ends up being more of the same. At the end of the day USUHS is a great school and has a proven, valuable role in military medicine.

Obviously this isn’t super objective but the tone on campus seems to be not to worry about it because A, the threat of closing the school happens almost yearly, and B, it is very unlikely anyone currently enrolled would be affected (ie, all current students would get to finish). Nothing official of course, but they are going to be answering questions about it at an optional meeting tomorrow.

 

[militaryPHYS]

Do they discuss retirement costs? USUHS grads are far, far more likely to stay for 20 and retire. Pension costs are extremely expensive.

An honest analysis of accession costs has got to at least acknowledge the tail. If that $1M figure doesn't account for lifetime costs including pension, it seems to me that the cost difference is likely a LOT more.

My knuckle dragging brain is trying to dig through the numbers and interpret their calculations. They quote a "life-cycle" cost which incorporates entire DoD career and say that USU is more expensive but only between 8 and 25% more than HPSP (compared to 250% more if looking at just accession cost). But again, I'm not exactly sure what numbers they assume for retirement/benefits/etc.

I'm not in the business of posting documents as even those NOT marked with FOUO can be considered OPSEC or some other social media violation. Review with a USUHS colleague for time being until public release document is out.

 

[militaryPHYS]

I caught a pessimistic tone in reading that email. I know there has been chatter behind the closing of USUHS several times in the past. Hopefully this ends up being more of the same. At the end of the day USUHS is a great school and has a proven, valuable role in military medicine.

I think if there was a time we should be most concerned it would be now. But I agree that the overall value to MilMed is easily justifiable so long as the lawmakers are receiving the correct information and not just looking at BLUF cost metrics during a 2 minute brief.

 

[Cooperd0g]

This comes up with the service academies as well on a regular basis. The problem is that the military is not designed to be something that is cost effective. It is the world’s most expensive insurance policy. Service academy grads cost more to make than ROTC and more stay in until retirement. Same as USUHS. But you know what? We need people to stay in long enough to retire. We need them at the higher levels running things. I do think there is value in the extra military exposure and training you get at those schools. Whether the people who go to the service academies or USUHS are more likely to stay in regardless if they went to those schools or not is impossible to tell.

Will the military collapse and fade away if the service academies and USUHS go away? No. But I think it will be less well off.

 

[orbitsurgMD]

One problem with these comparisons is that they don't make adequate calculations of the alternative personnel acquisition costs that would be required to produce the number of professional man/woman years at the level of expertise needed to replace the USUHS-educated officer contingent. Comparing cost of acquisition through USUHS to HPSP presumes the ability to replace the USUHS cohort with similarly-qualified HPSP-obligated accessions and the employment climate making those accessions want to stay for a longer service term. The services are undermining the attractiveness of their hospitals by reducing the breadth of residency offerings (courtesy of the DHA and its ridiculous "buckets" shenanigans). When an HPSP accession can punch out after their ADSO and have the whole civilian residency marketplace to consider without incurring additional service obligation as with a military residency, what is to make them want to stay? The money differences are not enough. The services have nibbled away at the retirement benefits (like rats!) such that a longer term of service is needed to draw a benefit, and then there is the cost of said retirement, which as other have said, is not small. Of course, the services would want to have top level candidates from the best medical schools who all want to preferentially fill exactly the buckets that the bucket-dreamers dream of and then resign with a smile and a wave after 18 years of active duty service. Since that won't ever happen in this universe, how exactly do they plan to get from their A to B without USUHS, and on the cheap, since this entire proposal is all about the cheapliness?

 

[pgg]

Another thing to consider about USUHS is that the medical school is only one piece of it. They also train nurses and other health professionals there, have graduate programs, do research, and support the GME programs at Bethesda. I don't know how the cost effectiveness and force effectiveness of all that stacks up, but USUHS has some fixed overhead costs that wouldn't go away if the F E Hebert School Of Medicine closed.

 

[Gastrapathy]

If anything, that other stuff should close. The have all these labs and PhD programs but don’t produce anything important. Show me basic science papers in top tier journals from USUHS. They just don’t have the quality there. CRNA and nursing programs are everywhere and easily replaced. If I was in charge of the .mil and trying to cut costs at USUHS, the med school would be the last thing I left standing.

They are totally missing the mark with the cost argument. The reason for the med school is that it attaches a service obligation to allopathic med school acceptance. That will attract quality applicants even when HPSP won’t. Most medical students have a single acceptance and the applicant pool is deep enough that they will always fill with students that are good enough. The same cannot be said for HPSP. The ceiling on HPSP quality might be higher but as the system fails around them, we’re going to see the drop in quality we saw in 2008 again (average HPSP MCAT < 27, etc).

If their entire argument is that USU accessions stay longer and thus deploy more, end up in leadership, etc, they will fail. They can’t prove that those same people wouldn’t behave the same if they took HPSP.

 

[armytrainingsir]

At the end of the day USUHS ..........has a proven, valuable role in military medicine.

Not trolling, but what exactly does USUHS offer vs physicians via other sources?

I always viewed it much like the argument for West Point vs ROTC. No real difference in the quality of officer until you get to 07 and that is where the WP grad starts to pull ahead of his peers. And that may be due to good ol boy WP network.

My AD experience, admittedly dated, was that USUHS grads were much more resigned to their fate as a career .gov worker and adopted a stereotypical VA work ethic right out of residency.

 

[militaryPHYS]

If anything, that other stuff should close. The have all these labs and PhD programs but don’t produce anything important. Show me basic science papers in top tier journals from USUHS. They just don’t have the quality there. CRNA and nursing programs are everywhere and easily replaced. If I was in charge of the .mil and trying to cut costs at USUHS, the med school would be the last thing I left standing.

They are totally missing the mark with the cost argument. The reason for the med school is that it attaches a service obligation to allopathic med school acceptance. That will attract quality applicants even when HPSP won’t. Most medical students have a single acceptance and the applicant pool is deep enough that they will always fill with students that are good enough. The same cannot be said for HPSP. The ceiling on HPSP quality might be higher but as the system fails around them, we’re going to see the drop in quality we saw in 2008 again (average HPSP MCAT < 27, etc).

If their entire argument is that USU accessions stay longer and thus deploy more, end up in leadership, etc, they will fail. They can’t prove that those same people wouldn’t behave the same if they took HPSP.

Solid points. Although I would argue that there are plenty of decent allopathic schools with an OK research department, mid-level training association, etc. I agree that if it is all about money crunching then shift towards the M.D. program, but if USUHS proves its worth to the longer term goal of DHA implementation then the research and other programs will be along for the ride.

USUHS is already an active duty, quad-service allopathic school that produces a quality product. It's already connected with every other MilMed institution somehow and can adjust to fit the need of whatever force adjustment the higher-ups are looking for right now.

Consolidate/cut/downsize while also removing the one solid thing MilMed has going for it is a bad idea. Then you are left filling what is left of MilMed with people who are only 50% on board with MilMed anyway and who may not be quality candidates as you discussed.

 

[militaryPHYS]

Not trolling, but what exactly does USUHS offer vs physicians via other sources?

I always viewed it much like the argument for West Point vs ROTC. No real difference in the quality of officer until you get to 07 and that is where the WP grad starts to pull ahead of his peers. And that may be due to good ol boy WP network.

My AD experience, admittedly dated, was that USUHS grads were much more resigned to their fate as a career .gov worker and adopted a stereotypical VA work ethic right out of residency.

USUHS gives MilMed physicians 4 years of being engrained in the system so they (1) know the pitfalls, experienced the pitfalls and have knowledge on how to work around them (2) start day #1 used to practicing within the system (EMR, socialized medicine, access to care, etc) (3) understand the non-clinical operational training requirements (Fitreps/evals, Online training, etc.)

If they choose to then take that time and apply it to a "stereotypical VA work ethic" that is up them just as it is an HPSP, HSCP, FAP or anyone else who comes in. The military doesn't create complacency. Underlying complacency might be exposed through ANY salary (non-productivity based) position, but the ownership of complacency and self-motivation lies within each of us as individuals.

 

[Cooperd0g]

The documents being sent out by the president specifically talk about how if the Med school closes, pretty much all of USUHS will be done. Meanwhile, with the other programs they do have, I can’t for the life of me understand why the PA program hasn’t been moved to USUHS.

 

[Gastrapathy]

Every govt agency under attack makes those arguments. They always argue that everything is special and pulling one brick would make the entire thing collapse. USUHS shouldn’t exist without the med school but it certainly could.