Cutting out GME would probably be a huge mistake for mil med. The Air Force has cut out GME much more than the army and navy, and what has that yielded them? It's lead to their hospitals being changed to super clinics, their surgeons being wasted, and a crisis in retention.
How many of the top civilian academic hospitals don't have residents?
I would suggest that WRAMC, NNMC, WHMC et al. are no longer "top academic hospitals": certainly not in my department or any that I know of. The glory days are long past, even if the name recognition continues.
But in any case it really doesn't matter what you or I think about maintaining military GME, because it really isnt up to the doctors. Take a look at AF surgical GME as a nice case study of how residency programs die. Air Force GME didn't collapse because of a conscious decision on the part of physicians to terminate residency programs. It fell apart because of command decisions made at a national level by people who have nothing whatsoever to do with GME. The programs weren't executed; they were starved to death by lack of resources.
For the most part, our accountants have decided that it is cheaper to outsource complex cases, dependents, and retirees to the civilian sector rather than maintain truly full-service medical centers. Hence, starting in the late 90's, Tricare largely eliminated our nationwide referral system and outsourced complex care to local civilian hospitals rather than transferring to big military medical centers. AF med. centers really lost their reason for existence and have gradually downsized to "superclinics." Then the over-65 crowd was gradually squeezed out of the system over the last 5-10 years, and those referrals dried up, leaving serious gaps in the resident experience.
Residency programs increasingly outsourced their trainees to get the needed case numbers or simply folded up and combined with local university programs. Formerly great programs were now less attractive to residents and faculty alike and the "best and brightest" are often not interested in working within the military GME system. Now no one is too enthusiastic about weak AF GME programs which are cobbled together with away rotations and the aforementioned "smoke and mirrors." It's great to see that Tired and Mirrorform are so wildly enthusiastic about their programs, but I don't hear similar enthusiasm from AF residents at any level in any surgical program.
The Army and Navy are headed down the same road whether you like it or not, although they seem to be moving more slowly and have larger systems to start with so they can hold out longer. Take a look at the CT program at Walter Reed, a once robust training program that was killed by outsourcing of the patient base. Vascular Surgery is rapidly headed down the same road and the General Surgery programs are not far behind. Talk to your General Surgery residents at NNMC about where they get most of their operative cases. I certainly have (since I work with them at my moonlighting job), and they tell me that the majority come from offsite rotations. It's hard to be loyal to an institution where you spend four years doing nothing but floor scut.
Ill concede that some of the NCA programs can continue to be robust based on sheer size of the existing local patient base and favorable politics, but for other GME locales, I don't see how you can be optimistic.
Sorry for the length of the post, but since we're apparently winning the war, there just isn't a whole lot else to do here in the middle of the Iraqi desert.
