After treating wounded warriors from America’s conflicts for more than a century, Walter Reed Army Medical Center will close its doors on Sept. 15. Of the more than 45,000 men and women wounded in Iraq and Afghanistan, approximately 18,000 have received treatment at Walter Reed. These patients often are the most severely injured, requiring cutting-edge surgical techniques and the expertise of an experienced physician. Unfortunately, these types of doctors are becoming increasingly rare within the military, leaving the armed forces with an emerging problem: a scarcity of specialists at a time when specialists are needed more than ever.
In a war in which 80% of wounds suffered in combat are blast injuries, only two neurosurgeons and a single facial plastic surgeon are deployed to the entirety of Afghanistan. The pace at which military and political leadership have responded to a broken physician retention system leaves multiple service branches exposed to the exodus of much-needed veteran, highly-specialized medical professionals.
The Health Professions Scholarship Program (HPSP) and Uniformed Services University of the Health Sciences (USUHS) do an adequate job of supplying the military with young physicians. However, the system begins to break down when doctors who came up though these systems complete their original commitment and have the option to pursue a career in civilian medicine.
The civilian medical world brings higher salaries, an end to deployments overseas or to war zones, fewer administrative responsibilities, and freedom to practice where one chooses. While a career as a military physician can provide an opportunity to serve that is equal to and, in some instances, greater than any in the civilian world, it cannot compete with the lifestyle opportunities available in private practice or academia.
To date, all of the military services have used retention bonuses, sometimes as high as $100,000 per year of additional service, as the primary tool to keep physicians beyond their initial contract. Given the policy’s failure to accomplish its mission to this point, any marginal expansion of this tactic is unlikely to see different results. A complete revision of the recruitment and retention of experienced doctors is needed if any significant progress is to be made.
The focus must be on modifying existing policies to allow for greater career flexibility for experienced physicians without losing them from service entirely. Programs allowing for leaves of absence for training, research, or work in a civilian hospital or clinic (without accruing extra service time) should be considered. Such an initiative would allow veteran physicians to regain at least some control over their professional development. Such breaks from service also would allow physicians to retain or even improve upon many of the techniques that decay from lack of use during war zone deployments.
Physician deployments should be limited to no longer than six months if at all possible, not only to make future deployments less of a concern to physicians considering their career opportunities but also because many caregivers are returning home with symptoms of post-traumatic stress disorder after tours of twelve months or more.
Even more radical changes could be the best solution until current combat conditions change. While all of the service branches recruit a small number of experienced physicians via direct commission or from the reserves, one-time, no-commitment tours should be considered for civilian physicians in crucial specialties. Opening the door to voluntary deployments without requiring a multi-year contract does not provide the military with a long-term solution to its medical personnel issues, but it likely would result in an increased ability to provide the best possible care to wounded servicemen and women.
As wounded warriors continue to pour in to military hospitals around the world, it makes sense that any and all measures, regardless of how unorthodox, should be on the table.
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