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imported_ManOSteel
03-24-2013, 09:02 PM
Recent thread about "fighting 2 wars" got me thinking about the AF Medical Corps (and by extension all services' medics). The tie-in is whether the manning and resources we use on the military medical service takes money away from our core mission...and may not be providing good value in terms of unique capabilities that civilian/reservists could provide. ie, we could have a much smaller/leaner medical corps if we only staffed for caring for active duty and military unique capabilities. Does it make sense to have military medical centers stateside when equal or better care could be obtained via private sector. Let me toss out a couple ideas and see what you guys think. I think most countries have much smaller medical corps, and may use "reservist" type medics when they need to ramp up. Idea is that these guys best maintain their medical skills in the busy hospitals/practices and it is more cost effective to activate them on an "as needed" basis. US has a huge military medical corps with tons of administrators and frequently specialists who do not get to do enough of their work to keep their skills up. Turn-over in hospital leadership and vision makes it impossible to build a long-term vision and plan for providing highest quality care. Military medicine failures are disturbing including some stories featured in AF times (Colton Reed--paralyzed after gall bladder surgery, accidental abortion (they thought baby was dead even though they had just done an ultra sound that documented living baby...and more). So, here's the real question, even if the medical corps was doing great work--which I'm not at all sure about---is it pulling critical resources from the real mission of the AF? AT any given time the medical corps takes a large number of officer and enlisted slots. We're talking about our ability to adequately fund war efforts and defense capabilities with current budget. I think the issue of the enormous foot-print of military medical corps needs to be considered as a possible area for adjustments. I am beginning to think that if a medical job is not critical to the core mission it should be outsourced. If this conversation is going on, I missed it. It seems like there is a huge amount of political clout in the AF to maintain the status quo. Thoughts?

Robert F. Dorr
03-24-2013, 10:58 PM
I wish ManOSteel had used shorter paragraphs.

My opinion isn't popular but my view is that whenever a military member's need can be met outside the main gate, it should be. Most stateside bases are near medical emergency clinics, hospitals, places of worship, and grocery stores. By having distinct versions of these establishments inside the fence, we pay extra to keep military members farther apart from the public they serve.

My overall solution to medical and health issues goes way beyond the question posed here. I would eliminate all other health care bureaucracies and put everyone in the United States on Medicare. But I would also enact rigorous safeguards to make it work.

imported_ManOSteel
03-24-2013, 11:21 PM
Good points. I had not thought about it in terms of the ongoing problem of mainstream society and military being separated but that is true. Military bases have become isolated little cities where life is different and mainstream society is generally not allowed to enter. This distancing is not good for a democracy.

Quality is a major part of my concern. I would rather my baby be born at a high volume, experienced medical center with a great US News and World Report ranking than an unknown military hospital. Why shouldn't that be an option?

70gto
03-25-2013, 12:17 AM
Interesting thread...and I agree the medical corps is too big. There are thousands in MDGs who have not deployed nor are they tasked to UTCs. The idea you are mentioning is very similar to the employment of Aeromedical Evacuation where there are only 4 active duty units and 28 Guard/Reserve Units. Only when the AD dwell is at or below 1:2 can they pull from the ARC units.

LogDog
03-25-2013, 01:06 AM
Recent thread about "fighting 2 wars" got me thinking about the AF Medical Corps (and by extension all services' medics). The tie-in is whether the manning and resources we use on the military medical service takes money away from our core mission...and may not be providing good value in terms of unique capabilities that civilian/reservists could provide. ie, we could have a much smaller/leaner medical corps if we only staffed for caring for active duty and military unique capabilities. Does it make sense to have military medical centers stateside when equal or better care could be obtained via private sector. Let me toss out a couple ideas and see what you guys think. I think most countries have much smaller medical corps, and may use "reservist" type medics when they need to ramp up. Idea is that these guys best maintain their medical skills in the busy hospitals/practices and it is more cost effective to activate them on an "as needed" basis. US has a huge military medical corps with tons of administrators and frequently specialists who do not get to do enough of their work to keep their skills up. Turn-over in hospital leadership and vision makes it impossible to build a long-term vision and plan for providing highest quality care. Military medicine failures are disturbing including some stories featured in AF times (Colton Reed--paralyzed after gall bladder surgery, accidental abortion (they thought baby was dead even though they had just done an ultra sound that documented living baby...and more). So, here's the real question, even if the medical corps was doing great work--which I'm not at all sure about---is it pulling critical resources from the real mission of the AF? AT any given time the medical corps takes a large number of officer and enlisted slots. We're talking about our ability to adequately fund war efforts and defense capabilities with current budget. I think the issue of the enormous foot-print of military medical corps needs to be considered as a possible area for adjustments. I am beginning to think that if a medical job is not critical to the core mission it should be outsourced. If this conversation is going on, I missed it. It seems like there is a huge amount of political clout in the AF to maintain the status quo. Thoughts?
You've raised some interesting points and I'd like to touch on a few of them.

One of the problems doctors, PAs, nurses, med techs would have if they dealt only with active duty personnel is military personnel are, on a whole, healthy so the medical folk won't be seeing enough variety of ailments/problems for them to experience. Remember, medical personnel treat not only military personnel but the have and do go on humanitarian deployments, such as the Third World, where they treat people of all ages and problems.

As for medical care within the local community, in areas near a medium or large city you'll have the equivalent care found in the military. But what about the bases near small cities or rural areas where their capabilities are limited. I'm thinking areas like Cannon AFB, Edwards, AFB, Laughlin AFB, Goodfellow AFB, etc.? I been assigned to bases with small hospitals/clinics and one of the things the AF does is they will contract with the nearby hospital(s) to get admitting privileges for their doctors and allow them to see civilian patients so they can get that variety of patients as well as keep up their medical skills.

Medical groups also have medical war readiness material programs maintained by Medical Materiel (who fall under the medical administration squadron) that deploy so who would build, maintain, and deploy these packages? Reserve personnel at reserve bases also have medical WRM programs that they take care of so using them to take care of active duty programs is out of the question.

The horror stories you hear about in military hospitals is also present in the civilian hospitals. The question is which one has the most mistakes per patient population?

Capt Alfredo
03-25-2013, 01:36 AM
As for medical care within the local community, in areas near a medium or large city you'll have the equivalent care found in the military. But what about the bases near small cities or rural areas where their capabilities are limited. I'm thinking areas like Cannon AFB, Edwards, AFB, Laughlin AFB, Goodfellow AFB, etc.?

I'm not sure I understand what you're saying here. In San Angelo (Goodfellow AFB), for example, there is no military hospital. Everything outside of basic immunizations and what-not is done downtown. There are actually two good hospitals there. This would appear to be the smart way to do business.

RobotChicken
03-25-2013, 01:44 AM
[QUOTE=70gto;615127]Interesting thread...and I agree the medical corps is too big. There are thousands in MDGs who have not deployed nor are they tasked to UTCs. The idea you are mentioning is very similar to the employment of Aeromedical Evacuation where there are only 4 active duty units and 28 Guard/Reserve Units. Only when the AD dwell is at or below 1:2 can they pull from the ARC units.[/QUO
:spy One thing I came across was the reserve force of air cargo civil aircraft. I know years ago they added AD pilot numbers to Civil aircrews numbers but left out the fact that many were reserve officers in flying billets! So in effect the did NOT have the transport numbers as advertised. OPPS....:bolt

LogDog
03-25-2013, 01:48 AM
I'm not sure I understand what you're saying here. In San Angelo (Goodfellow AFB), for example, there is no military hospital. Everything outside of basic immunizations and what-not is done downtown. There are actually two good hospitals there. This would appear to be the smart way to do business.
The last time I was at Goodfellow AFB was about 15 years ago so if they don't have a hospital then they probably have to rely on the local hospitals. My point was at small bases in rural or sparsely populated areas where medical care is limited necessitates the need for a military hospital/clinic.

Bunch
03-25-2013, 02:55 AM
My take on this is that they should combine all branches medical services and turn it into one agency inside DoD. Have USHUS ran it since they already have a system in place. I believe it will be very hard to gut the Medical Corps in any significant way due to the many rules and regulations that are in place when it comes to military healthcare.

imported_ManOSteel
03-25-2013, 04:16 AM
My take on this is that they should combine all branches medical services and turn it into one agency inside DoD. Have USHUS ran it since they already have a system in place. I believe it will be very hard to gut the Medical Corps in any significant way due to the many rules and regulations that are in place when it comes to military healthcare.


Congress recognized some time back that redundant military health care between the services was wasteful and they pushed for combining service and administration. Army and Navy agreed. Air Force held out and fought it largely justifying it with claims of service-unique issue with flying that could not be dealt with by combined services. I believe the tax payers are being bilked by this huge mess. Many layers of rules and administration of those rules have been unnecessarily created and used to justify even more growth. (my opinion obviously).

Efforts to combine medical services have occurred at Walter Reed/Bethesda "National Cap Region" and have not gone smoothly due to poor planning and leadership. Again, seems the current leaders don't want to make this work.

imported_ManOSteel
03-25-2013, 04:20 AM
Have you seen what medical centers charge and tricare allows?
Worlds apart.

True, Tricare has not attracted the best care outside the military hospital. It is not a good payer and private practices don't like to deal with it. That is clearly a problem that needs to be fixed if families/retirees have to go outside the mil hospital for care. Lowest bidder may not be the way to go on things like health care insurance.

imported_ManOSteel
03-25-2013, 04:33 AM
The last time I was at Goodfellow AFB was about 15 years ago so if they don't have a hospital then they probably have to rely on the local hospitals. My point was at small bases in rural or sparsely populated areas where medical care is limited necessitates the need for a military hospital/clinic.

I would argue that there are other solutions that make more sense than building everything on the base using active duty to staff it. It sounds like civilian care did emerge to meet the need you described (from what Capt Alfredo described). When we use military resources to build stores and hospitals I think we risk harming local economic growth and opportunity and creating and creating an entity that has not earned its position in the market with good product/performance/service.

imported_ManOSteel
03-25-2013, 04:47 AM
Interesting thread...and I agree the medical corps is too big. There are thousands in MDGs who have not deployed nor are they tasked to UTCs. The idea you are mentioning is very similar to the employment of Aeromedical Evacuation where there are only 4 active duty units and 28 Guard/Reserve Units. Only when the AD dwell is at or below 1:2 can they pull from the ARC units.

Yeah, it would take some major restructuring of the force to shift medical to more of a reserve/guard staffing but it appears to me to be worth a serious look.

Agreed, many medics don't deploy much...or at least not as full practitioners of their specialty. ie specialized doc may get sent to do sick call or assist on surgeries instead of doing a very specialized thing they were specially trained to do. Military medicine has paid to send doctors/techs/nurses for additional training for things distinctly not useful in the combat zone like specialties within pathology, pediatric neurology/radiology, and specialized surgeons. These guys get to their assignments and find the mil hospital does not have the case load or personnel for them to use that Harvard/Penn (name your favorite top tier training program) experience. They just spent 4-6 years in civies, pulling in an Air Force officer paycheck (and taking an officer billet) to get assigned to a place that under-utilizes them. Nearly inevitably they leave the military as soon as possible and feel they have been misled by being put in a job in which their skills dwindle from under use and military politics overshadows good medicine. Everyone loses. That's part of what is bugging me enough to start this thread.

CJSmith
03-25-2013, 04:50 AM
Military medicine failures are disturbing including some stories featured in AF times (Colton Reed--paralyzed after gall bladder surgery, accidental abortion (they thought baby was dead even though they had just done an ultra sound that documented living baby...and more). So, here's the real question, even if the medical corps was doing great work--which I'm not at all sure about---is it pulling critical resources from the real mission of the AF?

You hear about these cases because we are smaller and the crimes reports on just about all of them. They are magnified. Shit like this happens in the civilian sector DAILY! It's called medical practice for a reason.


I wish ManOSteel had used shorter paragraphs.

I agree!


Quality is a major part of my concern. I would rather my baby be born at a high volume, experienced medical center with a great US News and World Report ranking than an unknown military hospital. Why shouldn't that be an option?

I can speak on this personally. My wife worked as an L&D nurse in a civilian hospital as well as the ER for a stint. There are a lot more cases in larger facilities of neglect, malpractice and the like. Unknown military hospital? Please explain that one.


The idea you are mentioning is very similar to the employment of Aeromedical Evacuation where there are only 4 active duty units and 28 Guard/Reserve Units. Only when the AD dwell is at or below 1:2 can they pull from the ARC units.

AD AE has been doing 1:2 dwells for a long time and ARC has been right there along with them.


My take on this is that they should combine all branches medical services and turn it into one agency inside DoD. Have USHUS ran it since they already have a system in place. I believe it will be very hard to gut the Medical Corps in any significant way due to the many rules and regulations that are in place when it comes to military healthcare.

That would be a colossal CF. Back in the day there use to be 4F's that ran flight med. SG decided to pull 4N's and 4F's together since both were EMT's and had almost the same blueprint in training. It turned out to be a huge screw up. Now, 4N's are getting a shred out of F so they can become SME's in Flight Med. IDMTs will also be embedded in Flight Med so they can have a higher patient acuity. The point I'm trying to make here is merging all services together would never work. We couldn't even get two like AFSC's to get shit right.

The same situation by the OP can be applied to virtually any field. MPS, FSS, MPF, CBPO or whatever its called these days is the same way. Folks get rotated in and out of each section to get "career broadening experience" but nobody knows how to do their effing jobs because they aren't in it long enough. Same goes for medics. They are put in clinics/wards for 1-2 years at a time and then moved elsewhere. There are no SME anymore. The OP had one thing right about civilian hospitals though, they do have more knowledge in their field because they spend years in them.

imported_ManOSteel
03-25-2013, 05:11 AM
You've raised some interesting points and I'd like to touch on a few of them.

[QUOTE]One of the problems doctors, PAs, nurses, med techs would have if they dealt only with active duty personnel is military personnel are, on a whole, healthy so the medical folk won't be seeing enough variety of ailments/problems for them to experience. Remember, medical personnel treat not only military personnel but the have and do go on humanitarian deployments, such as the Third World, where they treat people of all ages and problems.

Agreed. One advantage of relying more on reservist/guard would be the daily experience they have with truly ill patients. Mil med, I think, has gotten way off track trying to make sure they keep an active duty medical corps busy enough with sick patients. Joint ventures with the VA have had a lot of problems and it seems to me the patient loses.


As for medical care within the local community, in areas near a medium or large city you'll have the equivalent care found in the military. But what about the bases near small cities or rural areas where their capabilities are limited. I'm thinking areas like Cannon AFB, Edwards, AFB, Laughlin AFB, Goodfellow AFB, etc.? I been assigned to bases with small hospitals/clinics and one of the things the AF does is they will contract with the nearby hospital(s) to get admitting privileges for their doctors and allow them to see civilian patients so they can get that variety of patients as well as keep up their medical skills.

True but I don't think this has been generally successful. When mil med makes these deals, we are providing "free" workers for civilian hospitals. The military members go back and forth between hospitals, not necessarily being fully available or invested in either place. They end up with at least 2 bosses. Again, an idea that may work sometimes but seems like a lot of compromises and wasted active duty time when there may be a better/cheaper way such as a more robust and versatile guard/reserve program for medics.


Medical groups also have medical war readiness material programs maintained by Medical Materiel (who fall under the medical administration squadron) that deploy so who would build, maintain, and deploy these packages? Reserve personnel at reserve bases also have medical WRM programs that they take care of so using them to take care of active duty programs is out of the question.
Agreed. You are hitting on what I would agree are the core competencies and requirements for medical support of the fighting mission. I think we should basically cut back to there (on paper) and then carefully add in only the people and resources that truly are mission essential and find other ways to get the non-mission critical tasks/care done.


The horror stories you hear about in military hospitals is also present in the civilian hospitals. The question is which one has the most mistakes per patient population?

True, mistakes occur everywhere. One problem I see with mil med is that it fits into a larger hierarchical military culture where one must be very cautious in questioning leadership and programs. Medical errors occur for complex reasons including communication and process failures. Transparent and humble leadership is necessary to make sustainable changes--if the staff, civilians included, don't trust the leadership then long-term improvements in processes will not work well. Our leadership changes every 2 years (how do you make sustainable changes when anyone who has been in a while knows that a sincere leader may be replaced by self-worshipping jackass). In Air force, all hospital commanders report to wing commander who certainly is more concerned about readiness issues than why the hospital commander is trying to deal with unseen medical safety issues. I think mil med has greater hurdles to safety than the average civilian hospital including a generally junior staff as the really passionate care-givers are often forced to either become adminstrators/commanders or separate.

imported_ManOSteel
03-25-2013, 05:22 AM
I can speak on this personally. My wife worked as an L&D nurse in a civilian hospital as well as the ER for a stint. There are a lot more cases in larger facilities of neglect, malpractice and the like. Unknown military hospital? Please explain that one.

I simply meant that public knowledge of quality and outcomes appears to be virtually "unknown" for military hospitals. I got to that assertion by thinking about the US NEW and World Report ranking of hospitals. They do an annual issue where hundreds of community hospitals (and university hospitals) are ranked in terms so the quality of their care. I've never seen a mil hospital make the list. So, if you move to DC, you can look at common measures of quality for a number of hospitals your family might use. I don't believe any of the several area mil hospitals were included. Does that mean they are not good? Maybe. Or maybe they didn't submit data (if not, wonder why not...). Hence my assertion that the quality of mil hospitals is less known or, apparently, knowable. Damn, another long paragraph. Sorry

imported_ManOSteel
03-25-2013, 05:36 AM
You hear about these cases because we are smaller and the crimes reports on just about all of them. They are magnified. Shit like this happens in the civilian sector DAILY! It's called medical practice for a reason.

There are some show-stopper error that should never happen. If they do, there is a serious problem that needs to be acknowledged and fixed. Failing to check an ultrasound before aborting a baby is absolutely out of the bounds of an error having to do with an uncertain science, what one might call "medical practice". Some of the other errors, when looked at critically indicate to me that mil med may be a particularly high risk environment for "medical practice". Errors escalate and have critical results if multiple systems fail--in each of the 2 cases I mentioned, that was the case. In the Reed case, it sounds like there was not a good plan in place for emergency evac to higher level of care. There was no vascular surgeon available in this large military hospital. These, I fear, are not isolated short-comings--they may be ubiquitous in mil med. Luckily, the errors or events that necessitate the use of the such resources are extremely rare...but who wants to play odds when there is a better way of doing things?

LogDog
03-25-2013, 05:39 AM
Agreed. One advantage of relying more on reservist/guard would be the daily experience they have with truly ill patients. Mil med, I think, has gotten way off track trying to make sure they keep an active duty medical corps busy enough with sick patients. Joint ventures with the VA have had a lot of problems and it seems to me the patient loses.
Having to rely more on reservists/guard is you'd be rotating in and out a lot of doctors without having much continuity with the support staff that would be there year-round.


True but I don't think this has been generally successful. When mil med makes these deals, we are providing "free" workers for civilian hospitals. The military members go back and forth between hospitals, not necessarily being fully available or invested in either place. They end up with at least 2 bosses. Again, an idea that may work sometimes but seems like a lot of compromises and wasted active duty time when there may be a better/cheaper way such as a more robust and versatile guard/reserve program for medics.
The military personnel are invested in the military hospital because that's where their main work is. The civilian community benefits because they now have more capability without much cost. If you have a small community hospital and the military has a specialty you don't have then by agreeing to allow them to see patients there helps them to maintain their currency on their skills. Examples are board certified plastic surgeons or neurosurgeons.


Agreed. You are hitting on what I would agree are the core competencies and requirements for medical support of the fighting mission. I think we should basically cut back to there (on paper) and then carefully add in only the people and resources that truly are mission essential and find other ways to get the non-mission critical tasks/care done.
When I was active duty, the positions in the medical field were also applied to a mobility position. I don't know if that's changed but I think that's still the current policy. If you don't need a military person for a mobility position but need them to support patient care then a civilian would probably suffice.


True, mistakes occur everywhere. One problem I see with mil med is that it fits into a larger hierarchical military culture where one must be very cautious in questioning leadership and programs. Medical errors occur for complex reasons including communication and process failures. Transparent and humble leadership is necessary to make sustainable changes--if the staff, civilians included, don't trust the leadership then long-term improvements in processes will not work well. Our leadership changes every 2 years (how do you make sustainable changes when anyone who has been in a while knows that a sincere leader may be replaced by self-worshipping jackass). In Air force, all hospital commanders report to wing commander who certainly is more concerned about readiness issues than why the hospital commander is trying to deal with unseen medical safety issues. I think mil med has greater hurdles to safety than the average civilian hospital including a generally junior staff as the really passionate care-givers are often forced to either become adminstrators/commanders or separate.
Mistakes are inherent in any organization but the goal is to minimize them. One of the things no one likes are inspections from outside your organization but the purpose of the inspections is to ensure you're following procedures and that your people know the procedures. In the medical groups, they have two types of inspections: the Health Services Management Inspection (HSMI) and the Joint Accreditation of Hospital Care Organizations (JACHO). When the HSMI comes in they have a dozen or more people looking at hospital/clinic operations. When JACHO, which is mandated by Congressi for military hospitals, comes there are only 3 - 4 people to inspect the entire hospital. Which inspection do you think is more thorough?

LogDog
03-25-2013, 05:45 AM
My take on this is that they should combine all branches medical services and turn it into one agency inside DoD. Have USHUS ran it since they already have a system in place. I believe it will be very hard to gut the Medical Corps in any significant way due to the many rules and regulations that are in place when it comes to military healthcare.
This has been talked about since at least the middle 70s. The combining of the services medical personnel would produce what was referred to as "Purple Suiters". The problem that most people saw with this setting a standard for medical personnel that would meet the war-time needs of each of the services. Army medics are different from Navy medics which are different from AF medics when the operate in the field because of the nature of each of the services. Other countries have no doubt combined them by they can do it because their forces are smaller allowing them to have one medical service for all.

imported_ManOSteel
03-25-2013, 05:56 AM
You join in 2009 and four years later go on a posting bienge. How's your resiliency???

Ha! I'm a little pissed, to be honest. The last thing that got me fired up enough to post was 4 years ago when some jackass jag lawyer made a big deal out of office March Madness Pools, of which I am very fond (although not doing so well on this year). Thanks for the interest in the thread--it is sincere. I think I am trying to find ways to talk about cost-savings/quality improvement without killing my relationships within mil med. There is a lot of vested interest in the status quo. Also, thanks to all for your patience with my novice posting.

imported_ManOSteel
03-25-2013, 06:10 AM
This has been talked about since at least the middle 70s. The combining of the services medical personnel would produce what was referred to as "Purple Suiters". The problem that most people saw with this setting a standard for medical personnel that would meet the war-time needs of each of the services. Army medics are different from Navy medics which are different from AF medics when the operate in the field because of the nature of each of the services. Other countries have no doubt combined them by they can do it because their forces are smaller allowing them to have one medical service for all.

Some bare bones service specific staff would be required to handle issues such as medical standards for unique areas like submarines, fighters, SERE, PRP, etc. I am not sure if anyone can give a really good answer to why naval "aviators" and AF pilots live by different regs. Seems like a medicine that is ok/not okay for one service's fighter pilot should be viewed the same way for all services--maybe we would have smarter regs if we combined them and made sure the combined version incorporated best knowledge/practice and eliminated fluff that tends to accumulate as time passes. The very existence of separate regs seems to be controlling the discussion rather than allowing the question of whether separate regs are really a good or necessary idea.

CJSmith
03-25-2013, 08:06 AM
There are some show-stopper error that should never happen. If they do, there is a serious problem that needs to be acknowledged and fixed. Failing to check an ultrasound before aborting a baby is absolutely out of the bounds of an error having to do with an uncertain science, what one might call "medical practice". Some of the other errors, when looked at critically indicate to me that mil med may be a particularly high risk environment for "medical practice". Errors escalate and have critical results if multiple systems fail--in each of the 2 cases I mentioned, that was the case. In the Reed case, it sounds like there was not a good plan in place for emergency evac to higher level of care. There was no vascular surgeon available in this large military hospital. These, I fear, are not isolated short-comings--they may be ubiquitous in mil med. Luckily, the errors or events that necessitate the use of the such resources are extremely rare...but who wants to play odds when there is a better way of doing things?

I think we need to know a couple things here. Did something happen to you that pissed you off about military medicine? Are you in the medical field yourself? These might clear things up.

Discussing cost savings measures is good and I like that you are doing it. However, I don't think you have any idea what you are talking about, unless this is troll bait. Is military medicine the best? No. Is it the worst? Hell no. Some of these issues you are discussing are inexcusable but they are few and far between compared to the civilian sector.

But if you want to purchase your own medical insurance and not use military medicine, by all means go ahead.

Chief_KO
03-25-2013, 11:08 AM
My issue with the AF medical system is their over indulgence in buying the latest and greatest of everything, every year. Every medical facility is always being upgraded, come in your annual what ever and they have all kinds of new toys. More and more money is spent every year and is there a return on investment? But, no one can stop this train...who wants to be the one to "cut medical care to the military".

Look at the scene from Monty Python's Meaning of Life when they switch on all the machines for the visitor...art imitates life.

imported_ManOSteel
03-25-2013, 01:59 PM
I think we need to know a couple things here. Did something happen to you that pissed you off about military medicine? Are you in the medical field yourself? These might clear things up.

Discussing cost savings measures is good and I like that you are doing it. However, I don't think you have any idea what you are talking about, unless this is troll bait. Is military medicine the best? No. Is it the worst? Hell no. Some of these issues you are discussing are inexcusable but they are few and far between compared to the civilian sector.

But if you want to purchase your own medical insurance and not use military medicine, by all means go ahead.

I am active duty in the medical field and am speaking largely from my observations and frustrations with what I see to be a bloated medical system that grows without good/thoughtful planning.

Active duty are required to use the mil system unless specifically referred off or some other rare exception applies. My wife has an excellent benefits package which includes health care I would rather use but can't. I don't have the option of cashing out the health insurance part of my mil compensation even though my family does not use it. I wish I could.

You may be right that I don't know what I'm talking about...I'm certainly not trolling...I'm trying to bounce ideas around and formulate some problems and solutions. It is a huge topic with lots of sensitive aspects which makes it easy to offend people (I'm sorry if I offended you). Like others on the forum, I would rather not give a detailed bio at this point but am certainly able to validate my immersion in the system in other ways.

I am not so much "pissed" about any one thing--I was actually drawn back to the forum after 4 years by the Col being fired over PT--my response to that was my first post after 4 years. Then I saw there were some good conversations going on and I posted the med corps question as it bothers me and needs exploring--I am part of it and don't think it is easy to discuss down-sizing your own organization in any kind of public forum.

70gto
03-25-2013, 02:09 PM
I think we need to know a couple things here. Did something happen to you that pissed you off about military medicine? Are you in the medical field yourself? These might clear things up.

Discussing cost savings measures is good and I like that you are doing it. However, I don't think you have any idea what you are talking about, unless this is troll bait. Is military medicine the best? No. Is it the worst? Hell no. Some of these issues you are discussing are inexcusable but they are few and far between compared to the civilian sector.

But if you want to purchase your own medical insurance and not use military medicine, by all means go ahead.

Seriously, the individual brings up valid points in an open forum... Who gives a rats arse what his background is.

JD2780
03-25-2013, 02:47 PM
I am active duty in the medical field and am speaking largely from my observations and frustrations with what I see to be a bloated medical system that grows without good/thoughtful planning.

Active duty are required to use the mil system unless specifically referred off or some other rare exception applies. My wife has an excellent benefits package which includes health care I would rather use but can't. I don't have the option of cashing out the health insurance part of my mil compensation even though my family does not use it. I wish I could.

You may be right that I don't know what I'm talking about...I'm certainly not trolling...I'm trying to bounce ideas around and formulate some problems and solutions. It is a huge topic with lots of sensitive aspects which makes it easy to offend people (I'm sorry if I offended you). Like others on the forum, I would rather not give a detailed bio at this point but am certainly able to validate my immersion in the system in other ways.

I am not so much "pissed" about any one thing--I was actually drawn back to the forum after 4 years by the Col being fired over PT--my response to that was my first post after 4 years. Then I saw there were some good conversations going on and I posted the med corps question as it bothers me and needs exploring--I am part of it and don't think it is easy to discuss down-sizing your own organization in any kind of public forum.

I see what you're saying. I'm not in the med world. Just married into it 9 yrs ago. I was AD and had my own frustrations with the med world. My wife is a 4N and I've had to listen to the idiocy that goes on there in the med world. I've also experienced first hand the lack of professionalism shown by quite a few medics and docs. I've also seen some great professionalism. Amy question how can they justify bringing in a guy and making him a light bird just because he has been a civilian doc since the dawn if time. The guy doesn't k now shit about the military yet will be expected to lead. No he won't be in a leadership position but all the Airmen are going to see is some brass on his hat. It sets a horrible precedence as well. Then you have medics with NO emergency medicine experience telling people they're EMTs. Again false sense of security. At one point in my career I had more real world emergency medicine experience than my wife. She worked peds, family medicine, and pha. There needs to be a better way to ensure 4Ns keep the E in EMT. To bad many simply wipe noses and take BPs. As far as insurance goes, that is a headache in itself.

CJSmith
03-25-2013, 02:57 PM
I am active duty in the medical field and am speaking largely from my observations and frustrations with what I see to be a bloated medical system that grows without good/thoughtful planning.

Active duty are required to use the mil system unless specifically referred off or some other rare exception applies. My wife has an excellent benefits package which includes health care I would rather use but can't. I don't have the option of cashing out the health insurance part of my mil compensation even though my family does not use it. I wish I could.

You may be right that I don't know what I'm talking about...I'm certainly not trolling...I'm trying to bounce ideas around and formulate some problems and solutions. It is a huge topic with lots of sensitive aspects which makes it easy to offend people (I'm sorry if I offended you). Like others on the forum, I would rather not give a detailed bio at this point but am certainly able to validate my immersion in the system in other ways.

I am not so much "pissed" about any one thing--I was actually drawn back to the forum after 4 years by the Col being fired over PT--my response to that was my first post after 4 years. Then I saw there were some good conversations going on and I posted the med corps question as it bothers me and needs exploring--I am part of it and don't think it is easy to discuss down-sizing your own organization in any kind of public forum.

Sheet, you didn't offend me. I was just wondering what angle you were going for. There are large issues with the med world, that much is true - both military and civilian. Bouncing ideas on here are good and healthy for discussion. The only thing that gets me (and I'm not finger pointing you) are folks that are quick to say military medicine is crap. When the Reed thing went down, pretty much all medics (Docs, RN's, 4's) were looked at as incompetent a-holes. This is far from the truth. There are some phenomenal medics (again Docs, RN's, 4's) out there.


Seriously, the individual brings up valid points in an open forum... Who gives a rats arse what his background is.

Meh...

imported_ManOSteel
03-25-2013, 03:07 PM
Amy question how can they justify bringing in a guy and making him a light bird just because he has been a civilian doc since the dawn if time. The guy doesn't k now shit about the military yet will be expected to lead. No he won't be in a leadership position but all the Airmen are going to see is some brass on his hat. It sets a horrible precedence as well. O-5s

Totally agree with this--it gets to the way that mil med has not been set up well. Part of the reason rank is given to doctors fairly easily (I too have seen guys come in as O-5s with no mil experience--no street cred, if you will) is to lure them in with the added "prestige" and pay of a senior officer. From what I've seen, I think maybe doctors and chaplains should have a clear pathway that is not rank-based. You respect them because of their position and expertise but only a select few who actually need to "command" should wear the rank. That would solve a lot of problems, imho. Other problem with rank in Med Corps is that it can be used inappropriately and can interfere with good medical practice. The other issue that I've previously mentioned is that filling the hospital with officers certainly must cut into billets for line. If we don't need the oncologist, pediatrician, endoscopist, etc in uniform...then why are they still in their (often sloppily worn) uniforms?

imported_ManOSteel
03-25-2013, 03:16 PM
Sheet, you didn't offend me. I was just wondering what angle you were going for. There are large issues with the med world, that much is true - both military and civilian. Bouncing ideas on here are good and healthy for discussion. The only thing that gets me (and I'm not finger pointing you) are folks that are quick to say military medicine is crap. When the Reed thing went down, pretty much all medics (Docs, RN's, 4's) were looked at as incompetent a-holes. This is far from the truth. There are some phenomenal medics (again Docs, RN's, 4's) out there.


Thanks-I openly acknowledge that I have seen some great people and care given within mil med. Many have left mil med at some point in frustration with a poorly run organization. I am a believer that when significant errors happen we can learn alot by trying to figure out if there are processes broken and not automatically scapegoating individuals. Individuals will always make errors but systems have to be designed to pick those up and correct for them. I think the organizational structure (hierarchical and short-term) has made it virtually impossible to look for and correct the system/process failures in mil med. This sets individuals up for failure and patients at higher risk for bad outcomes than in an organization with a different core mission.

CSARmedic
03-26-2013, 02:15 AM
You've really uncovered a sleeping giant with this one. The (AF) military medical machine is an unwieldy, dinosaur that is ALWAYS 10 years behind the other services and civilian counterparts. How do I know? Been an SME (Reserve) medic for 22 years after spending 11 years in SF hell on AD. As an SME (for those of you who don't know, a Squadron Medical Element is a small flight surgeons office that is deployed with the flying squadron which they are assigned). As a rescue SME (CSARME) we go where the 60's and 130's take us. The true joy of the job is being one of the few, true Air Force "operational medics" that isn't a medic by name alone. We have to be competent (para)medics and practitioners in advanced levels of emergency care and I'm not talking about IDMT primary care BS but RSI, intubation, ventilator, cut downs, burn management, in-flight care, etc.
With that, I've been on the "outside" of military medicine looking in and see a ridiculously bloated bureaucracy that seems to only serve it's own needs and can't get out of it's own way.
One example, the CASF or ASTS squadron. A cold-war era philosophy that hasn't been utilized since Vietnam yet is a mainstay of military "efficiency" and "operational" usefullness. I mean, on the Reserve side, an ASTS hasn't been called up (except for onesy-twosy) or used as an ASTS during the last two wars yet they still train and "fight" the concept like it's the saving grace of military field medicine (and consistently get in my people's way and slow us down in unending turf battles). If the AF did away with EVERY ASTS no one would ever miss them. And how much money are they eating up annually (at they expense of my small shop's budget?).
No, you've really brought up a good point. The military medical machine has surely outlived it's usefullness but with all the senior brass running around pointing out how proud they are of what "great work" they are doing I don't foresee any changes within our generation

imported_ManOSteel
03-26-2013, 03:10 AM
You've really uncovered a sleeping giant with this one.
It is painful to see discussions of people trying to do their jobs without supplies or train without the right resources and not consider whether the medical corps might be a place to find major savings. Literally billions of dollars are dropped into equipment, training, and manpower and the return needs to be evaluated. I don't feel like I'm getting much traction here with the topic-thanks for weighing in.





Been an SME (Reserve) medic for 22 years after spending 11 years in SF hell on AD. As an SME (for those of you who don't know, a Squadron Medical Element is a small flight surgeons office that is deployed with the flying squadron which they are assigned). As a rescue SME (CSARME) we go where the 60's and 130's take us. The true joy of the job is being one of the few, true Air Force "operational medics" that isn't a medic by name alone. We have to be competent (para)medics and practitioners in advanced levels of emergency care and I'm not talking about IDMT primary care BS but RSI, intubation, ventilator, cut downs, burn management, in-flight care, etc.
Very cool. You've got cred with me and I think you may be the very person that represents my thought about having reservists have a larger role and limiting med corps to real mission related jobs. What does a guy like you do when not activated? I would assume you work in a trauma center or ride an ambulance for a shock-trauma center? Just curious.




One example, the CASF or ASTS squadron. A cold-war era philosophy that hasn't been utilized since Vietnam yet is a mainstay of military "efficiency" and "operational" usefullness. I mean, on the Reserve side, an ASTS hasn't been called up (except for onesy-twosy) or used as an ASTS during the last two wars yet they still train and "fight" the concept like it's the saving grace of military field medicine (and consistently get in my people's way and slow us down in unending turf battles). If the AF did away with EVERY ASTS no one would ever miss them. And how much money are they eating up annually (at they expense of my small shop's budget?). Good stuff. I don't speak your language but I get the point. If we all could find stuff like this and have a merciless look at what makes sense and what doesn't we could make the medical corps much more efficient, relevant, and inexpensive.


The military medical machine has surely outlived it's usefulness but with all the senior brass running around pointing out how proud they are of what "great work" they are doing I don't foresee any changes within our generation
Agreed. It feels pretty hopeless when the AF Surgeon General continuously briefs on the successes of the corps and people buy it. There is huge bloat and waste. No Med grp commander wants their 2 years marred by their subordinates questioning and potentially bringing about a downsizing of their fiefdom. Liven up this discussion, please. You sound like you have some more ideas.

Airborne
03-26-2013, 04:13 AM
Active duty are required to use the mil system unless specifically referred off or some other rare exception applies. My wife has an excellent benefits package which includes health care I would rather use but can't. I don't have the option of cashing out the health insurance part of my mil compensation even though my family does not use it. I wish I could.

There may be some fine print, but Im pretty sure if youre not on flight status then you can use any health care you want at your own cost, which for you would be your wife's plan. It doesnt hurt to ask, then ask someone else, then ask where it's written.

JD2780
03-26-2013, 10:21 AM
There may be some fine print, but Im pretty sure if youre not on flight status then you can use any health care you want at your own cost, which for you would be your wife's plan. It doesnt hurt to ask, then ask someone else, then ask where it's written.

Also you could be seen off base and simply use her insurance avoid that pesky AFI that would ground you. Something I should've done.

imported_BKKEMPER
03-27-2013, 04:23 PM
O-5s

Totally agree with this--it gets to the way that mil med has not been set up well. Part of the reason rank is given to doctors fairly easily (I too have seen guys come in as O-5s with no mil experience--no street cred, if you will) is to lure them in with the added "prestige" and pay of a senior officer. From what I've seen, I think maybe doctors and chaplains should have a clear pathway that is not rank-based. You respect them because of their position and expertise but only a select few who actually need to "command" should wear the rank. That would solve a lot of problems, imho. Other problem with rank in Med Corps is that it can be used inappropriately and can interfere with good medical practice. The other issue that I've previously mentioned is that filling the hospital with officers certainly must cut into billets for line. If we don't need the oncologist, pediatrician, endoscopist, etc in uniform...then why are they still in their (often sloppily worn) uniforms?

Medical Corps and Dental Corps officers are non-DOPMA constrained officers. That means that the number of Field Grade officers in the MC/DC do not count against the Congressionally mandated ceiling of field grade officers. No line billets are at risk with greater amounts of MC/DC O-4,5 or 6s at all. Since they are non-DOPMA constrained, they have their own rules for promotion eligibility and promotion rates. 100% promotion opportunity to O-4 and O5, as one.

LogDog
03-27-2013, 04:45 PM
One thing that could change is to remove doctors as commanders and replace them with medical administrators. Put these doctors back into a full day of seeing patients.

imported_ManOSteel
03-29-2013, 01:59 AM
Medical Corps and Dental Corps officers are non-DOPMA constrained officers. That means that the number of Field Grade officers in the MC/DC do not count against the Congressionally mandated ceiling of field grade officers. No line billets are at risk with greater amounts of MC/DC O-4,5 or 6s at all. Since they are non-DOPMA constrained, they have their own rules for promotion eligibility and promotion rates. 100% promotion opportunity to O-4 and O5, as one.

I didn't realize that. However, the point still remains that when you look at total manpower costs/numbers, every body in uniform ultimately counts toward "end strength" numbers. Some of those bodies are uniformed medics doing jobs that civilians could do. Budget guys see big picture how many active duty people we have and mandate numbers. I would rather have a higher percentage of the end strength doing the core mission. We've got a major "mission creep" issue.

imported_ManOSteel
03-29-2013, 02:03 AM
One thing that could change is to remove doctors as commanders and replace them with medical administrators. Put these doctors back into a full day of seeing patients.

Yeah, something is wrong with the system. I think that overall there are too many adminstrators in the medical corps some of whom are doctors not doing medicine but many of whom are other medical folks who got away from patient care. Some are great leaders, some are taking space and hurting effectiveness. Frequently it appears to me that mediocre performers can spend a career in the med corps getting moved around and not really doing much. It seems more like a GS system than what I perceive the line side to be like.