Agencies   /   Department of Defense (DoD)

GAO: ‘Gaps’ in MHS Physician Specialties Could Affect Wartime Readiness

By Sandra Basu

In honor of National Caregivers Month this November, the VA Palo Alto, CA, Health Care System, held events for friends and family who provide care to ill, injured or disabled veterans. VA photo
WASHINGTON — The military services need to develop “targeted and coordinated strategies” to alleviate military physician gaps, a recent report recommended.

The recommendation was included in a Government Accountability Office (GAO) report entitled, “Additional Actions Needed to Address Gaps in Military Physician Specialties.” The report reviewed DoD’s recruitment, accession, and retention of health care professionals.

“Despite the services’ success in recruiting medical students, their current approach in the use of their programs is not fully addressing critical military physician gaps, in part because the services do not have targeted and coordinated strategies for reducing gaps,” the report explained.

Until DoD is able to fill gaps in critical specialties, it “may be hindered” in its ability to provide medical support for its troops during wartime, the review suggested.

“Military physicians are essential to maintaining DoD’s capability to deliver health care services to servicemembers and other DoD beneficiaries, but various factors, including national shortages in certain physician specialties and competition with the private sector, make it difficult for DoD to recruit and retain fully qualified physicians,” the GAO noted.

The report explained that, despite the use of the Armed Forces Health Professions Scholarship Program (AFHPSP), the Uniformed Services University of the Health Sciences (USUHS) and other programs and incentives to recruit and retain physicians, gaps continue to exist in critical specialties.

While the Navy exceeded its overall physician authorizations in fiscal years 2011 through 2015, the Army, Air Force and all of the five reserve components were below their overall physician authorizations, the report pointed out.

GAO also noted that, for FY 2011 through 2015, each of the service components “was persistently below 80% of authorizations in 19 physician specialties, 11 of which are designated as being critically short wartime specialties.”

Examples included the persistent shortfalls in critical care and trauma medicine among Navy and Air Force medical services. The Army reported shortfalls, meanwhile, in neurological surgery and nuclear medicine.

GAO stated that “service officials expressed concerns about their ability to meet authorizations for a number of specialties, including General Surgery, Surgery subspecialties (such as Orthopedic Surgery and Cardio-Thoracic Surgery), and Primary Care specialties (such as Family Medicine). Air Force officials noted that fully qualified Family Medicine physicians have become increasingly difficult to recruit.”

Among the issues was that the services have not developed a targeted and coordinated strategy for maximizing their use of the AFHPSP program, “including expanding the program to recruit reserve component physicians, which could bridge the gap between authorizations and end strengths.”

In addition, the services “have not developed a strategy to channel AFHPSP and USUHS students into the specialties where they are needed,” the report explained, adding, “DoD’s medical student programs generally begin funding students’ training prior to their selection of a specialty. Officials from the Army, the Navy, the Air Force and USUHS stressed that they cannot predict the specialty choice of medical students recruited through AFHPSP and USUHS, making it difficult to use these programs to target certain specialties.”

At the same time, the military services have not developed strategies for “mitigating military GME program limitations in order to more fully leverage the program in addressing gaps in some physician specialties,” the report stated.

Officials told GAO that, “even though the services use GME to train physicians, various factors limit their ability to fill GME slots for specialties where there are critical gaps, including that military residency programs can accommodate only a limited number of residents … that there are not enough qualified applicants for the specialty; or that not enough qualified candidates are interested in the residency program for that specialty.”

Another challenge is that the services have not developed metrics to measure how effective their recruitment, training and retention programs are in addressing gaps.

“While service officials stated that they measure the success of the AFHPSP program by monitoring the extent to which recruitment goals are achieved, these officials did not indicate that they assess the effectiveness of their combined programs in reducing physician gaps,” report authors wrote. “In addition, while DoD uses special and incentive pays and non-monetary incentives to attract and retain physicians, it has not established metrics to measure the effectiveness of these recruitment and retention programs in addressing gaps.”

The GAO also cited a concern that, while most medical students accepted into AFHPSP and USUHS have met or exceeded minimum acceptance qualifications, DoD “has not consistently tracked data on its medical students, thus potentially hindering opportunities to improve the quality of its accession programs.”

Recommendations included that the services track complete, accurate, and accessible information on the qualifications, performance, and progress of AFHPSP medical students and that USUHS should track complete, accurate, and accessible information on the performance and progress of USUHS medical students. DoD did not provide comments on the recommendations.

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