Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime

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“Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime” – Chinese Proverb

One of the most stimulating aspects of being a federal medicine provider is the truly global nature of our medical community and patients. Whether at a combat support hospital at Camp Bastian, Afghanistan, a health clinic in Diego Garcia, British Indian Ocean Territories, or the 8th Medical Group, Kunsan Air Base, South Korea, few places on this planet have not been touched at some point by federal medicine.

I believe the worldwide scope of the federal healthcare system is one of many positives that attract and hold many of our outstanding healthcare providers. Providing health care on a global scale does come with challenges for both our providers and patients.

Like most large healthcare systems, our federal system places a tremendous amount of the burden for the care of our worldwide beneficiaries squarely upon the shoulders of primary care providers. Primary-care providers are the principal access point for our patients into the federal system of care and serve as an essential entry and coordination point for patients needing specialty-care services. Because of the “gatekeeper” role that primary-care providers play within their community, they are the common denominator for federal health policy implementation, therefore taking the brunt of all new requirements generated by federal medicine policymakers. A common concern expressed by many primary-care providers is the lack of time, training and specialty-care support needed to comply with the burgeoning list of requirements considered necessary to manage the most common health issues in our patient populations. This situation can lead to inappropriate consultation to specialists that inconveniences patients, delays care, clogs specialty clinics and increases healthcare costs.

As a member of the Army Surgeon General’s Pain Task Force1, the issue of supporting and educating federal primary-care providers in effective pain management has been a focus of the initiative. One solution used within our Warrior Transition Unit (WTU) primary-care clinic at Walter Reed Army Medical Center has been to embed a pain-specialist physician within the clinic to serve as a local consultant and specialty-care coordinator. WTU physicians have thus been empowered by being able to immediately discuss difficult pain issues, such as pain-medication management, with a specialist and in this consultation process have quickly become primary care pain management experts. While this approach has been tremendously successful at this medical center, it is expensive and unsustainable throughout the entire federal system. There will never be enough specialty-trained pain physicians to provide local services in all the primary-care clinics where that is needed. Even if it were possible to co-locate a pain specialist in every primary-care location, the cost would be exorbitant. Page 2

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