“He who wishes to be a surgeon should go to war.” – Hippocrates (460-370 BC)
Editor-In-Chief, Chester “Trip” Buckenmaier III, MD, COL (ret.), MC, USA
I was teaching this month at Fort Indian Town Gap, PA, for Bushmaster 2020. Running a Bushmaster exercise in the spring is uncharacteristic since the event usually occurs in October. Unfortunately, the COVID-19 pandemic struck in March of last year with a vengeance. Like many folks, the calendar at my desk in our office building is still on March 2020 as I sit at home writing this. The Uniformed Services University (USU) class of 2021 had been waylaid by the pandemic like the rest of the country. They have continued their training and become far more facile with Zoom than they probably ever desired to be. USU medical and advanced nursing students are not alone in experiencing the challenges of attending medical school during a pandemic. Their civilian counterparts throughout the country have been no less challenged academically during this difficult year. There is one key and essential difference regarding the physician product produced by USU that will graduate in May: The Bushmaster experience.
USU was chartered by an act of Congress on September 21, 1972, as the nation’s only federal health sciences university. Similar in mission to the Nation’s undergraduate military academies, USU was established to address the nation’s critical need for health professionals to support the readiness needs of the uniformed services in their role within the US National Security Strategy. Although many elements of the health education offered USU students can be found at any accredited medical school, the emphasis on military health care, leadership, readiness, and public health sets USU apart. The annual Bushmaster exercise hosted by the University uniquely defines this difference. It provides a physical example of why USU military graduates are necessarily different from their civilian counterparts. Like their civilian peers, USU graduates will earn the degree of medical doctor (MD) this spring and be recognized as physicians. Because of experiences like the Bushmaster exercise, USU graduates will earn an additional distinction as military physicians.
From time to time, Congress, especially in peacetime, can forget the importance of military physicians to the national security infrastructure that the uniformed services provide. This is expressed through misguided attempts to severely cut the University’s budget or even calls to close the institution. The rationale behind this behavior is the misguided belief that medicine is medicine, whether practiced at home or on the battlefield. Proponents of this way of thinking believe the nation’s wartime needs could easily be serviced by clinicians drawn from civilian practices. There is a mythos that we can just invite civilian healthcare providers to the battlefield in times of national emergency, and they can do their doctor thing. This argument is bolstered by the reality that a significant proportion of clinicians who served in the last 19 years of conflict came from civilian systems and performed admirably. Assimilation into the military health system from civilian medicine is undoubtedly possible. Still, it is greatly facilitated because the institutional memory that defines a military physician and their role on the modern battlefield exists through USU and its graduates. Civilian providers have the benefit of a structure to form upon and emulate. This eases the transition from the civilian to the military medical environment and, in my opinion, saves lives.
I believe this situation is like the relationship between the officer product from Reserve Officer Training Corps (ROTC) at civilian colleges and universities and the officer graduating from the nation’s service academies. I am a product of ROTC, and I have enjoyed a full career in the Army, retiring as a Colonel. I certainly felt my ROTC training prepared me to be a successful junior officer. I benefitted from the similar, albeit different, experience of officers who came up through the service academies. Both systems, I would argue, are needed to defend this nation.
The importance to the nation’s security in having a ready source of military physicians defines the existence of USU. It explains why, despite being a mere few weeks away from graduation, the school invested in running a rare spring iteration of Bushmaster. This effort was no small feat. The USU Department of Military Medicine (also unique in medical training) is congratulated for pulling this off; COVID be damned. This provided the “COVID” graduating class of 2021 the same distinction and training that has defined military physician graduates from USU for decades (including my class of ’92). I am confident no other American medical school was performing a similar field exercise this April to learn the medical skills required to defend this nation. Bushmaster is the final stress test and a final exam that defines a USU graduate as a military physician. The experience is physically and mentally demanding. The realistic casualty scenarios (played by first-year medical students in impressive moulage) are pulled from the pages of the nation’s recent conflicts. Granted, this military training is not SEAL training, Ranger training, or PJ training, but then none of those exercises are Bushmaster. Bushmaster is not an exercise that is mastered or won. Many notional casualties die because of mistakes that are made by the students. Far better to learn and experience these lessons at Bushmaster, where everyone goes home with little more than a bruised ego. The alternative is to make these mistakes on a modern battlefield that is far less forgiving, and lives are literally in the balance.
I demand much from the students, soon to be my peers, during the Bushmaster exercise. I enjoy Bushmaster as an instructor for the sheer entertainment value of seeing just how screwed up a scenario can play out. Then again, I have never managed a Bushmaster where I have not learned something new from the students. I have served as a senior instructor in far more Bushmaster exercises than I care to count. I take this training very seriously and demand the students do the same, since these young military physicians may be caring for my daughter someday, as she is currently in the Army Reserves.
I look forward to the exercise because it reminds me why, when I am asked what I do for work, I reply, “I am a military physician.” I encourage USU graduates at the end of their Bushmaster experience to proudly don the title of military physician as well. They have earned it.