|
February 2001 Letters To The Editor of US Medicine
Military
Physicians Leave For A Plethora Of Reasons
I have been reading several of the articles in your publication
concerning
military physician retention. I have recent experience
with military medicine and find much of what has been written
very
accurate.
I do wish to add some things:
During my four year stint in the military I did
not witness one
single physician with the rank of O-4 or below remain in the military
beyond their initial
obligation for HPSP or USUHS. Thus, from what I
have seen, military physician retention at the rank of O-4 and below
is
zero. This goes for all specialties across the board.
The only physicians I have seen stay are those in ranks
of O-5 and
above who seem "stuck" in the system for whatever reason. But, they
are certainly in the minority
and are mostly in administrative non-
clinical jobs.
This all combines to produce a practicing military
medical corps that
is consistently youthful and relatively inexperienced.
Why this severe military physician
retention problem? Obviously, the
military is not a good place to practice medicine. Here are some
contributing
factors:
Low Pay and Difficult Working Conditions. Why continue to work for
the federal government,
[which] is consistently demanding more and
more from physicians, when one can go to the private sector and still
work
as hard but be much better compensated for it?
This is true for all specialties and is a "no-brainer."
Inadequate
Retirement Plan. The retirement plan is not a good deal
for physicians. This is because it is based upon "base pay"
only, and
is not based upon the total income.
Too much Managed Care. The military now seems to have
a love affair
with managed care, and has forced it upon its physicians. Unless one
shares this passion for
managed care, practicing medicine in the
military, especially as a "PCM," is demanding, difficult and
frustrating.
This
is mainly because one does not have the autonomy to limit the
amount of HMO patients in his or her practice. Military
medicine (in
the MTF) is now 100 per cent HMO.
One primary care physician who recently left the military
described
the experience as "hellish" because of this. This leads to the next
reason.
Lack
of Autonomy. All physicians place a high degree of value upon
this, whether they are willing to admit it or not.
Most, if not all,
physicians are strong-willed, independent people or they would not
have the "right stuff"
to get into and through the rigors of medical
school and residency. (If the military allowed them a residencywhich
is
a whole other problem.)
Military physicians, simply because of the organization they are in,
have less autonomy
than any others. Granted, this is given up when
one chooses to "sign on the dotted line" and accept money from the
government
for medical education. But as soon as freedom can be
regained, most take advantage of the opportunity.
However
just because one "belongs" to the military does not mean that
there needs to be as much micromanagement of military
medical
practice that there now seems to be. This micromanagement is a direct
result of total "managed care."
Loss
of Traditional, "Old-Fashioned" Medical Values. Military
medicine now seems to be concerned more with numbers such
as
"metrics" and "productivity." Whatever happened to the patient?
The patient seems to have become lost in all this.
In fact, the
patient no longer exists at all; this is evidenced by the fact that
the patient has become
a "customer."
Pardon me, but a "customer" is someone who buys a hamburger from
McDonalds. A "patient" is
someone who seeks the help of a physician.
But wait, the physician has been lost also, the physician no longer
exists
either but is now a "provider." So, we
have "customers" "accessing" "providers." This doesnt sound like
medicine
at all. Sounds more like business doesnt it?
So, there we have it folks, military medicine is now all about
business.
What is business all about? MONEY. So, what is military
medicine all about now? MONEY.
Yes, private practice
is about earning money also, but it is not the
prime focus. Believe it or not, most physicians I know did go to
medical
school because they wanted to help people. People are what is
most important in their lives, not making money. On
the other hand,
the prime focus of military healthcare as a whole now seems to be
centered around money.
What
does this have to do with physician retention? Practicing
medicine in such an overly cost-conscious environment is
often very
difficult and frustrating because of the limitations that are imposed
in an effort to preserve
that which is valued the most: money.
What limitations? Limited pharmacy formularies, strict referral
criteria,
and the many other limitations imposed by managed care.
Career Progression Leads Out of Clinical Medicine. In
the military,
achieving higher rank (and thus higher pay), almost certainly means
leaving the practice of
medicine for a "desk job." This is a good
thing for physicians who dont want to practice medicine anymore, for
whatever
reason. But for most who want to continue the full time
practice of medicine AND experience career progression, there
is only
one direction to go: out.
Promotion Dependent upon Unnecessary Non-Applicable Professional
Military
Education. In the military, physicians cannot be promoted
beyond the rank of O-4 without "Professional Military Education."
This
"PME" is not geared toward medical officers in any way shape or
form, but rather is totally oriented toward line
officers. For a
physician who wants to become a line officer, this is probably a
necessary thing, but how
many of those are there?
Furthermore, I doubt we will ever see a medical officer in command of
a line organization.
Little
or No Professional Development. The military continues to deny
medical school graduates the opportunity to obtain
a seamless medical
education from medical school through residency before entering
practice. The military
has come under congressional heat for this and
deserves every bit of it. Hopefully, Congress will keep the pressure
on
to put an end to this archaic practice. No need is so great as to
justify this. All too often, these unfortunate
physicians must serve
out their entire time with incomplete medical training, because the
military
then
refuses to provide them with the additional education they need
and ask for, or they are so disillusioned and disappointed
with their
military medical experience (after what has happened to them) that
they just want to get it behind
them. This goes for GMOs and GMO-
flight surgeons.
Speaking of GMO-flight surgeons, isnt it baffling that
its pilots
among the militarys most valuable human assetsare being cared for
by its least trained physicians?
Go figure.
This list is by no means exhaustive. I could go on and on, but I
think most would agree that
I have hit the big ones. Will anything
be done to correct all this and thus the physician retention problem?
|
