2020/02/24 by Mark W. True, Mark W True, David Bell +9
Health Professions · Medicine · #Healthcare cost, quality, practices #Primary Care and Health Outcomes #Trauma and Emergency Care Studies
paper · pdf · doi:10.1093/milmed/usaa030
To ensure the Department of Defense (DoD) has a reliable supply of fully qualified physicians to serve in the Military Health System (MHS), the Armed Services fund over 3,000 physician trainees in various stages of graduate medical education (GME). This represents approximately 25% of the military physician workforce. About 1,200 residents and fellows begin their training programs each year. Together, the Army, Navy, and Air Force direct 183 nationally accredited internship, residency, and fellowship programs at 21 medical treatment facilities (MTFs) nationwide. Programs exist for the majority of medical specialties, and the services specify the number of trainees each program will admit, based on authorized and projected requirements for that specialty. Graduates are fully prepared to serve in a variety of military settings, from stateside MTFs to forward deployed teams worldwide. In the context of recent DoD budgetary pressure and transition of tri-service GME oversight to the Defense Health Agency (DHA), some senior DoD and congressional leaders question the value of military GME, assuming it would be better and cheaper to outsource preparation of military physicians to civilian GME programs. Neither assumption is correct, although it is important to acknowledge the additional value of civilian partnerships to augment case experiences of our residents, particularly surgical residents. Sending our trainees to civilian programs also makes sense when the MHS does not have the ability or capacity to train the number of physicians needed in a particular specialty. Even so, in this commentary, we cite seven key reasons (summarized in Table I and aligned with the MHS Quadruple Aim in Fig. 1) for maintaining the essence of military GME in its current form.