Letter to the Editor Concerning: Graduate Medical Education in the Military Health System: Strategic Analysis and Options, Degutis, L, et al., Military Medicine, 188, March/April Supplement, S1:1, 2023

COMMENTARY

I appreciate the authors’ Military Medicine March/April 2023 Supplement DHH article “Graduate Medical Education in the Military Health System: Strategic Analysis and Options” initiated at the request of the then ASD-HA, Dr Jonathan Woodson in 2014.

I will also appreciate the authors’ thoughts on the following comments/suggestions:

I suggest the term Medical Corps Officers is more representative of the roles, responsibilities, and expectations of volunteers who simultaneously serve the profession of arms and the profession of medicine than “military physicians.” The same is true for Dental Corps, Medical Service Corps, Nurse Corps, Specialist Corps, and Veterinary Corps Officers.

I suggest Family Medicine should be included in the list of specialties that “MTFs desiring to provide high-volume garrison, family, and retiree care require robust support from…” Not only is Family Medicine (Army, Navy, and Air Force) “among the major specialties with high shares of deployed time per year,” uniformed family physicians are foundational to primary care within our military hospitals and clinics.

I suggest primary care (Family Medicine, Internal Medicine, and Pediatrics) and Preventive Medicine be included in Specialties required for Combat Operations. Historically, the majority of casualties during Combat Operations are Disease NonBattle Injuries; many of these casualties are preventable and/or easily treatable and Returned to Duty; and, thus, Disease NonBattle Injuries casualties often may resume their status as available forces. As Viscount Slim noted in his must-read memoir, Defeat into Victory: Battling Japan in Burma and India, 1942–1945, “Nor was it much use trying to increase our hospital accommodation; prevention was better than cure. We had to stop men getting sick, or, if they went sick from staying sick.”

Since “about 85% of medical students in military GME programs come from HPSP,” it will be helpful to have data to support the Gaussian-Curve statement: “the quality of HPSP students is variable: some are outstanding, many are solid performers, but a concerning number arrive with poor skills, or limited knowledge and require extensive remediation.”

Military Health System (MHS) and Veterans Health Administration (VHA) collaboration in the care of our patients is a natural and obvious partnership.

I suggest that it is the responsibility, and of critical and urgent importance, to our MHS and our VHA to create conditions for local Military Treatment Facilities and Veterans Administration Medical Centers to partner in the care of our patients. Such a partnership has been discussed for decades with no tangible result leaving it to the personalities, inclinations, and administrative ingenuity of local MTF and VAMC leaders to collaborate in the care of our patients.

Thus, I suggest a fifth Course of Action:

MHS and VHA set a deadline of September 30, 2023 to establish an agreement that sets an expectation and the framework (cost, workload accountability, quality and safety, etc.) for local MTF and VAMC leaders to collaborate in the care of our patients to achieve the following: Ready Medical Force, Access to Care, GME opportunities for MHS trainees, Stewardship and Accountability of Resources, etc.

Jeffrey B. Clark MD, MPH, MSS, FAAFP

Major General, US Army, retired

[email protected]

505-660-9614

ACKNOWLEDGMENTS

None declared.

FUNDING

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CONFLICT OF INTEREST STATEMENT

None declared.

DATA AVAILABILITY

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CLINICAL TRIAL REGISTRATION

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INSTITUTIONAL REVIEW BOARD (HUMAN SUBJECTS)

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INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (IACUC)

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INDIVIDUAL AUTHOR CONTRIBUTION STATEMENT

The Letter to the Editor are the comments of the author.

INSTITUTIONAL CLEARANCE

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Author notes