Response to Letter to the Editor concerning: Graduate Medical Education in the Military Health

We appreciate the comments made by Major General (Ret) Clark and have the following responses to his comments and suggestions.

With respect to our choice of term we used “military physician” as it is widely used in the Military Health System (MHS), more likely to be understood by civilian readers of the journal and our article dealt with graduate medical education (GME).

We concur that Family Medicine and the other primary care specialties are essential to providing high volume garrison care. They also play key roles when deployed. This is another argument for military GME, which requires trainees in all specialties to be more versatile and adaptable than their civilian specialty counterparts.

We agree with MG (Ret) Clark that physicians with skills in preventing “disease and non-battle injuries” are vital to sustaining combat operations. Shortly after the Civil War, Maj Jonathan Letterman, “the Father of Battlefield Medicine,” wrote: “A corps of medical officers was not established solely for the purpose of attending the wounded and sick. The leading idea is to strengthen the hands of the Commanding General by keeping his army in the most vigorous health, thus rendering it, in the highest degree, efficient for enduring fatigue and privation, and for fighting.” Although we noted the value of Preventive Medicine specialists in assuring the health of the force, other primary care disciplines also play important roles. Unfortunately, this is not currently reflected in the DoD’s list of combat casualty care specialties although primary care specialties are listed in the group of deployed specialties.

With respect to the observation regarding the variable quality of HPSP students, it was based on qualitative feedback received from MTF commanders and GME directors. This is why we recommend that the MHS track the success rate of graduates from different MD and DO medical schools to identify those that consistently turn out graduates who are well prepared for military GME.

Despite aligned missions (and overlapping responsibility for current and past Servicemembers), the organizational cultures of the MHS and Veterans Health Administration have hindered seamless cooperation.¹ A stronger partnership, built of unity of effort and accountability for results, would benefit both departments, promote the health of those they serve, and help assure a ready medical force.

ACKNOWLEDGMENTS

None declared.

FUNDING

The original manuscript and research were funded by the Henry M. Jackson Foundation for the Advancement of Military Medicine. There is no current funding for this work.

CONFLICT OF INTEREST STATEMENT

There are no conflicts of interest.

CLINICAL TRIAL REGISTRATION

Not applicable.

INSTITUTIONAL REVIEW BOARD (HUMAN SUBJECTS)

Not applicable.

INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (IACUC)

Not applicable.

INDIVIDUAL AUTHOR CONTRIBUTION STATEMENT

All authors reviewed the commentary and draft response and revised response as needed.

DATA AVAILABILITY

Not applicable

INSTITUTIONAL CLEARANCE

Does not apply.

REFERENCE

Author notes