thedrifter
10-22-07, 06:27 AM
Not enough doctors
Stalled recruiting efforts may lead to greater shortage
By Chris Amos - camos@militarytimes.com
Posted : October 29, 2007
The Navy could have a 10 percent shortfall in its normal complement of 3,700 physicians and a 5 percent shortfall in its 1,000 dentists by 2013, a shortage that could put more pressure on an already strained Navy health care system.
And the shortage could be more painful than the numbers suggest because it would be concentrated in the ranks of the Navy’s newest doctors — lieutenants who do much of the primary care work in the fleet and at base hospitals, and fill residency programs that will provide most Navy medical specialists in future years.
Navy medical fellowships, which provide follow-on training for specialties such as neurosurgery and psychiatry, could be forced to close because they fall below the minimum number of students needed to keep their accreditation.
Military officials agree that a major cause of the shortfall has been the war in Iraq, which has led increasing numbers of students to reject a scholarship program that has historically provided about 80 percent of Navy doctors.
The Health Professions Scholarship Program pays tuition and a monthly stipend for every year of medical school that the student participates, according to Capt. Jeff Macdonald, director of personnel policy at the Navy’s Bureau of Medicine and Surgery. The stipend of $1,605 will increase to $1,907 next September.
In exchange, medical and dental students must serve one year as a physician or dentist for every year of financial aid they get. For most, that means a four-year commitment to the Navy after they finish their training.
The HPSP had done well until recently. In fiscal 2003 — which included a six-month period before the invasion of Iraq — the Navy missed its goal of 290 medical students by just one student and met its goal of recruiting 80 dental students.
But as the war in Iraq drags on, recruiting shortfalls are mounting. In fiscal 2007, the Navy recruited into the program 62 percent of the doctors and 87 percent of the dentists it needed and now has a cumulative shortfall of 372 medical students and 54 dental students since fiscal 2004. That gap will be felt over the next few years, as fewer medical students graduate and get commissioned.
This is noteworthy, because in 2006 the average medical student at a public university graduated with more than $119,000 in medical school debt. Their counterparts at private schools graduated with more than $150,000 in debt.
But military officials say that increasing numbers of medical students would rather leave medical school deep in debt than face the prospect of repeated deployments to Iraq and Afghanistan.
A smaller source of Navy doctors, the Uniformed Services University of the Health Sciences, has met its recruiting goal of about 50 people each year for the past five years. Navy officials say that this is because students are paid more than the scholarship recipients.
Billet cuts are coming
Navy doctors said the war has not been the only cause of the shortfall. Navy medical billets have been slashed as Defense Department officials seek to use civilian doctors at base hospitals that treat large numbers of dependents and retirees.
Between 2005 and 2012, the Navy is projected to lose 28 percent of its dentist billets; 14 percent of medical service corps billets, which include physical therapists, pharmacists and physician assistants; 6 percent of physician billets; and 4 percent of nurse billets.
Cmdr. Larry Bateman, deputy director of personnel for BuMed, said cuts will be done either through attrition or by allowing personnel in billets targeted for conversion to civilian jobs to move into operational billets.
But a Navy doctor who declined to be identified said conversions make it harder to recruit doctors because a major draw of military medicine is the opportunity to work with a broad range of patients in different environments.
“The question is whether deploying personnel will have any place to return to and provide medical care for active duty, retirees and dependents as they have been trained to do,” he said.
Moreover, the doctor noted, the Navy has had a hard time competing for the best civilian physicians and dentists because the pay, benefits and working conditions it offers often do not compete with civilian employers.
The result is that Navy physicians and dentists are overworked and over-deployed, and as word of that has spread, recruiting has predictably dropped.
In an effort to head off the shortage, the Navy has begun paying $20,000 bonuses to encourage students to accept the HPSP scholarship.
While that might address shortfalls in future years, it will do nothing to reduce the shortages that could be present in military medicine for the next 20 years. To address those shortages, the Navy plans for the first time to begin paying bonuses to lure doctors into uniform.
Ellie
Stalled recruiting efforts may lead to greater shortage
By Chris Amos - camos@militarytimes.com
Posted : October 29, 2007
The Navy could have a 10 percent shortfall in its normal complement of 3,700 physicians and a 5 percent shortfall in its 1,000 dentists by 2013, a shortage that could put more pressure on an already strained Navy health care system.
And the shortage could be more painful than the numbers suggest because it would be concentrated in the ranks of the Navy’s newest doctors — lieutenants who do much of the primary care work in the fleet and at base hospitals, and fill residency programs that will provide most Navy medical specialists in future years.
Navy medical fellowships, which provide follow-on training for specialties such as neurosurgery and psychiatry, could be forced to close because they fall below the minimum number of students needed to keep their accreditation.
Military officials agree that a major cause of the shortfall has been the war in Iraq, which has led increasing numbers of students to reject a scholarship program that has historically provided about 80 percent of Navy doctors.
The Health Professions Scholarship Program pays tuition and a monthly stipend for every year of medical school that the student participates, according to Capt. Jeff Macdonald, director of personnel policy at the Navy’s Bureau of Medicine and Surgery. The stipend of $1,605 will increase to $1,907 next September.
In exchange, medical and dental students must serve one year as a physician or dentist for every year of financial aid they get. For most, that means a four-year commitment to the Navy after they finish their training.
The HPSP had done well until recently. In fiscal 2003 — which included a six-month period before the invasion of Iraq — the Navy missed its goal of 290 medical students by just one student and met its goal of recruiting 80 dental students.
But as the war in Iraq drags on, recruiting shortfalls are mounting. In fiscal 2007, the Navy recruited into the program 62 percent of the doctors and 87 percent of the dentists it needed and now has a cumulative shortfall of 372 medical students and 54 dental students since fiscal 2004. That gap will be felt over the next few years, as fewer medical students graduate and get commissioned.
This is noteworthy, because in 2006 the average medical student at a public university graduated with more than $119,000 in medical school debt. Their counterparts at private schools graduated with more than $150,000 in debt.
But military officials say that increasing numbers of medical students would rather leave medical school deep in debt than face the prospect of repeated deployments to Iraq and Afghanistan.
A smaller source of Navy doctors, the Uniformed Services University of the Health Sciences, has met its recruiting goal of about 50 people each year for the past five years. Navy officials say that this is because students are paid more than the scholarship recipients.
Billet cuts are coming
Navy doctors said the war has not been the only cause of the shortfall. Navy medical billets have been slashed as Defense Department officials seek to use civilian doctors at base hospitals that treat large numbers of dependents and retirees.
Between 2005 and 2012, the Navy is projected to lose 28 percent of its dentist billets; 14 percent of medical service corps billets, which include physical therapists, pharmacists and physician assistants; 6 percent of physician billets; and 4 percent of nurse billets.
Cmdr. Larry Bateman, deputy director of personnel for BuMed, said cuts will be done either through attrition or by allowing personnel in billets targeted for conversion to civilian jobs to move into operational billets.
But a Navy doctor who declined to be identified said conversions make it harder to recruit doctors because a major draw of military medicine is the opportunity to work with a broad range of patients in different environments.
“The question is whether deploying personnel will have any place to return to and provide medical care for active duty, retirees and dependents as they have been trained to do,” he said.
Moreover, the doctor noted, the Navy has had a hard time competing for the best civilian physicians and dentists because the pay, benefits and working conditions it offers often do not compete with civilian employers.
The result is that Navy physicians and dentists are overworked and over-deployed, and as word of that has spread, recruiting has predictably dropped.
In an effort to head off the shortage, the Navy has begun paying $20,000 bonuses to encourage students to accept the HPSP scholarship.
While that might address shortfalls in future years, it will do nothing to reduce the shortages that could be present in military medicine for the next 20 years. To address those shortages, the Navy plans for the first time to begin paying bonuses to lure doctors into uniform.
Ellie