The Coast Guard is struggling to recruit and retain physicians, flight surgeons, pharmacists, dentists and physician assistants after their five-year details to the service, the Government Accountability Office found in a new report.
The difficulties are largely due to a lack of promotion opportunities and financial incentives, the agency said. That means Coast Guard clinics studied by the GAO were often undermanned, lacking adequate U.S. Public Health Service staff and an insufficient number of Coast Guard health service technicians, who handle a variety of clinical tasks.
Roughly 37,000 Coast Guard men and women and more than 51,000 family members receive medical care from a variety of resources -- service members through Coast Guard clinics manned by the Public Health Service clinicians and Coast Guard health technicians, and members and beneficiaries through Defense Department medical facilities and the civilian Tricare network.
For Coasties, Coast Guard clinics are the primary resource for medical care, given that they are located in "medically underserved areas" that lack a sufficient number of health care providers.
The staffing issues, a nationwide physician shortage and the remoteness of many installations significantly affect health care access for members of the Coast Guard and their families, the GAO reported.
As of September, the Coast Guard had a Public Health Service vacancy rate of 18%, according to the service. The U.S. Public Health Service is one of eight uniformed services in the country, part of the Department of Health and Human Services that provides medical personnel and public health experts to the Centers for Disease Control and Prevention, the Indian Health Services, the Food and Drug Administration, the Coast Guard and the Bureau of Prisons.
Pre-deployment medical care demands, as well as the Coast Guard's transition to a new electronic health records system, MHS Genesis, have increased the workload on health service technicians and also reduced the number of appointments available at the clinics that were reviewed.
Service members not located near a Coast Guard clinic and their beneficiaries also can get medical care at Defense Health Agency facilities, although dependents have a lower appointment priority.
Given the remote locations of many duty stations, a significant number of Coast Guard beneficiaries do not reside near a military health facility.
They can enroll in Tricare Prime Remote, a program that allows them to go to a military treatment facility or primary care manager despite excessive drive times. They can also enroll in Tricare Select, which means they are dependent on Tricare networks run by civilian Tricare benefits management companies -- Health Net Federal Services in the West Region and Humana Military in the East.
This is where some Coast Guard families found the most significant challenges in getting care, according to the report.
Coast Guard family members with access to military health facilities generally could get specialty care within the accepted standard of 28 days. But they faced challenges in the network, particularly for obstetrics and gynecology, mental health and dermatology.
According to the GAO, one Coast Guard clinic said its patients had no access to a psychiatrist or psychologist that took Tricare patients, while another said its patients had to wait up to five months for a mental health appointment.
For its report, generated at the request of Congress in 2020, the GAO reviewed records and interviewed officials at six Coast Guard clinics: Kaehler Memorial Clinic in Buzzards Bay, Massachusetts; Air Station Detroit Clinic in Selfridge, Michigan; Sector Key West Clinic in Key West, Florida; Base Kodiak Rockmore-King Clinic in Kodiak, Alaska; Sector Humboldt Bay Clinic in McKinleyville, California; and Base Portsmouth Clinic in Portsmouth, Virginia.
The service is taking steps to improve access to care, to include hiring contractors, relying more heavily on telehealth, and shifting assignments or filling open positions with Reserve members.
The Coast Guard also has launched a direct commission program to create its own health service officer corps and had recruited six physicians and four dentists as of November. And beginning this year, it is training health service technicians to provide behavioral health care for Coast Guard personnel.
Still, the service needs to do more, GAO analysts said. They made seven recommendations that included the Coast Guard digging deeper into the reasons Public Health Service providers leave; improving data collection and sharing with the Defense Health Agency on Coast Guard beneficiaries' access to health care; routinely monitoring access to care, not just when a problem arises; and keeping better track of access to military treatment facilities and network providers.
In its response to the report, the Department of Homeland Security, which oversees the Coast Guard, largely concurred with the GAO's recommendations, saying the service already had taken steps to monitor beneficiaries' access to Tricare physicians and citing the new health services commissioning program.
Jim Crumpacker, director of the DHS' GAO-Office of Inspector General Liaison Office, said the service expects to implement many of the recommendations by March 2024.
"DHS remains committed to ensuring access to medical and dental care for Coast Guard active-duty personnel and their dependents, and others, in support of Coast Guard missions as appropriate," Crumpacker wrote in the response.
-- Patricia Kime can be reached at Patricia.Kime@Military.com. Follow her on Twitter @patriciakime