The United States is facing a serious doctor shortage. As a retired military physician employed by the UNC health care system in North Carolina, we are constantly dealing with the consequences of too few physicians.
It has taken us one year to find a qualified doctor for our practice, although we are actively recruiting and paying tens of thousands of dollars in commissions to find one physician. I am considering retirement but we want a physician as well trained as I am to replace me. The military still produces similar providers, but there are already too few of us to go around.
Unfortunately, this crisis is poised to get even worse. According to its 2020 budget, the Pentagon plans to cut 18,000 doctors, nurses, dentists and other specially trained medical positions from its ranks.
This plan is bad news for doctors and patients alike.
Military doctors — a role like no other
As an Army family physician, I trained in advanced trauma life support care. I was parachute-qualified and sent on foreign missions starting just two months after completing my residency. I was in the first plane when I was told the white tape on my arm meant that if my plane could not launch, I would be moved to another plane. I was mission essential. Of the as many 3,600 paratroopers lined up behind planes, only 14 of us were doctors. Each one of us wore the white tape on our arms.
There were very few U.S. civilian doctors in Iraq when I was there in the early 2000s. There was a great need for advanced trauma care 24-hours a day during the war, and uniformed doctors filled that need.
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We were military doctors. We were in combat zones to save lives during battle, but we also carried guns — and we knew how to use them. I have delivered over 200 babies in war zones and in the states. They became my new patients. I followed them as they grew. I circumcised the boys. I provided every child's life-saving immunization.
My uniform told soldiers, and their family members, I was a military doctor. I jumped out of the same planes as they did. I wore flight surgeon wings and cared for pilots who trusted me. My rank told them how many years I had practiced. No one worried about my abilities or credentials. Military doctors like me earned a patient’s trust by serving side-by-side.
When I retired from the Army in 2006 and decided to start a private practice, my malpractice insurance provider told me my rates would increase by $100,000 if I continued to deliver babies. To perform another vasectomy would add $7,500 to my malpractice insurance.
So, I stopped doing some of the tasks I was trained to do, and I sent my patients to the hospital where the cost of their care often tripled.
Civilian health care is broken
Sadly, my civilian patients often can’t afford their medicines or an office visit. Their high deductible insurance plans require them to pay as much as $250 for an office visit, when their insurance will only pay, say, $68. This continues until they have paid between $2,500 and $13,000 — the cap on their deductible. These plans offer lower monthly premium rates for coverage, but they come with untenable upfront costs if they need a doctor for any reason.
Here’s an example of civilian medicine in action: When patients lose their insurance, diabetics stop coming to needed office appointments. They stop taking their insulin and blood pressure medications. After getting a new job and new insurance, they come back with a pile of problems that could have been mitigated if the treatment was affordable and accessible.
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Many civilian clinical providers in the Department of Defense are eligible to join a union, and there are workplace benefits to union membership that are not extend to active duty troops. Civilian contractors don’t have a union. However, to get a contract provider to the many less-desirable locations is a challenge — and likely a costly one. I've seen less qualified physicians volunteer for these challenging roles, or the uniformed providers will be sent. This can hurt quality of care and military retention, as well as potentially greatly increasing the cost.
Military doctors are not paid as much as their civilian counterparts. And I know from my experience in both spheres that military doctors work longer hours. Their families, mine included, move and change schools frequently. They are stationed in Seoul, Korea; Minot, North Dakota; and Fayetteville, North Carolina, where civilian providers are often reluctant to go. They stay, and serve, for retirement benefits, and national pride.
A medical and military colleague recently reminded me that his patients currently in uniform as well as veterans routinely ask for a military provider. It provides an instant rapport and trust that positively affects patient care and compliance.
Surgeons need to operate. Pulmonologists need to have access to an intensive care unit. Family physicians need to deliver babies and care for infants. The remaining uniformed physicians, if the proposed cuts occur, will likely be relegated to operational jobs that contract providers are not trained for. Provider skills will deteriorate as they increasingly perform only active duty sick calls on soldiers, sailors and Marines.
The snowball effect will find uniformed providers underutilized in their specialty, contractors caring for soldiers in the emergency room and hospitals, and the soldiers losing trust in both. The long-term costs for our military and medical system will be enormous.
Bob Adams is a former Navy SEAL and a retired colonel with the Army Medical Corps. He is the author of "Six Days of Impossible – Navy SEAL Hell Week." While in uniform, he commanded various Army clinics and served as the Delta Force command surgeon. He is on the board of the Veterans Life Center of North Carolina and a life member of the Military Officers Association of America. Follow him on Twitter @buds81.
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This article originally appeared on USA TODAY: US doctor shortage: Pentagon plans unwise cuts in military doctors