Points of Interest: Navy Told to Phase Out Undertrained Doctors

By Tom Philpott

Martin said it is time the military raised physician standards to match trends in mainstream America. "The judgment is that [the GMO program] might have worked 10 or 20 years ago, but today they're not adequately trained to provide care, particularly in isolated duty," Martin said.

The Defense Department has set a four-year deadline for the Navy, Air Force, and Army to phase out recruitment of general medical officers and pull them from billets where their performance cannot be monitored.

Current general medical officers will be allowed to stay for full careers, but some will see their assignment choices narrow as the military tightens standards on care. Most GMOs will be given an opportunity to get two or three more years of graduate training to become fully qualified specialists. Over time, GMO billets will be filled with medical board-eligible specialists in family practice, pediatrics, internal medicine, emergency medicine, or occupational medicine.

Service officials have worried for years about general medical officer qualifications but have been slow to raise standards. It is easier and cheaper to fill fleet billets with GMOs than with more-qualified physicians.

Phasing out general medical officers was one of 13 initiatives Martin unveiled before Congress in February to improve the quality of military medicine. It was not sparked by any high profile malpractice case or a rash of mishaps, officials said. "There is every indication GMO performance has been excellent," said the Navy in a statement.

But Martin told his staff he does not want to wait until a tragedy occurs to raise physician quality. "We all know, conceptually, these people should be better trained, so let's do it," said a Defense official paraphrasing Martin's message to the services.

It will be a particularly tough challenge for the Navy, Martin conceded, given the "sizable number of doctors involved."

The Army has a few hundred general medical officers. The Air Force has 450, about 14% of its physician inventory. One-fourth of Navy physicians—or 750—are GMOs. That quality gap will be expensive to close.

The Navy came to depend more heavily on GMOs because it is a forward-deployed force. One-third of its physicians serve with operational forces. It made perfect sense at one time to send young doctors, only a year out of medical school, to care for young, healthy populations at sea. More highly trained physicians are in hospitals where there is a greater need and where their skills can remain sharp.

Deploying GMOs also made fiscal sense. "The Navy didn't have to invest in specialty training for these people until they were mature enough to know this is the life they really wanted," an official said.

After operational tours, many general medical officers go on to complete their residency program and become board-eligible specialists. Others become comfortable as GMOs and never seek additional formal training.

Over the years, however, medical school has become focused more on classroom work rather than providing the practical, hands-on experience that helped to prepare general medical officers for isolated duty, an official explained.

Also, more is expected of doctors today when assigned to ships or deployed with Marine Corps forces. For example, many GMOs lack training in female health issues, yet more and more women are being assigned to operational units.

To comply with the general medical officer phase-out program, the Navy will begin an aggressive recruiting effort of civilian doctors currently enrolled in residency training. It already has begun removing GMOs from units that have a "broad spectrum" of patients, officials said. That includes aircraft carriers and amphibious ships.

Dr. James A. Zimble, president of the Uniformed Services University of the Health Sciences in Bethesda, Maryland, where many service doctors are trained, warned that replacing GMOs with fully trained specialists must be done incrementally. A former Navy surgeon general, Vice Admiral Zimble said he is not even certain all GMOs need to be phased out.

"We have to be sure in key locations that we do have the appropriate training," Dr. Zimble said. "But perhaps a better solution would be increased use of tele-consultation and other aspects of tele-medicine to reinforce the GMO."

The Navy continues to recruit GMOs but their numbers are expected to decline steadily. The Air Force stopped recruiting general medical officers last fall and began assigning GMOs only to medical units that have residency-trained physicians who could be consulted when questions arise.

Navy officials said plans to deploy better-trained physicians to operational units will not come at the expense of hospital care. "There will be no impact on staffing of Navy hospitals for family member and retiree care," said officials in a statement. "One key element in developing the plan is to ensure staffing of Navy hospitals will not be compromised."

 

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