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V—Jince July 1973, for the first time in 23 years, the U. S. Navy can no longer depend on the draft for its physicians. Except for the physicians committed to the draft-oriented Berry Plan pool—which permits full deferment from active duty until specialty training has been completed in exchange for a two-year service obligation—we now must compete on the open market with the civilian sector and all other consumers of physicians for our requirements. Various skeptics at all levels within and outside of the military prophesy that without the doctor draft, military medicine is dead as a viable and professionally attractive institution.
This is ironic because the Navy’s health care delivery system is outstanding professionally, is innovative in health matters, and is professionally viable. It ranks high among our nation’s outstanding total health care systems. With 29 hospitals and medical centers accredited by the Joint Commission on Accreditation of Hospitals, 35 graduate training programs in naval hospitals, approximately 150 interns and 740 residents with 261 first year positions, 165 dispensaries, multiple research centers both in-country and abroad, multiple technical training schools in every field of health care, and a continuously enlarging group of eligible patients of close to three million in all age groups, sexes, and races, the U. S. Navy has the base for the development of highly qualified professionals needed to cope with the full range of health and medical problems, civilian and military.
Congress must and will provide Navy Medicine with the full compensatory resources with which to compete, economically and professionally, with the private sector.
But what will happen if Congress docs not provide the necessary support? Figure I illustrates the medical officer strength projections for the next five years if neither congressional action nor our in-house initiatives are fruitful.
Once into a decline, the trend will be difficult to reverse. Losing a physician means losing a teacher;
Figure 1 Projected Medical Corps Shortfalls
| FY 74 | FY 75 | FY 76 | FY 77 | FY 78 |
Requirement | |||||
Plan | 4080 | 3841 | 3763 | 3763 | 3763 |
On Board | |||||
Strength | 3340 | 3052 | 2752 | 2362 | 2068 |
Predicted Losses | 1790 | 1030 | 1000 | 900 | 715 |
Known | |||||
Accessions | 997 | 742 | 710 | 510 | 421 |
Shortfall | 740 | 789 | 1011 | 1401 | 1395 |
without teachers we lose accreditation of our postgraduate specialty training programs; without training programs we lose recruiting and retention incentives; without incentives we lose the physician, and so on.
Even with full congressional support, our renewal will be a protracted "iffy” thing with a lot of hard work in store; it will be measured in a short, mid-term, and long-term time frame.
By short term, I refer to our present shortage of physicians, due mainly to the end of the doctor draft in the absence of needed compensatory reprogramming. By the most informed estimate, this short-term crucial problem will last two years and is expected to worsen before it recedes.
The mid-range years of roughly 1976 through 1978 will bring a remarkable recovery. We will then be well on our way to the greatest renewal military medicine has ever known. A doctor draft will have been held in reserve, but never used. The three features most responsible for the turnabout will have been pay scales more equitable with the civilian sector; an ambitious educational subsidy with high volume accessions; and a heavy commitment in medical military construction, emphasizing the use of automation not only in the administrative side of the house but in patient care areas as well.
Especially significant in the long term will be the new Uniformed Services University for Health Sciences now off to a very healthy start, and programmed for initial class entry in September 1975 and for bricks and mortar in 1978.
Congressional Support. Many factors will be responsible for the survival of the Navy Health Care Deliver)' System in an all volunteer force environment—but because the lifeblood of military medicine flows from the Congress, the primary responsibility must rest with that body. Congress has placed us in the categorically untenable position of having to compete with the civilian sector for that high priced commodity, the draft-free physician. It is time that Americans, both those actively involved in public life and the American citizen himself, realize that we cannot end military' conscription and then fail to support the cost of attracting and retaining volunteer servicemen. If military medicine is to survive in an all volunteer force environment, three initiatives—Equitable Pay, Educational Subsidy, and Modern Treatment Facilities—must be taken now by Congress to help retain those physicians who are on active duty and to attract young physicians to military medicine.
The first of these initiatives, more equitable pay scales for physicians, would serve to get us through the short term period of our problem and form the foundation upon which other "factors” could build a
The Survival of Navy Medicine 37
Figure 2 Comparison of Military Physician* earnings with Civilian Physician in the first five years of private practice
Fiscal | Military** | Civilian*** | Military as a Percent | Actual Dollar |
Year | Earnings | Earnings | of Civilian Earnings | Difference |
1951 2 | $ 7923 | $ 12360 | 64.1% | $ - 4437 |
3 4 5 | $ 9201 | $ 12970 | 70.9% | $ - 3769 |
6
7
8 9 |
|
|
|
|
|
1960 1 | $ 11251 | $ 17900 | 62.9% | $ | - 6649 |
2 3 | $ 13450 | $ 20290 | 66.3% | $ | - 6840 |
4 |
| $ 22920 |
|
|
|
5 | $ 14193 | $ 24300 | 58.4% | $ | -10107 |
6 •7 |
| $ 25200 |
|
|
|
7 8 | $ 15197 | $ 33500 | 45.4% | $ | -18403 |
9 | $ 15961 | $ 35000 | 45.6% | $ | -18039 |
1970 | $ 17574 | $ 36250 | 48.5% | $ | -18676 |
1 | $ 19672 | $ 40790 | 48.2% | $ | -21118 |
2 | $ 21639 | $ 44390 | 48.7% | $ | -22751 |
3 | $ 23840 | $ 48310 | 49.3% | $ | - 24470 |
* Lieutenant Commander, over 8 for pay purposes with Copay ** Military pay tables for appropriate years *** Average for first 5 years of practice
more attractive career package for health professionals.*
Physicians suffer the greatest financial loss by having to serve. The pay and allowances received by a young doctor entering military service have been approximately one-half the amount he could earn as a civilian, as illustrated in Figure 2. Despite relatively rapid promotions, special pay and continuation pay, a military physician, compared to his civilian counterpart, is significantly underpaid throughout his career.
Primarily for this reason, doctors do not usually remain in the military. In fact, 60% of all military doctors have served less than two years.
The second initiative will have to be an ambitious educational subsidy from which we can reasonably expect high volume accessions. Our subsidy programs have been our most fertile source for career physicians. For instance, of the 1,300 physicians accessed in the Navy Intern and Senior Medical Student Program during the 1960-1969 period, 455 or 35% remained beyond
'The President recently signed a bill which authorizes the maximum of *13,500 in a variable incentive bonus to be paid to certain physicians. The "nplementing directive is being prepared.
their obligated time. Much of this success can be attributed to our excellent residency training programs. Although we are not fully satisfied with this retention rate, it compares favorably with the retention rates experienced through the draft, Berry Plan, and volunteers for the same period which were 1.5 per cent, 1.1 per cent, and 9-9 per cent respectively.
We now have a sufficient array of attractive scholarship, education, and research-oriented programs. We need support from the Congress to maintain the current level and in some instances, increase the scholarship enrollment and the opportunities for professional training, education, and research in military medicine.
Navy Medical and Osteopathic Scholarship Program (A1QSP). The Naval Academy has a pre-medical bioscience major track in which up to 2% of the class may participate. Members of the Naval Reserve Officers Training Corps scholarship program may pursue a premedical major. Up to 2% of the graduates of these programs may be selected competitively for appointment to the fully sponsored Navy Medical and Osteopathic Scholarship Program. Any officer or enlisted
38 U. S. Naval Institute Proceedings, August 1974
member of the Navy or Marine Corps who has on his or her own initiative, obtained an admission commitment from an accredited school of medicine or osteopathy in the United States or Canada, is eligible for competitive selection for the Navy MOSP. A MOSP participant is commissioned on entry as ensign 1965. During medical school he serves on active duty at full pay and allowances with all fringe benefits and normal promotion opportunity. Tuition fees and a book allowance are provided by Navy Medical Department training funds. The program participant incurs an obligation to serve on active duty which is in addition to any other obligation he may have previously incurred. This obligation is calculated as three years for the first year of participation and two years for each year thereafter, but not to exceed a total of seven years.
Cumulative Years of Sponsorship Years of Obligation
1 3
2 5
3 7
4 7
The MOSP graduate may seek continuum of his graduate education through application to in-service programs or he may be assured of one year of graduate education in a civilian program after which he can expect to return to active duty. We hope to derive the future "core of the Corps” from MOSP. The medical officer who then completes residency training in Navy programs and becomes fully trained will have at least seven years of active duty under his belt, and upon completing his remaining obligation, will have accumulated around 16 years of active duty. Such an investment is highly conducive to a 20-plus year career.
At present there are only 250 billets for the Navy Medical and Osteopathic Scholarship Program. Competition is intense and selection opportunity in Fiscal Year 1971 was 1:10. In Fiscal Years 1972-1973, it was about 1:8. Selection to this program for FY-74 is limited to active duty members of the Navy and Marine Corps and graduates of the Naval Academy or Naval Reserve Officers Training Corps Scholarship Program. Congress has directed that no further appointments will be offered to Naval Academy graduates beginning with the Plebe class entering in 1974.
Uniformed Services Health Professions Scholarship Program. This program, implemented by DOD Directive 1215.14 of 5 Oct 1972, covers all health professional disciplines with a scholarship ceiling of 5,000. Of these, 1,050 have been allocated by the Department of Defense to the Navy for the disciplines of medicine and
osteopathy. Procurement is through competitive selection from civilian or nonobligated inactive reserve members in or accepted to accredited schools of medicine or osteopathy in the United States (including Puerto Rico). Selectees are commissioned in the inactive Naval Reserve component at the ensign level with a 1975 designator. The participant receives $400 per month. Ordinary and necessary educational expenses and tuition are paid by Navy Operation and Maintenance funds. The participant is called to active duty under instruction for 45 days each year. He may remain in the civilian institutional program during this 45 days if the curriculum does not permit his duty under instruction to be performed at a naval facility. His annual direct income approximates $5,300 in addition to tuition, fees, normal educational expenses and fringe benefits. Active duty obligation upon completion (or termination) of the program is year-for-year, but not less than two. The graduate must seek his graduate training in an accredited in-service program. If not selected, he may continue in civilian inactive reserve status without Navy sponsorship in a deferred status to pursue graduate training in a discipline approved by the Navy on the basis of a projected requirement for his services in that specialty.
Senior Medical Student Program (SMSP). This is an older program, formerly popular as an alternative to the uncertainties of the physicians’ draft, but of interest to relatively few students in the present climate. Billet authorization has been reduced from 200 to 55 for Fiscal Year 1974. Selectees are brought on active duty under instruction during the senior year and receive full pay and allowances of their rank (ensign or lieutenant, junior grade). No additional support in the nature of tuition, fees or book allowance is provided. The participant is obligated to serve on active duty for three years.
Early Commissioning Program (Ensign 1919). This is another older program, dating from 1940. It is basically a no-cost program except for about 100 spaces per year and provides for up to 60 days duty under instruction for clinical and research clerkships in naval medical facilities. It remains a path by which the medical student may identify with the Navy early and increase his opportunity for selection to sponsored educational programs.
Graduate Medical Education. We now have accredited clinical residencies and fellowships of one to five years duration for medical officers in 35 specialty and subspecialty disciplines at nine naval medical facilities. These programs are carried out in the context of a formal on-the-job effort so that the training and operational components are not actually separable. Instructors, and the residents and fellows are also working
together to supply quality health care services while simultaneously achieving education and training goals and objectives. The resources used for these programs serve the needs of three concurrent efforts—quality patient care, education, and clinical investigation.
The Navy also sponsors full time training in clinical md research disciplines where a clear-cut requirement exists for expertise in particular fields and where the training spaces of in-house military programs are numerically insufficient, or where no service capability exists. Selected examples include accredited training in neurosurgery, radiobiology, the required curriculum of general preventive medicine, occupational medicine, and aerospace medicine. Our professional graduate education programs are individually approved by the Council on Graduate Medical Education of the American Medical Association. Continuing education is essential to professional competence and credible public accountability. This is accomplished through a variety of formats, Usually involving short periods of intense effort ranging from hours spent in conferences or individual study through several days in seminars or symposia, to several months spent in postgraduate courses.
Uniformed Services University of Health Sciences. The Uew Uniformed Services University of Health Sciences, established by Public Law 92-426 will play an increas- lngly important role in the future of an all volunteer health professional environment. The law provides that the University will graduate not less than 100 medical students annually with the first class graduating not tater than ten years after the date of the law’s enact-
At the National Naval Medical Center, Betbesda, Maryland, above, and at nine other naval medical facilities, the Navy has accredited clinical residencies and fellowships in 35 specialty and subspecialty disciplines. Betbesda Medical Center, consisting of a training hospital, a graduate dental school, a data services center, a research institute, a medical training institute, a school of health care administration, a toxicology unit, and the Armed Forces Radiobiology Research Institute, will be the site of the new Uniformed Services University for Health Sciences.
40 U. S. Naval Institute Proceedings, August 1974
ment, which was 21 September 1972. Students will be commissioned officers of a uniformed service serving on active duty in pay grade 0-1 with full pay and allowances of that grade. Students who graduate are required, unless exempted, to serve for not less than seven years.
The University will provide a small, steady portion of the physician needs of the Armed Forces. Such a school should not attempt to satisfy all the medical officer requirements of the Armed Forces any more than the Service academies now attempt to meet all the line officer requirements of the Armed Forces. The majority of our physicians will continue to be trained at the many varied civilian medical institutions. This intermixture of multiple sources is desirable. It will ensure diversity, fresh ideas, and avoidance of inflexibility.
It will complement and enhance the numerous professional affiliations and agreements already existing and continuing to expand between military and civilian facilities. It will offer an opportunity for our medical personnel in all the health professions to advance in their professional program, to do teaching, research, and to obtain further professional leadership required for military medicine of today. The university will revitalize military medicine by presenting career personnel with new challenges and new opportunities not presently available in any program, civilian or military.
Patient Mix. Anyone who understands medicine at all knows that patient care, medical education, and research is an indispensable triad, the segmental qualities of which are mutually dependent upon each other. However, several government agencies are bent on rendering us incapable of any academic endeavor. They hold that military medical care should be restricted to the active duty patient to the exclusion of our dependents and retirees.
Not only do these agencies fail to recognize in military medicine one of the few truly successful comprehensive health care systems in the country, but they are totally unappreciative of the fact that only with a cross-sectional clinical load can our system engage in the education, training, and research so essential to quality professionalism.
The third and last incentive directly related to attracting and retaining quality health professionals and which requires congressional support, is the need for a heavy commitment in medical construction. Given the other two features already discussed, physicians would be more prone to voluntarily associate with a Navy health care system in which the facilities are functionally adequate and offer the latest in equipment and supplies. There simply are too many opportunities for young physicians coming out of our nation’s medical schools to practice in modern, fully equipped, pro
fessionally oriented treatment facilities; Navy Medicine must offer equitable opportunities if it hopes to compete.
In recent years the Chief of Naval Operations has fully supported the Navy’s Medical Construction Program. Early in 1970, Admiral Thomas Moorer approved construction of one hospital per year with additional dispensaries. Additional funds were added to the Fiscal Year 1973 Military Construction Program so that the Navy had, at that time, the largest medical construction program in its history.
Officials in the Office of the Secretary of Defense (OSD) predicted that the steady but slow program to replace outmoded and inefficient Department of Defense military facilities built before and during World War II, if not significantly accelerated, would take approximately 40 years to complete. Therefore, on 5 August 1972, the Navy, at the request of the Secretary of Defense, forwarded to OSD a five-year program in the amount of $685 million for the correction of Navy medical construction deficiencies. The Secretary approved the program. Congress has since approved the first year of the five-year construction program- continuation of the program remains with the Congress!
As the result of the efforts in medical construction thus far we can, in certain areas, offer those health professionals now* on active duty and those we hope to attract, functionally adequate, professionally oriented facilities in which to practice. For example, we have installed in facilities recently constructed, all modern services and systems including air conditioning, central oxygen systems, central nitrous oxide, central dictating systems, television for both therapeutic and recreational purposes, central vacuum cleaning for housekeeping purposes, automated vertical transportation of supplies, plus a closed circuit television system for security and monitoring of the building entrances and parking spaces. All of the new hospitals contain larger outpatient clinics and conveniently located adjunct services such as, pharmacy, laboratory, x-ray, surgery, obstetrics, and training facilities.
We currently have data processing equipment ranging from accounting machines to computer systems in 33 major medical commands, including 25 naval hospitals. Heretofore, the majority of our computer technology was dedicated to supporting management information systems. However, we are now actively pursuing acquisition of state-of-the-art computer supported clinical systems. This effort is intended to provide increased support to the physician and patient through efficient and economical use of current computer technology.
Approval by the Congress of our special five-year program will provide the Navy with a health care
delivery system supported by modern, functionally adequate, professionally oriented facilities. In addition to 'he great benefits accruing to our patients, this factor, if combined with equitable pay for health professionals and ambitious educational subsidies, would give the Navy a tremendous recruiting leverage in attracting and Staining quality health professionals voluntarily.
Should the Congress bear the total responsibility for 'he success of an all volunteer health professional force? The answer is self-evident. The Navy community, as an integral part of our society, has shared in the nation’s common problems generated by the shortage of physicians. We, too, are plagued by the rising costs of health professionals and health care in general. We, too, have pockets of physician maldistribution, albeit mainly because of military reasons, too few general practitioners, and inefficient physician utilization, all common to the civilian sector. We do not want to consume any more of this valuable national asset than is essential to efficiently and effectively protect the health of our Navy and Marine Corps members, active and retired, and 'heir dependents. To this end, Navy Medicine long ago initiated programs and implemented policy changes designed to streamline our health care delivery system 'o achieve an optimum use of health professionals and improve service to our patients. Many of the initiatives already in being, those in early stages of implementation, and the ones on the planning boards, do indeed complement the actions we believe Congress must take to ensure Navy Medicine’s survival in the all volunteer
42 U. S. Naval Institute Proceedings, August 1974
force environment. Therefore, we in Navy Medicine share with the Congress the responsibilities for an all volunteer Navy health force.
Physician Utilization. For example, for some time now we have been taking a new look at how we employ our health professionals with the goal of improved efficiency and economy. Concurrently, we are making changes which will ensure that as many as possible of our physicians are employed in professionally stimulating and rewarding assignments.
No longer will we be assigning a physician full time in every remote facility where his knowledge and expertise are under-utilized. To adjust for this change, we are looking at a "circuit rider” concept where a physician will visit a remote activity at specified times. Another concept is a Medical Van equipped and staffed to handle routine medical problems visiting remote areas. This latter idea is now in limited use in the San Diego, California, and Portsmouth, Virginia, areas.
Fewer of our patients in our hospitals and dispensaries will be seeing a physician on every visit. More and more use will be made of physician extenders, such as physician assistants, pediatric and obstetric nurse practitioners. These individuals will be highly trained paraprofessionals who will complement our physician force. Our physicians’ capability, scope of operation and effectiveness will be broadened and their new role should be more professionally rewarding because of physician extenders.
Assignment of Medical Service Corps Officers to Command and Staff Billets. During 1973, the Navy initiated a plan to assign Medical Service Corps (MSC) officers to commanding officer and executive officer billets previously held by physicians. This plan was designed as the initial phase for implementation of new policies for staff and command assignments of health professionals. It is being implemented for evaluation, consistent with the availability of qualified officers and the size and mission of the facilities. Phase 1 of the Navy plan provides for assignment of MSC officers as commanding officers of three medical treatment facilities; as executive officers of 30 naval hospitals, medical centers and dental activities; and as assistant officers in charge of four preventive medicine units. Upon completion of Phase 1 in 1974, a total of 34 physicians and dentists will have been released from administrative assignments.
Currently, the Navy has 21 Medical Department activities with MSC officers assigned as officers in command; 17 of these are at naval medical activities and four are in operating forces activities. We have 32 Medical Department activities with MSC officers assigned as executive officers; 16 of these activities are medical centers and hospitals; three are dental centers, two are medical and dental research activities; eight are
other fixed medical facilities; and three are in operating forces activities.
The assignment of MSC officers as commanding officers of the Naval Regional Medical Clinic, Washington, D.C., in July 1973, and of the Naval Dispensaries at Seattle and San Francisco in September 1973, marked the first such assignments at medical treatment activities.
The assignment of MSC officers as executive officers at the Dental Research Institute in Great Lakes, and at the dental centers in Norfolk, Virginia, and San Diego, California, in September 1973 marked the first such officer assignments in dental activities. Of the planned 30 executive officer assignments in medical centers, hospitals, and dental activities, 19 have been completed with the remaining 11 expected to be completed in the first part of 1974.
A Phase 2 plan is now being developed for assignment of MSC officers to command and executive positions in as many other medical and dental facilities as possible.
Navy Medical I Dental Regions. One of the most far- reaching and innovative efforts of the Navy Medical Department in recent years has been the realignment of our health care delivery system into Regional Medical Centers. In the past two years the great majority of Navy medical facilities, hospitals, dispensaries, and clinics in a specific geographic area, have come under the command of a single regional medical director who has direct access to the Surgeon General.
Our health care delivery system has been reduced to the least possible number of management levels with the shortest possible chain of command and lines of communications. Our dispensaries now stand only two organizational levels away from the headquarters or "home office.”
At the present time, we have established 28 naval medical regions with 147 component medical facilities and branch dispensaries assigned. There are approximately 75 medical facilities which have not been regionalized. It has now been determined—and a plan is under development—to extend medical regionalization to all fixed medical treatment facilities in order to bring the total health care delivery systems under the planning and management responsibility of the Surgeon General.
We have had excellent results: we have achieved more effective use of specialists; cross-staffing; periodic rotation away from undesirable or uninspiring medical assignments; better use of our capable enlisted personnel; better emergency and after-hours service; more reliance on and extended use of paramedics, nurse practitioners, and allied scientists; and less duplication in the management and distribution of medical sup
plies, drugs and expensive equipment. Finally, as expected, we found that we could provide better health care services to more satisfied patients, which in essence is what medical care is all about.
Operational Support. Can we afford to keep our current level of physicians on board ships and in garrison I during peacetime? We have sizable numbers of physicians assigned to surface vessels, Marine divisions, and I Navy and Marine air wings. Many of them are specialists and their assignment often does not represent effi- j cient utilization. No physician wants to sit for long I periods during peacetime, on a ship or in Marine bar- i racks, essentially underemployed because he has only | healthy young male adults as patients. Therefore, we are reassessing operational medical requirements to en- I sure that operational forces are fully supported (which i w the primary purpose of the Medical Department) and ] yet ensure more efficient use of the doctors.
A single manager system with geographical pools , of operational medical officers is the feasible and plausi- hie way to provide medical support to the Fleet, partic- i uUrly during peacetime.
Briefly, it will work like this: Pool members will be ordered to a Fleet commander-in-chief or Fleet Ma- j r'ne Force with additional duty within one of our regional medical centers. Between operational deploy-
we find to be the needs of today and the future. A task force is studying and redefining four basic priorities. These are:
► Medical support for the operating forces.
► Reorganization of the Medical Department for general increased responsiveness.
► Education and training upgrade and realignment.
► Possible establishment of a Navy Medical Research and Development Command.
The task force will reorganize the Navy’s Bureau of Medicine and Surgery to consolidate all medical support for operational forces under one department within the Bureau. The primary responsibility of the head of that department will be to ensure top priority for Navy and Marine Corps operational commitments, regardless of the level of resources. Concurrently, a planning board is developing a single Naval Medical Department Education and Training Command. The goal is to consolidate existing teaching structures to achieve higher quality professional training of all Medical Department personnel. Items scheduled for the Board’s considerations are:
x'he interface of Medical Department education and training programs with the new Uniformed Services University of Health Sciences. Anticipating our role in the university organization, the Navy Medical Department serendipitously expects to:
► Project its own image on the medical academia.
► Refute the "second rate” impression ascribed to us by certain of our civilian peers.
► Participate as an equal in developing health care programs and demonstrate the inherent high quality of the system.
► Provide a rotation base for its academically oriented physicians and give professorial rank to senior talent.
ments, pool members will participate in the region’s health care program and available professional training. The advantages of this system to the Navy, our patients, and the physicians are obvious. But, regardless of the number ofphysicians we have, we will place the highest priority on medical support of our operational forces.
Just as we need to change our frame of reference when predicting the success or failure of the all volunteer force, the end of the doctor draft compels us also to re-evaluate the "shape” of our organization; to be more flexible; and to adjust and respond to change more decisively, more quickly, and without causing debilitating shock waves throughout our system. The traditions and the shape of our current organization have held us in good stead through many difficult years—we will integrate the best of the past with what
Identification and consolidation of all graduate training for maximum responsiveness to the requirements of the Medical Department facilities and the operational medical and dental needs of the Fleets and the Fleet Marine Force, i.e., aerospace, hyperbaric, submarine, amphibious, preventive medicine, tropical medicine, and other areas peculiar to the military.
Consolidation of all current education and training schools into a naval institute to train personnel in allied health science disciplines and technologies, and to provide related short, intermediate, and long-range planning.
Establish an in-service continuum of undergraduate and graduate education with degree-awarding potential for the whole spectrum of health professionals.
The task force anticipates reporting their findings, conclusions, and recommendations this summer. Thus
The Survival of Navy Medicine 45
for, based on preliminary soundings, we have every reason to expect that the ultimate reorganization will contribute substantially in complementing the support which Congress must give us in the volunteer environment.
The Role of the Reserves. Our Medical Department reservists have always played a vital part in the health care of the Navy and, in an all volunteer medical establishment, the function of the reservists can be expected to increase. They are being integrated into the total force and are assuming an even closer relationship with the regular Navy.
Last summer, Medical Department reservists were offered the opportunity to substitute for active duty personnel at dozens of medical activities in the continental United States, Alaska, Puerto Rico, and the Mediterranean area. The response to the request for assistance was gratifying. Reservists can expect more °f such very meaningful active duty training to be ■dentified in the future.
For the first time, the reservist has been assured an opportunity to work within his or her specialty during Aguiar drill periods. Members of seven Naval Reserve Medical Companies, located in close proximity to naval hospitals, have been authorized to augment activity staffs in lieu of meeting in a classroom setting. The arrangement has not only proved mutually rewarding and an aid to recruiting efforts, but has been received Enthusiastically by both reservists and regular Navy members.
New Recruiting Initiatives. Because Navy Medicine relied heavily on the doctor draft, it lacks experience ‘n recruiting physicians into the Navy. No effective physician recruiting effort existed prior to 1 July 1973. The Navy Recruiting Command assumed responsibility for the program on that date and Medical Department bruiting programs are now growing in the all volunteer force environment.
The objective of this new venture in recruiting is to fill vacancies in four separate segments of the Navy Medical community: medical student scholarship programs, internships, residency training, and practicing Physicians (general practitioners and fully trained specialists).
Our student scholarship programs are extremely Popular and fully subscribed. The interest in Navy "Uernships is excellent. Navy residency training programs, always highly regarded because of their superior Quality, are well accepted. Applications for the latter training are often in excess of need.
However, a genuine problem exists when trying to 'merest the practicing physician in a Navy career. In 'his regard, a one-to-one contact with prospective applicants is being emphasized. Eight medical recruiters
have been assigned to Navy recruiting areas throughout the United States. They are coordinating a "personalized” recruiting effort which involves them, their staffs, naval district medical program officers, and a large but select group of inactive naval reserve physicians. All segments of the active medical establishment, certain other members of the reserve community, and the retired community are also being called upon to assist.
The efforts of these men and women are being reinforced by a sophisticated advertising campaign, primarily in medical journals, and modern audiovisual aids. In the latter category, we are going to acquaint the civilian medical community with the Navy’s significant contributions to medicine, its continuing high quality, and its many attractions and advantages for health professionals. In this same vein, civilian medicine is being invited to take a closer look at us through expanded participation in Navy sponsored professional medical meetings and vice versa. An "open house” series at naval hospitals is also being aimed at the civilian medical community, with a highly satisfactory level of interest apparent.
Navy Medicine, then, can survive in an all volunteer environment. However, survival hinges on the degree of support from the Congress, and the efforts of every man and woman in the Navy Medical Department. Congress must quickly provide:
► Equitable pay for health professionals.
► Generous educational subsidies.
► Support for our five-year medical construction program.
In turn, the Navy Medical Department must continue to streamline its delivery system, become more efficient in the use of scarce resources, and find new ways to complement the congressional support. With this "partnership” approach, Navy Medicine will experience its greatest renewal in the all volunteer environment.
Admiral Custis received an A.B. from Wabash College, Indiana, in 1939. Commissioned as an ensign in the Naval Reserve, he completed his medical training on inactive duty at Northwestern University. Commissioned a Lieutenant (j.g.) in the Medical Corps in 1943, he served as a medical officer on board the USS Clinton (APA-144) during 1945 and early 1946. On release from active duty, he completed a residency in surgery and practiced in Seattle, Washington. Returning to active service as a Commander in 1956, he served at the USNH, Portsmouth, Va. until he became Chief of Surgical Service at USNH, Guantanamo Bay. From I960 to 1963 he served at USNH Great Lakes followed by tours at USNH Beaufort and USNH Philadelphia as Chief of Surgical Service. He became XO of the latter hospital in 1967. Duty as Senior Medical Officer at NSA Danang from 1969 to 1970 preceded a tour as CO of USNH Bcthesda and Deputy CO of the Naval Medical Center. In 1973 he became the Surgeon General of the Navy and Chief, BuMed.