Who is bearing the brunt of current casualities and who will bear the brunt in the future? Clearly the Army. No one can challenge the United States on the seas or in the air, but as always the foot soldier will suffer most of the injuries and deaths. Therefore the Army, even more than the other services, needs the capability to care for the critically wounded. The lethality and destruction of the improvised explosive device (IED) is well-known and will be copied by future enemies of the United States. Soldiers on the battlefield must have a military physician when needed. The closing of Walter Reed Army Medical Center could decrease the likelihood that they will have those physicians.
Where do Army doctors come from? Most come from Army graduate medical education programs. The majority of these programs and trainees are in the major medical centers. Why there instead of the community hospitals? Because that is where the types of patients are that we need to train military physicians as well as many other critical-care providers.
These are the exact facilities that were devalued by the 2005 Base Realignment and Closure's (BRAC) military-value metric. The reason major military medical centers exist is to provide the complex care needed in war and to provide a platform for training and skill competency in time of peace. Without major tertiary medical centers and the environment they provide, the Army would not be able to retain the cadre of senior experienced medical officers needed in war. Polytrauma casualties (amputation, fracture, head injury, burns, etc.) from the current conflict are surviving in numbers not previously seen, and medical centers such as Walter Reed are needed to care for them.
The BRAC military-value metric gave no credit in the health-care services area for graduate medical education, clinical research, and capability to provide tertiary care. This explains why an outpatient clinic in Florida (Hurlburt Field) was given a higher military value than five medical teaching centers, including Walter Reed. BRAC actions would indicate that primary care is the future of military medicine.
The vast majority of severely injured patients are brought to Walter Reed. Over the years the hospital has purposely developed the capability for in-patient care as well as graduate medical education and clinical research. This environment of cutting-edge care, medical education, and research has attracted a highly motivated, experienced, and skilled group of senior officers who are daily fulfilling the promise to our soldiers on the battlefield as well as in the medical center, of providing them every chance to recover to lead full and rewarding lives.
This capability exists in war because it was developed and maintained during peace. Tertiary medical centers committed to complex care, education, and research during peace are part of the cost of having a competent medical force during war. The reason the worst of the injured come to Walter Reed is because years ago, it chose to be that place.
Closing Walter Reed devalues the work that has been done there over decades, discourages others from attempting that same work elsewhere, and strikes at the sustainability of military medicine. It sends the wrong message to young physicians who may be considering a military scholarship for medical school because it decreases the graduate medical education training opportunities, as well as further research-and-development opportunities. Actions that decrease the Army's ability to attract and train the best and brightest to become military physicians decreases the likelihood that injured soldiers on the battlefield will receive the care they need.
The Army cannot provide this health care without attracting and retaining the very best physicians. Walter Reed is one of the military's great teaching hospitals; we should not be so naïve as to think that we can readily reconstitute these world-class programs at two new, and separate, facilities. Walter Reed's location has been a major factor in the Army's ability to both attract and retain the best senior military doctors and to provide specialized instruction to our military doctors of the future. Many of these senior people will likely choose not to move to other locations and will leave the Army at a time when we need their specialized skills the most.
Colonel Pierce was formerly chief of the medical staff at Walter Reed and is now the medical inspector for the Veterans Health Administration.