Make Independent Duty Corpsmen Warrant Officers

With great power competition looming, distributed maritime operations in denied environments will be the norm. In the event of mass casualties, the tyranny of distance will quickly be apparent. Independent duty corpsmen (IDCs) can help fill the capability gap if the Navy grows the community, transitions the billets from senior enlisted to warrant officer, and provides them sufficient training and authority to operate as physician’s assistants or nurse practitioners.

Today, most Navy surface combatants deploy with limited medical personnel and assets. Except for aircraft carriers and large-deck amphibious ships, most combatants rarely deploy with physicians or nurses embarked. Large surface combatants and submarines usually deploy with an IDC or several corpsmen. Smaller ships and Marine Corps units typically have only basic corpsmen assigned. While any medical professional must be able to independently render care during the “Golden Hour” of trauma, the Navy currently relies on a medical evacuation (medevac) team or higher-echelon medical facility to render that care. Plans call for prolonged field care of at least 24 hours prior to evacuation to definitive care. Yet, a gap exists between the resources the Navy has and those it needs to keep sailors in the fight or return them to it after an attack.

Regular corpsmen generally are trained to verify readiness requirements, handle medical records, render basic first aid, and take accurate vital signs. But IDCs have more extensive training. Over a 12-month pipeline, they conduct many rotations that would be completed by a mid-tier credentialed provider, including rotations in emergency rooms, anesthesia, operating rooms, and various clinics.¹ They are highly capable practitioners and efficient physician extenders—junior clinicians capable of expanding physicians’ span of control. Every command, except the very smallest, should have at least one IDC, or ideally several, in lieu of a more advanced provider. IDCs should be supported by as many basic corpsmen as necessary to meet the command’s medical requirements. By using IDCs more extensively, commands gain an enhanced organic medical capability, which would allow them to keep more sailors on the waterfront, instead of their having to travel and wait for care in military treatment facilities.

The Chief Warrant Officer Solution

IDCs have their limitations. Hospital corpsmen (HMs) typically apply to be IDCs during or after their first tours. They are usually E-6s (HM1s) or E-5s (HM2s) by the time they complete IDC training. Some E-4s (HM3s) are chosen for IDC duty, but this comes at a cost. Junior sailors have not acquired the on-the-job training and experience necessary to attain working knowledge of the complex art of medicine. Hospital staff receiving orders on a patient from junior sailors are unlikely to trust their judgment or assessment of the situation. Senior IDCs generally promote to chief petty officer quickly, but then they no longer practice routinely as IDCs, limiting their utility in the role. The Navy needs those with IDC skills and experience to stay in prolonged practice.² Furthermore, while current IDC training is significant and appropriate for peacetime operations, to prepare for a significant maritime fight in the western Pacific, the Navy likely would have to consider increasing IDC training in trauma surgical procedures.

A solution is to convert IDC billets from enlisted to warrant officer, as the latter are technical experts in their fields. On smaller combatants, IDCs would become part of the wardroom and department heads. This would give them equal weight at the table when advocating for increased medical readiness and survivability, keeping crews healthy and in the fight. In the military treatment facilities, warrant officers would carry more weight too, as all other care providers—nurses, physician’s assistants, physical therapists, laboratory officers, and physicians—are also officers. Taking IDC billets out of the enlisted corpsmen billet base and coding them for warrant officers would allow IDCs to advance in their careers by remaining clinically current and operationally relevant subject-matter experts on field trauma care.

Advancement rate percentages to chief are frequently in the single digits or less. Currently, of the 24,729 hospital corpsmen in the Navy, 1,423 are IDCs. These IDCs are winnowing toward Navy medicine’s 153 master chief petty officer (E-9) billets. The current IDC billets are funded by a variety of sources, including Navy medicine, the Marine Corps, and the four Navy unrestricted line warfare communities. While representing approximately 6 percent of the hospital corpsmen rating, former IDCs comprise approximately 43 percent of hospital corpsmen master chiefs.

Many corpsmen pursue IDC jobs to make chief but then leave clinical practice as soon as they are selected for chief. This is not a good investment. The Navy should keep them in the clinical profession for which it has paid to train them. Allowing them to submit packages for both a chief selection board and a warrant officer selection board would enable the Navy to both promote them to chief and keep them in the IDC field as warrant officers. IDCs who wish to remain clinically oriented would have a viable path to a Navy retirement, allowing them to select the career path that best fits their needs.

Recruiting more physicians, physician’s assistants, and nurse practitioners (NPs) is a possible alternative solution, but it is not economical, and the Navy does not require that higher tier of capability in all locations. NPs present their own difficulties, as their scope of practice and licensing is limited. NPs, for example, are certified in either acute care or outpatient care, but rarely both, and usually adult or pediatric care only. The IDC scope of practice is much more flexible and covers all active-duty beneficiaries, under all conditions, and worldwide with only indirect supervision by a physician. Other providers are significantly costlier. Costs to recruit and train a Navy physician are hard to quantify because of the multiple pathways by which they enter the service. On average, they are between $180,000 to $400,000 dollars per year.³ Typically physicians enter service with a four- to five-year commitment, after which many leave service.

While in service, physicians and other specialty providers also receive specialty pays that range from $46,000 to $90,000 per year for multiyear retention contracts that can be served concurrently with other obligations. Given these training costs and incentives, and that all Medical Corps officers are commissioned at least as lieutenants, the annual amortized cost of a physician can be in excess of $200,000 dollars for an active-duty physician, or more for a civilian contract staff or network provider. At $99,600, warrant officer annual pay, even at 20 years of service, is a relative bargain. The cost to train can be much less than $100,000. Therefore, the annual expense of an IDC should average less than $100,000, half the cost of any other medical provider. For smaller commands and routine medical concerns, IDCs are the most affordable and best option.⁴

A physician shortage is looming, and budget cuts are already here.⁵ Converting IDC billets to warrant officer will keep sailors on duty, increase capability, decrease personnel costs, and retain valuable talent. The Army did this long ago with its highly successful flying warrant program. A test IDC warrant officer program, in the appropriate setting, such as with some Indo-Pacific command units, will likely pay significant dividends. The Navy cannot afford to maintain its medical status quo in an era in which major at-sea combat is an increasing possibility.