Proposed Military Cuts Ignite Worries for Medical Education

Marcia Frellick

September 13, 2019

A proposal to replace up to 19,000 uniformed medical personnel with potentially untrained combatants at the Military Health Service (MHS) over 3 years is causing concern at the Uniformed Services University of the Health Sciences (USU) in Bethesda, Maryland, known as the "West Point of Medicine."

On Wednesday, the Senate received the House-passed 2020 National Defense Authorization Act, which reportedly contains the proposed cuts.

An official with the Association of American Medical Colleges (AAMC) said that enactment of the proposed cuts could have important consequences.

Minutes of a May 17 Board of Regents meeting reflected comments made by Arthur L. Kellermann, MD, MPH, dean of the F. Edward Hébert School of Medicine at USU,  in which he said that MHS workforce members replaced will include physicians and nurses, and the changes "will impact those medical and surgical subspecialties deemed less combat relevant."

US News & World Report reported in late August that a provision to delay or eliminate the cuts has reportedly been added to the Defense Authorization Act legislation.

According to the minutes, Kellermann said, "The Services may respond by maintaining more control over where they assign their uniformed positions, potentially removing them from Military Treatment Facilities (MTF) to operational units. The DHA (Defense Health Agency) may then need to backfill thousands of uniformed positions with Federal employees or contractors to man the MTFs (many of which would not be permitted to provide medical education or research)."

The DHA is a combat medical services support agency for the US Army, Navy, and Air Force.

Kellermann, according to the minutes, said that news of the proposed cuts brought up several questions: Will the workforce reductions affect military graduate and undergraduate education? Should the changing mix of graduate medical education positions be worrisome? Should the military outsource its graduate medical education to civilian medical education programs? And how will this affect undergraduate medical education?

He added, "We are beginning to have students share their trepidation regarding the availability of military medical education."

Kellermann's office this week referred all questions about the proposed cuts to the Pentagon. Medscape Medical News contacted the Pentagon for comment, but a response was not received before publication time.

However, in late August, Kellerman told US News, "The cuts are real, and actionable information on how many positions and what types — doctors, surgeons, nurses, techs and medical corpsman — isn't readily available. There's considerable concern in the academic community, in the military and certainly on the part of my faculty."

A Regent reportedly agreed with Kellermann's concern in the May minutes and said, "the military being able to turn to the civilian sector to pick up the medical education load is a ludicrous proposal."

Civilian Sector Couldn't Absorb Trainees

John Prescott, MD, chief academic officer for AAMC and a former US Army officer, told Medscape Medical News he has been aware of the proposed cuts for some time and shares that concern.

"Quite honestly, the civilian sector cannot easily absorb several hundred or 1000 [graduate medical education] spots of people going in search of residency programs," he said.

"If these reductions were to cut back on the required number of individuals who serve as mentors and teachers it could have an incredible impact — programs might have to close down. If they close down, those residents would have to seek training somewhere else. Right now — there aren't these open slots," Prescott added.

Students at the USU medical school study tuition free and, according to the website, are paid at least $64,000 to train as future physicians and medical leaders in return for their promise of years of service.

The replacements for the displaced specialists would need time to adapt to the system and the culture. Prescott said it takes time in the military to get up to speed and understand the particular medical needs of soldiers, sailors, and airmen and noted that emergencies don't allow for that ramp-up time.

"It's not something where you can turn a spigot on and off," he said.

Prescott has reported no relevant financial relationships.

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