Research for Physicians

This study estimates the impact of increasing the active duty obligation (ADO) for the Armed Forces Health Professions Scholarship Program (AFHPSP). We found that the amount by which accession requirements could decrease depends on the size of the graduate medical education (GME) program. Specifically, accession requirements and costs are less if the GME program were optimized than if it were fixed at current levels. If GME is fixed, many AFHPSP accessions are needed, not to fill billets, but simply to support the GME program. We find that increasing the ADO from 4 to 5 years for 4 years of subsidization is supportable. We based this finding on (1) recruiters’ perception that they could still meet the recruiting mission with a 5-year ADO, (2) the willingness of current AFHPSP students to consider and accept AFHPSP with a 5-year ADO, (3) the downward pressure on the medical billet file, and (4) the Services’ success in meeting recruiting goals that vary substantially from year to year. We find that increasing the AFHPSP ADO beyond 5 years is not warranted because it is not supportable from a recruiting standpoint and most AFHPSP students didn’t express a willingness to accept an obligation beyond 5 years.

Health care personnel are expensive to educate and train. Retaining them is critical for any health care system. This study considers the impact of special pays and bonuses in helping recruit and retain qualified doctors, dentists, and other health care providers.

The purpose of this research memorandum is to report and comment on the findings of an analysis of Navy Medicine Primary Care (NMPC) to members of the Primary Care Product Line (PCPL) Advisory Board (the Board) and to the Bureau of Medicine and Surgery (BUMED). This report is part of the support that CNA is providing to the product line. It analyzes Ambulatory Data System (ADS) records of visits made to Navy Medical Treatment Facilities (MTFs) during FY 2000, as well as data from two Department of Defense (DOD) surveys that provide information on the satisfaction of users of NMPC. Its intent is to provide empirical information as background to the Board's and BUMED's optimization activities. In this report, we describe what NMPC is, based on what primary care providers (PCPs) do in Navy MTF primary care (PC) settings, and identify how and to what extent the content and nature of NMPC varies by provider and setting. This approaches NMPC from the supply side - what care is provided by whom, and where. Its focus is not on how much care is provided (e.g., number of visits) but rather on the nature and distribution of that care (e.g., percentage of visits by clinical content and provider type).

As the military health system (MHS) evolves to meet the managed care environment of the peacetime benefit mission, Navy Medicine in particular, and DOD in general, must continue to concern themselves with three principles: (1) Navy Medicine will attract and access quality individuals; (2) the medical department will retain the best of the people accessed; and (3) the best people will want to remain in the military because of the challenge, training, professional ism, and overall environment of Navy Medicine. DOD implemented TRICARE to maximize the quality of healthcare while minimizing the cost of that care. To meet this goal, military medicine must continue to attract and retain quality personnel under this changing work environment. Given these challenges and concerns, the Navy Surgeon General asked CNA to evaluate physicians' job satisfaction within the existing climate to determine whether major problems exist that adversely affect relation of specialists. We have examined Navy physician retention and compensation patterns over the past decade, and find that there has been a decline in retention for the majority of specialists, but the cause and extent of the decline are difficult to quantify. We have attempted to identify the main drivers behind this decline, including compensation, work environment, and promotion opportunity. Contrary to anecdotal evidence, there has been no decline in promotion opportunity] however, we do find that the military- pay gap has been widened by 4 to 24 percent for most specialties during the 1990s.