Tuesday, June 05, 2007

Nothing New

In the Tuesday edition of USA Today, reporter Gregg Zoroya highlights some of the difficulties facing the nation's military health care system. Crowded facilities. Overworked staff. Funding shortfalls. Limited availability for appointments. Difficulties in hiring civilian doctors to replace deployed military physicians.

There's only one problem with Mr. Zoroya's story.

The issues he describes are hardly new.

In fact, they're more than familiar to anyone who's been associated with military health care, as a patient or provider.

Crowded facilities? In response to the "crisis" at Walter Reed, we observed that the military began shuttering health care facilities more than a decade ago, under the BRAC process. Fewer clinics and hospitals means that those still operating must absorb patients that once used other facilities--and with only modest increases in funding and staff.

Overworked staff? My first job in the military was as an EMT at an Air Force hospital in the southeast. At the time (1981) the Reagan defense build-up had yet to kick in, so we were short of doctors, nurses, technicians, and administrators. I routinely worked seven days in a row, followed by two days off. When our manning eventually "improved," I worked four days in a row (12-hour shifts) with two days off, then stated the cycle over again. So much for my off-duty education plans, not to mention my social life.

Limited funding? Yep. Problems in getting an appointment? Been there, done that. Long drives to another base for specialized care? Ditto. My wife once drove our oldest daughter more than 300 miles--one way--for an appointment with a specialist, and we shelled out money for gas, meals and a hotel to boot (I was a Second Lieutenant at the time). The government reimbursed us two months later.

And, when our son developed a severe case of acne, the off-base dermatologist (had to wait six weeks for that referral) recommended accutane. Trouble was, the base pharmacy didn't stock the drug because it wasn't available in a generic form. Luckily, the officer-in-charge of the pharmacy was a friend of mine, and by pulling a few strings, he was able to obtain a supply of accutane. Otherwise, I would have been shelling out hundreds of dollars a month for the drug, and waiting for the military to reimburse me.

As for the provider problem, I've experienced that one as well. During my brief career as an EMT, I worked with a number of military doctors who had been recruited overseas. Language was sometimes a problem, and on a few occasions, we had questions about the qualifications and expertise of our foreign-born docs. Arriving at the base hospital to start a morning shift, I spotted one of our primary care physicians (a native of the Philippines) working in the medical records section. A friend explained that the "doctor" had been reassigned, because the military couldn't confirm that he had actually graduated from medical school. He was the same doctor who put a woman with severe back and abdominal pain in traction for three weeks. The patient was subsequently--and correctly--diagnosed with terminal liver cancer.

This is not an effort to dismiss or downplay current problems with military health care. The men and women who wear the nation's uniform (and their dependents) deserve quality health care, and in many respects, the current system simply isn't delivering. But the problems Mr. Zoroya describes didn't begin with the current War on Terror, or individual unit deployments to Iraq. Instead, they're a continuation of long-festering difficulties in the military health care system, problems that have lingered for decades and won't be solved overnight, or even with a massive budgetary infusion. Military health care is simply a modest example of socialized medicine, and the issues inherent in that approach to medicine.

And remember, Hillary Clinton, Barrack Obama, John Edwards (and other presidential candidates) want all Americans to experience a similar level of service and care.

It's the medical equivalent of a hand grenade with the pin pulled and a missing safety handle.

You don't want it.


Anonymous said...

I wound up with 50% VA disability due to inept military docs. I was almost boarded before I offered to cross-train out of my MOS. There are some very good military docs, but most of them are general practice docs. Specialists in the military are the scary ones... If you have the option to go off-base to see a specialist, do so with great haste.


Unknown said...

Couldn't agree more...during my brief tenure in military medicine, I worked with a radiologist who had lost three high-profile malpractice cases, and couldn't obtain malpratice insurance. Naturally, the AF was only too happy to have him, and brought him into the service as a Lt Col.

There was also a series in the Dayton Daily News (?) a couple of years ago about the high number of military docs licensed in Oklahoma. At the time, Oklahoma had some of the loosest licensing requirements in the nation, and had become a haven for quacks with past ethical, legal and professional problems. With their Oklahoma license in hand, their next stop was the recruiting station.