Air Force Community - Air Force Times

Privatization problems

It is refreshing to read that the surgeons general are fighting to keep more active-duty medics instead of allowing them to be replaced with civilians.

Civilianizing our medics is not a new idea. This march toward mediocrity began more than 10 years ago with the institution of Tricare. Gradually, the folks running things are dismantling a proud and effective system and replacing it with what one of my patients called “mangled care.” Before these rocket scientists drive our train completely over the cliff, it would be educational to consider the reasons we have a medical corps and some of its advantages.

The present system was not dreamed up in a vacuum. It was the product of some bad years and some bad medicine. At various times, the medical corps has been caught unprepared to respond when we needed to go to war. At other times, we have had poorly trained doctors, doctors who fled malpractice claims by coming into the military, or doctors who could not make it in civilian practice because of a variety of inadequacies — strangers to excellence. Military medical care suffered; patients paid a price.

In 1978, when I reported to Eglin Air Force Base, Fla., some doctors couldn’t speak English. Some were graduates of questionable medical schools in strange foreign countries. And we had dissatisfied patients who were getting shoddy care.

About that time, some of our leaders decided we could create a better system. We would acquire a core group of leaders in the medical world. We would eliminate the bad apples. We would offer scholarships to medical students at the world’s best medical schools, and those students would incur a military obligation in return. We would also begin a military medical school of our own in Bethesda, Md.

Our medical centers would be staffed by the very best minds in the business. We would establish training programs for specialists. We would grow our own world-class doctors who could seek full careers in the military.

By about 1990, we had everything in place and working beautifully. Traditions were established. Important research was accomplished. Centers of excellence were springing up within the military.

Then came Tricare, which has nibbled away at the system we had until we today are looking at the collapse of a national treasure. Tricare was supposed to save us money. Instead, we have sacrificed excellence for mediocrity, and we are paying huge bucks for the privilege. Tricare has emptied our hospitals and left many active-duty doctors without enough to do. Thus, it has perversely worked to make us less ready to go to war. It has made lots of business folks very rich.

This new plan will not attract the best and the brightest civilians into military medicine, but it will eliminate a generation of physicians who wear the uniform proudly, who have served with distinction and who are needed.

We lose command and control when we civilianize. We demoralize the active-duty medics, who take call, get deployed and do all the heavy lifting while civilians sometimes get two to three times as much pay.

We need to keep a “full-service bank” going in the military. Surgeons need pediatricians, who need internists, who need pathologists. Once destroyed, our medical corps will take much blood and treasure to recreate.

The writer, a retired colonel, was a surgeon in the Air Force for 30 years. His e-mail address is wellinglindydave@yahoo.com.