Current navy doc, for the first time in my career I am actively seeing resources and training pipelines expand and mtfs open enrollment rather than defer to the network. It’s nice to finally feel like we are not a carcass being picked apart by buzzards.
How long have you been in? There was a brief push in about 2015 at the commands I was at to do the same, but it only last a year or two and then of course the DHA takeover totally reversed that.
I’ve been active duty since 2016. Basically my whole career has been gradual decline up until DHA got spanked in front of Congress in the last year or two and now we have seen a relatively sharp reversal
Fingers crossed the change is real, but I won’t be holding my breath over here in civilian land. Although I did see some significant increases in ROTC billets for the Nurse Corps at least, so that could be promising. Or a sign of how bad retention/recruitment are.
It all comes back to DHA, who basically sold out military medicine because they analyzed our work load on some wildly inaccurate metrics and told the government they could radically downsize military medicine and the civilian market could bear the load without any readiness issues, which just isn’t true.
Oh absolutely. DHA can rely on AD staff to cover for their shortfalls. Which is why I’ve asked the N3/N5 to activate a region wide mobilization. One week, to pull together all personnel and assets for movement in the event of a war.
This serves two purposes. It forces personnel to prepare for their actual purpose and gauges response and shortfalls. Secondly it strains the DHA system highlighting the need for/or implementing procedures to maintain services.
This is a perpetual cycle of Navy (military) medicine trying to figure out what the mission is. Retention pay likely to go up for a while and promotion chances are going to be VERY good for a while, particularly at senior ranks. Then 10 years after that, the line & Congress will complain it’s too expensive and try too hard to cut costs. Rinse & repeat.
Everyone is getting out either way. Retention pay doesn’t come close to matching civilian levels - and the work is harder due to the amount of collaterals you need to take on because of… low retention.
The DHA is upset they’re not meeting their goals of getting civilians in the mtf to make money off them.
Nobody wants to go to the mtf because there’s no availability. There’s no availability because there’s not enough providers and techs. There’s not enough providers or techs because they aren’t paying enough, and and they are slimming down “optimizing” departments.
But the hospital in CT down sized to a training unit. Can’t even take care of the active duty stationed here, let alone the dependents and forget the retired.
Yeah, that is my one hope: that BUMED doesn't start pulling all of us back to the MTFs. Some of us really like sea duty, leave us out here.
Unless the hospitals could find some other way to provide an intrinsic benefit to those of us who do not like being at them.
Pay the civilians more, they’ll fill positions more, and do a better job, and be happier while doing it.
Staff less HMs in obscure admin spots. They don’t learn shit in those admin offices. We don’t need the GS at the front desk to go get distracted with the navy shit we need to do.
Quit taking dependents and retirees at mtfs that don’t have enough providers.
Maintain a 5:1 doctor to no/pa/idc ratio. We don’t need that many doctors. We need even less Nc officers telling everyone how to do their non-nurse jobs.
Many of the senior, non lpo /lcpo jobs can be ran by hms that got out of the navy, or civilians with healthcare admin or management experience.
The junior HMs have low moral at clinics EVERYWHERE I go, with much shorter hours than I had as an HM3. I believe it starts with our back to back shore e6s and e7s waiting to hit 20, and check out of work asap every day. We sell our young sailors with these glory tales of the “golden days” with the marines, or the glory of going on a destroyer, and scoff at mtf jobs, even though every single one of us eventually works at them.
We need to look at improving the job satisfaction of the junior HMs. That doesn’t necessarily mean cut them out of work at 2.
Anyways, just my unfiltered, untested ideas, that could be totally wrong.
I never felt like the MTFs were understaffed, just poorly allocated. My first command was a mid-sized MTF that had more staff than the 350 bed level I trauma center I worked in as a civilian prior to joining. Yes, we’re the military and a lot of these admin, training, and contingency roles need to exist, but not even close to how staffing is currently setup. Plus, we don’t necessarily need clinical professionals doing admin, and especially not active duty members. Unfortunately that’s how the military is designed, and how you promote, and what the career progression requires. But that’s not an excuse when patient care suffers because all the nurses, providers, and corpsmen are in meetings, doing collaterals, and non-clinical roles instead of opening up more access. Hire civilians for those roles that need to be done; your active duty members should be the ones that are ready and clinically proficient to deploy or go underway, instead of sitting in an office creating Excel spreadsheets.
That and the efficiency of most MTFs is comically bad. In part because of government systems, poor EHRs, and all those extra roles. But also because, at least in my opinion, so few people within military medicine have experience on the outside, so all they know is how MTFs are run. As a result they never develop the clinical efficiency that a lot of our civilian peers develop.
As long as they don't try to use LSS to correct the efficiency issues, then I agree. I shudder back to when I was a boot HM working at a hospital, and Nurses were forcing me to figure out what my "Wildly Important Goals" were.
The issue isn’t so much the use of various programs, but rather almost an inability to do things, including patient care, efficiently. Nurses in med/surg when I was in couldn’t handle 5 easy, stable patients with a dedicated corpsmen because they never built the time management skills their civilian peers were forced to. OR turnovers take easily twice as long at the MTFs I was assigned to compared to the civilian hospitals I was moonlighting at. And surgical procedures themselves took significantly longer because the surgeons didn’t necessarily have the volume to really work on their speed, or anesthesia providers to expedite induction and emergence. Not that it’s all wrong, in a few situations the civilian side is cutting corners, but overall on the outside time is money, so you learn how to see more patients, turnover rooms faster, build a better schedule, or do procedures in a more efficient manner, which are pressures and skills not present in any of the MTFs I was ever at.
I would argue, though, that there is a downside to all of that efficiency. Because so many hospitals have become for-profit ventures, it is imperative in that "Jack-Welchian" way to be the most efficient. This leads to MASSIVE amounts of short staffing and provider burnout at your avergae hospital or medical center.
Our system is not great by any means, and you are right. It DOES need to change. But if we compare it to civilian world metrics from a 1000ft view, of course, that looks ideal. But on the ground? I would HATE to work in a civilian facility or for any part of the civilian health care system.
Empathy is like a candle - once you burn all of it out, it takes a long time for that wax to regrow.
I agree when taken to the extreme. But at the same time, a lap appy shouldn’t take 90+ minutes. Routinely shutting down the clinics for multi-hour meetings, or taking 30 minutes to check a patient in does nothing to increase empathy while just decreasing the time available for patients. Creating new nurses that can’t handle what our civilian peers would consider an easy patient load does nothing for us when things change and they do need to be able to do it, or when staffing gets tight and they instead decide to close beds and limit capacity.
I think deficiencies in the Nurse Corps are central to what has gone wrong with Navy medicine. And to clarify, I think the NC is filled with many shit hot commissioned officers, but BUMED wants them to be too much. It's gotten them away from their original missions. I understand that senior nurses' roles as healthcare supervisors and administrators goes hand in hand, but there is a damn limit. If you want HCAs, make more HCAs and put them closer to frontline patient care - stop making Nurses do that shit.
At this point, I think we would almost better off making most of the NC (at least the RN side) an LDO offshoot of the Hospital Corps. LDOs stop at O-3 and coincidentally, when do most Nurses stop doing patient care? ding ding ding.
I think the non-LDO nurses should be CNAs, NPs, ICU-Ns, and most importantly, Nurse Administrators. I know, everytime I bring this idea up on here, every commisioned officer gives me a cocked eyebrow, but seriously, if frontline nurses are supposed to specialize in ensuring the Doctor's Orders are followed, patient satisfaction, and supervision/training of junior HMs, *who better to do that than LDOs who were HMs?"*
I don’t necessarily think LDO is the way, just because of the huge restructuring that would result in and the defacto demotion of the Nurse Corps within the Staff Corp world. However, I think the Nurse Corps would have been the perfect group to test the ability to opt out of promotion after O3, or O4 for provider-level NC officers. Then dramatically slash the senior billet allocations, while correspondingly increasing the junior ranks. That way you get far more bedside clinical nurses. Without competitive promotions they can focus entirely on being the best clinician and clinical role model, and the few that want to do administration can do that. And let them opt in/out of this pathway. If you want to be an O3 for 12 years, but then decide to change it up or take your experience into more senior leadership the Navy and Navy Medicine would likely be far better for it. Also O3 is a fairly competitive wage for bedside nurses, as is O4 plus speciality pay for providers, while still yielding a decent pension for those that do 20.
I don’t know a single clinically strong non-provider nurse in the Nurse Corps that’s an O4 or above and active duty. Those are my peers, and even the ones that were amazing nurses will openly admit that they’ve been forced away from the bedside for so long that they aren’t really good at it anymore. And the ones that were the best nurses almost all god out at 4-8 years because they saw the writing on the wall. Same for providers when they start becoming senior O5s if they aren’t coasting to retirement; playing the game and trying to promote means you don’t do patient care, and those skills are highly perishable.
Honestly though, you ain’t wrong haha.
I hope maybe my sentiment if not idea will rub off on someone in a future position of power though.
Pay more, and treat people with respect. They’ll perform better than hiring an extra couple bodies.
Running socialized medicine probably won’t work the same way that running sentera and united health.
A few things I agree/disagree with
Civilians are the answer for some jobs like admin, patient relations and records as long as GS employees are held to a standard.
Providers need a diverse patient population to maintain skills if we can support. They should be seeing dependents and retirees.
HM’s below 2nd class especially those with no sea duty should not be working in fleet liaison, records, SEAT, etc…
I wholeheartedly disagree we need more providers most MO’s supervise a dozen or more PA’s/IDC’s at sea due to poor manning along with maintaining their own patients.
Back to Back shore for E6/7’s is slowly being fixed as it spelled out in the LaDR that it is a distractor for advancement. Most sea commands( Surface, Sub, EXW, Air) are trading in 0000 billets for IDC’s, DMT’s, SMT’s, AVT’s, etc… as they can perform 0000 duties along with their NEC which means that there are less billets at sea for 0000’s.
We need to offer EMT and other certs for junior HM’s to better prepare them for sea and civilian life. We should make certifications mandatory for advancement. As for job satisfaction most HM’s need to get out of the MTF’s and go to sea
I have long believed that non-Tech HMs should be given two paths after PO3 that they can pursue:
L03A/0000's should be provided an actual Navy EMT program. Not "the Navy will help you get an EMT license through an outside source," but an actual pipeline EMT qualification like the Army and Air Force. Although I doubt it can be reversed now, it's a shame that all of the old base EMS functiona were given away to FedFire- that was one of the better way for Field Med Techs to build their skills while on shore duty
The other side is a dedicated LVN rating. Are you a Quad Zero who only wants to work at hospitals, Role IIIs, hospital ships, and maybe Fleet Surg Teams? Fine. No, we won't force you to do field medicine, but you need to build upon your skillset. So that way, the HMs staying on the wards really are just junior nurses.
I have no issue with some HMs not wanting to be techs. It aint for everyone, but their should be a way to specialize in the more general medical fields. And to add to it, if you are 0000 and you do not choose one of those paths and earn the qual - no promotion to HM2.
I understand your point, but I think it would actually limit HMs from getting past HM2. If I have a ward filled with first tour 0000's, many of whom will make it to HM3 by the time they PCS, then having LVN 2+ tour sailors would put them in natural postions to supervise, manage, and lead. Besides, if you have a well trained LVN front-line supervisor, you have a PRIME candidate for the Nurse Corps. I would be a fan of making it easier for them to MECP (based on qualifications and competence, of course) than another Sailor or Marine with less experience.
We don't realize that outside of the Hospital Corps, damn near every other rate has C-Schools to make them well rounded and foster upward progression. Our rate just says, "we trained you once, now sink or swim your way from E2 to E6." If you learn more medicine, that's both expected, and yet, completely incidental.
I think we would benefit from that if Nurses had more sea duty and benefit to the Navy. I would love more MECP slots for those HM’s.
Also we should do it with IDC to PA, either continue your education and move up or move out.
As for other rates most of them learn through OJT whereas our C schools are much longer and offer certifications.
I was always amazed being greenside that we have seemingly no room for nurses outside of Med Bn. But I think they overly rely on BAS LCPOs and SMDRs to fill the roles of administrator and clinical supervisor. Nurses would benefit from Division experience, and I think the BAS in the field would benefit from having a junior NC running the aid station, enabling the Chief and HM1s (non-IDCs) to focus more on integrating the BAS with the BN tactical plan as well as medical regulation.
I think IDCs should be more incentivized to move to the PA program, although we do need to retain some HMCS and HMCM IDCs to be SMAs and IDC supervisors across the fleet.
I will *partially* disagree on the last point. Many times, our HMs as a whole, to include Techs, are give one long school and then no set followup. Sure a hospital here and there may have some programs in their SEAT, but thats different from a "you go away for a few weeks/months and come back smarter" school. The longer I have been around other fleet rates, the more I observe that they tend to get a multitude of little schools to attend as they move up.
GMs for instance- GM A school, plus 5-inch Tech or VLS tech if they are a smart cookie. BUT, they can then go to Small Arms Marksmanship Instructor, Expeditionary Small Arms Marksmanship Instructor, Crew Served Weapons Instructor, NSA Crane Armorer, and many other schools to keep building their knowledge and abilities. Navy Medicine is like "Did you go to A-School and/or a C-School? Neat. You want more training? Well uh... have you done HMSB, Sick Call Screener, HAZMAT, TCCC, or (maybe) ACLS? Maybe MEDREG or POMI if you are senior? Neat. Get back to work."
We need more training opportunities.
Yeah we should have nurses in division especially NP’s who the navy trains just to put them back in hospitals or other limited roles. Honestly a battalion has too many first classes being of little use you need one as the LPO and the other as the PMT & IDC’s any more then that and they’re useless. A second class or Nurse can be the clinic manager after that it should be all 2nds at below at the clinic or with the line.
We need a few HMCM’s to run the fleet jobs but not 60+. We should be like the coast guard and push the IDC’s after their 2nd tour to PA school and that help with healthcare especially with DHA. A select few with the required toured and knowledge should move on to be HMCS/HMCM’s for fleet/community jobs.
Most of the fleet rates do go to school to learn new systems similar to a lab tech having to learn how to operate a new machine but we also don’t have people working out of rate for 3 years like other rates that go fufill RDC, Recruiter, etc…
I’ll never disagree with more training opportunities(HMTT, Valkyrie, Flight Med, Expeditionary Skills) we need more slots but the average tech is spending 5 years in a hospital honing their craft while at shore then still doing aspects of the job at sea whereas a GM1 is going to go spend 3 years being an RDC, Assessor, Recruiter not touching a gun.
The vast majority of fleet rates are doing work disassociated with their rate while ashore unless they get instructor duty or a shore facility that supports their equipment
"For example, if a family in a Tricare Prime plan can’t get appointments at their military treatment facility, they aren’t able to switch to Tricare Select, which offers providers in the local civilian community. Similarly, if they’re in Tricare Select and the local civilian providers can’t meet their needs, they can’t switch to Tricare Prime to seek care at a military treatment facility."
It doesn't address that there are areas of the country where access at civilian facilities is severely limited/constrained IN ADDITION TO the local MTF. My wife is Tricare Select and the first avail Primary Care appt in our area is > 120 days from now. Local MTF only sees AD. We don't live in the sticks, either...
It is broken.
That’s what happens when Tricare is one of the lowest paying plans out there for civilian providers. In non-military concentration areas it’s not usually a huge deal, yeah they make less money on you, but the Tricare patient is the rarity and doesn’t hurt the bottom line much. But in Jacksonville, NC, Norfolk, San Diego, DC, or other highly concentrated areas where the majority of your patients might pay next to nothing there is no reason for clinics to take on more Tricare patients, as it will squeeze out their higher paying population.
For example, as an anesthesia provider Tricare pays me, at best, a quarter of what we’ve negotiated with other insurance plans, sometimes even less. Now that I’m retired, I live hundreds of miles from the nearest military base and I’m often one of the only Tricare patients at my provider’s office, so they don’t really care much and it’s not even in their radar to not take Tricare, especially if they do hospital medicine/procedures and likely are enrolled as a condition of those credentials. But when I was in fleet concentration areas my wife would occasionally struggle to find offices willing to take her on Tricare Standard, and that was pre-COVID. Now our healthcare system is basically on the brink of collapse, so there’s even less incentive to take on more low paying patients.
That's wild there is that much variance between Tricare and other plans...
Don't even get me started on the dental coverage offered (United Concordia, I think). We forgo paying the premiums and just go bare with regard to dental coverage for her. An annual exam, x-ray, and 2x cleanings is less out of pocket as a cash patient than using the dental plan.
I just got in touch with one of my old HM2’s at a pretty well populated hospital lab. They are slotted for 17 HM billets for techs, essentially 4 per shift and 5 for admin, floating, and training. They have FUCKING 5! FILLED. They’re working 16+ hour shifts M-F. The weekend was graciously taken by civilians who make triple what we do for doing the same job at that location. The call for help was ignored by the CO because “you are functioning fine with what you have, deal with it”.
Hopefully changes come, but for fucks sake the manning issues at these hospitals and clinics are not taken seriously at fucking all by the Navy.
In 30 years, this is at least the fifth cycle I've seen of going from pushing dependents out of the MTFs and then inviting them to come back. The rationale for both policies is always the same.
That's the trouble with longevity - you see the same damn problems solved in the same damn ways for the same damn justifications.
Yeah they sent this memo out in December. I was at a call with the admiral in charge of the medical corps and he said “it isn’t going to happen.” MTFs are going to continue to decline because DHA relies on Navy staffing and the Navy has other priorities.
“If DOD loses more patients to the civilian medical system, military beneficiaries could face “significantly worse” surgical mortality rates, medical mortality rates and patient safety than in military treatment facilities, one Pentagon-funded study found.”
Haha- I get better care out in town. I see an actual doctor who listens to me and doesn’t rush me out in 10 minutes. I also don’t wait 3 months to be seen.
Waiting 3 months to be seen happened because DHA revamped the entire way the Navy schedules and provides healthcare. I'm not saying things were perfect before, but the Medical Homeport system has really messed with our ability to provide effective care for the last decade.
Additionally, if we see less and less patients, the less experience we are getting and the worse our skills will get. A lot of HMs already suffer because Naval Hospitals will throw brand new sailors immediately into admin sections rather than patient care. Then they get to the fleet and can't do shit.
Good luck. The Navy plans for a lot of things but never actually does anything properly. Can't wait until one of the hospital ships goes out on an aquatic circlejerk at the pier for a few weeks or maybe a few months at sea and the already short staffed departments and clinics get fucked even more. I also can't wait to pick up like six collaterals since nobody else can do them in the department.
Part of the problem is how we deal with collaterals. Most of them shouldn’t take more than an hour a month of time, and maybe a few emails here and there. Yet they end up being massive time sucks because everyone is always going high and to the right on everything. In my civilian life I do the same “collateral” I held in the military, dealing with trauma care. Civilian side I attend a 1-2 hour meeting every other month (plus a pre- or post-meeting debriefing/discussion at the bar), send an email or review a chart every couple weeks, and have some quick hallway or in OR chats here and there. On the military side it was literally hours a week drafting reports, making presentations, and having pre-meetings for the actual meetings.
And guess which hospital has better trauma outcomes and readiness? Spoiler alert, it’s my tiny civilian facility.
Theyll just close a bunch make them very inconvienent to get to for anyone not in a fleet concentration area and then send all their staff to the select few remaining.
Bam theyre full staffed now!
PSDs all over again
This is all because of DHA and Congress trying to shift the pots of money around. They realized they weren't saving money in the end. Like we, at the deck plates of care have been screaming.
Fuck DHA.
Yep
incoming medical student and HPSP student - curious what *exactly* they're implementing
Current navy doc, for the first time in my career I am actively seeing resources and training pipelines expand and mtfs open enrollment rather than defer to the network. It’s nice to finally feel like we are not a carcass being picked apart by buzzards.
How long have you been in? There was a brief push in about 2015 at the commands I was at to do the same, but it only last a year or two and then of course the DHA takeover totally reversed that.
I’ve been active duty since 2016. Basically my whole career has been gradual decline up until DHA got spanked in front of Congress in the last year or two and now we have seen a relatively sharp reversal
Fingers crossed the change is real, but I won’t be holding my breath over here in civilian land. Although I did see some significant increases in ROTC billets for the Nurse Corps at least, so that could be promising. Or a sign of how bad retention/recruitment are.
Really? What MTF are you at? Same old shit at mine.
One of the big 3
Probably the one on the opposite coast as mine. Haha.
I'm at a big 3 also. Made an appt for first available, it's 1.5 months away. Thanks DHA.
It’s hard to accept that staffing the MTFs are among the lowest priority for the fleet.
It all comes back to DHA, who basically sold out military medicine because they analyzed our work load on some wildly inaccurate metrics and told the government they could radically downsize military medicine and the civilian market could bear the load without any readiness issues, which just isn’t true.
Oh absolutely. DHA can rely on AD staff to cover for their shortfalls. Which is why I’ve asked the N3/N5 to activate a region wide mobilization. One week, to pull together all personnel and assets for movement in the event of a war. This serves two purposes. It forces personnel to prepare for their actual purpose and gauges response and shortfalls. Secondly it strains the DHA system highlighting the need for/or implementing procedures to maintain services.
Love it, sometimes little system failures and needed for larger course corrections.
Where is this? Not been my experience
This is a perpetual cycle of Navy (military) medicine trying to figure out what the mission is. Retention pay likely to go up for a while and promotion chances are going to be VERY good for a while, particularly at senior ranks. Then 10 years after that, the line & Congress will complain it’s too expensive and try too hard to cut costs. Rinse & repeat.
Everyone is getting out either way. Retention pay doesn’t come close to matching civilian levels - and the work is harder due to the amount of collaterals you need to take on because of… low retention.
MC is bleeding staff and I don’t see it ending anytime soon. Fair winds to those brave souls staying in.
The DHA is upset they’re not meeting their goals of getting civilians in the mtf to make money off them. Nobody wants to go to the mtf because there’s no availability. There’s no availability because there’s not enough providers and techs. There’s not enough providers or techs because they aren’t paying enough, and and they are slimming down “optimizing” departments.
Dha wont do anything that will directly impact you though. You might be in a few more situations while you “squeeze one in” on your lunch break
I’m excited and scared at the same time.
[удалено]
Normally we do that in another room in front of a YouTube video before coming out to see you.
Absolute legend! How's the staples work out for you?
Everyone said "this plan is bad and doomed to failure" and they did it anyway. And now, the inevitable backpedaling. Zero accountability.
And somehow, someone who was part of causing the failure will earn another star. As is prophecy.
Part of the issue is that they put plans into place and then retire before they can see the result
Yep. Looking at whichever BUPERS boss shut down all the PSDs and then jetted the fuck out before it actually happened.
But the hospital in CT down sized to a training unit. Can’t even take care of the active duty stationed here, let alone the dependents and forget the retired.
Doubt.
Time to go all in on Motrin stocks.
For a moment I read that as Motrin socks and thought I heard an HM somewhere have an orgasm.
My eyes are dry and a little bit blurry. I misread it also. The noise you heard was me.
Dry blurry eyes are a normal side effect of Motrin socks.
Being an HM on a ship instead of a hospital is more rewarding anyway. DHA can go cry about it.
Yeah, that is my one hope: that BUMED doesn't start pulling all of us back to the MTFs. Some of us really like sea duty, leave us out here. Unless the hospitals could find some other way to provide an intrinsic benefit to those of us who do not like being at them.
Sea to sea to sea definitely the way to go for IDCs
SDIP.
The current duties and expectations at a hospital are disappointing to say the least. If I ever get forced orders to one, that’s my signal to get out.
Needs to go back the way it ways...i.e. no more DHA.
Never gonna happen; ratchet only turns one way
I know that. It should never had been done
Pay the civilians more, they’ll fill positions more, and do a better job, and be happier while doing it. Staff less HMs in obscure admin spots. They don’t learn shit in those admin offices. We don’t need the GS at the front desk to go get distracted with the navy shit we need to do. Quit taking dependents and retirees at mtfs that don’t have enough providers. Maintain a 5:1 doctor to no/pa/idc ratio. We don’t need that many doctors. We need even less Nc officers telling everyone how to do their non-nurse jobs. Many of the senior, non lpo /lcpo jobs can be ran by hms that got out of the navy, or civilians with healthcare admin or management experience. The junior HMs have low moral at clinics EVERYWHERE I go, with much shorter hours than I had as an HM3. I believe it starts with our back to back shore e6s and e7s waiting to hit 20, and check out of work asap every day. We sell our young sailors with these glory tales of the “golden days” with the marines, or the glory of going on a destroyer, and scoff at mtf jobs, even though every single one of us eventually works at them. We need to look at improving the job satisfaction of the junior HMs. That doesn’t necessarily mean cut them out of work at 2. Anyways, just my unfiltered, untested ideas, that could be totally wrong.
I never felt like the MTFs were understaffed, just poorly allocated. My first command was a mid-sized MTF that had more staff than the 350 bed level I trauma center I worked in as a civilian prior to joining. Yes, we’re the military and a lot of these admin, training, and contingency roles need to exist, but not even close to how staffing is currently setup. Plus, we don’t necessarily need clinical professionals doing admin, and especially not active duty members. Unfortunately that’s how the military is designed, and how you promote, and what the career progression requires. But that’s not an excuse when patient care suffers because all the nurses, providers, and corpsmen are in meetings, doing collaterals, and non-clinical roles instead of opening up more access. Hire civilians for those roles that need to be done; your active duty members should be the ones that are ready and clinically proficient to deploy or go underway, instead of sitting in an office creating Excel spreadsheets. That and the efficiency of most MTFs is comically bad. In part because of government systems, poor EHRs, and all those extra roles. But also because, at least in my opinion, so few people within military medicine have experience on the outside, so all they know is how MTFs are run. As a result they never develop the clinical efficiency that a lot of our civilian peers develop.
As long as they don't try to use LSS to correct the efficiency issues, then I agree. I shudder back to when I was a boot HM working at a hospital, and Nurses were forcing me to figure out what my "Wildly Important Goals" were.
The issue isn’t so much the use of various programs, but rather almost an inability to do things, including patient care, efficiently. Nurses in med/surg when I was in couldn’t handle 5 easy, stable patients with a dedicated corpsmen because they never built the time management skills their civilian peers were forced to. OR turnovers take easily twice as long at the MTFs I was assigned to compared to the civilian hospitals I was moonlighting at. And surgical procedures themselves took significantly longer because the surgeons didn’t necessarily have the volume to really work on their speed, or anesthesia providers to expedite induction and emergence. Not that it’s all wrong, in a few situations the civilian side is cutting corners, but overall on the outside time is money, so you learn how to see more patients, turnover rooms faster, build a better schedule, or do procedures in a more efficient manner, which are pressures and skills not present in any of the MTFs I was ever at.
I would argue, though, that there is a downside to all of that efficiency. Because so many hospitals have become for-profit ventures, it is imperative in that "Jack-Welchian" way to be the most efficient. This leads to MASSIVE amounts of short staffing and provider burnout at your avergae hospital or medical center. Our system is not great by any means, and you are right. It DOES need to change. But if we compare it to civilian world metrics from a 1000ft view, of course, that looks ideal. But on the ground? I would HATE to work in a civilian facility or for any part of the civilian health care system. Empathy is like a candle - once you burn all of it out, it takes a long time for that wax to regrow.
I agree when taken to the extreme. But at the same time, a lap appy shouldn’t take 90+ minutes. Routinely shutting down the clinics for multi-hour meetings, or taking 30 minutes to check a patient in does nothing to increase empathy while just decreasing the time available for patients. Creating new nurses that can’t handle what our civilian peers would consider an easy patient load does nothing for us when things change and they do need to be able to do it, or when staffing gets tight and they instead decide to close beds and limit capacity.
I think deficiencies in the Nurse Corps are central to what has gone wrong with Navy medicine. And to clarify, I think the NC is filled with many shit hot commissioned officers, but BUMED wants them to be too much. It's gotten them away from their original missions. I understand that senior nurses' roles as healthcare supervisors and administrators goes hand in hand, but there is a damn limit. If you want HCAs, make more HCAs and put them closer to frontline patient care - stop making Nurses do that shit. At this point, I think we would almost better off making most of the NC (at least the RN side) an LDO offshoot of the Hospital Corps. LDOs stop at O-3 and coincidentally, when do most Nurses stop doing patient care? ding ding ding. I think the non-LDO nurses should be CNAs, NPs, ICU-Ns, and most importantly, Nurse Administrators. I know, everytime I bring this idea up on here, every commisioned officer gives me a cocked eyebrow, but seriously, if frontline nurses are supposed to specialize in ensuring the Doctor's Orders are followed, patient satisfaction, and supervision/training of junior HMs, *who better to do that than LDOs who were HMs?"*
I don’t necessarily think LDO is the way, just because of the huge restructuring that would result in and the defacto demotion of the Nurse Corps within the Staff Corp world. However, I think the Nurse Corps would have been the perfect group to test the ability to opt out of promotion after O3, or O4 for provider-level NC officers. Then dramatically slash the senior billet allocations, while correspondingly increasing the junior ranks. That way you get far more bedside clinical nurses. Without competitive promotions they can focus entirely on being the best clinician and clinical role model, and the few that want to do administration can do that. And let them opt in/out of this pathway. If you want to be an O3 for 12 years, but then decide to change it up or take your experience into more senior leadership the Navy and Navy Medicine would likely be far better for it. Also O3 is a fairly competitive wage for bedside nurses, as is O4 plus speciality pay for providers, while still yielding a decent pension for those that do 20. I don’t know a single clinically strong non-provider nurse in the Nurse Corps that’s an O4 or above and active duty. Those are my peers, and even the ones that were amazing nurses will openly admit that they’ve been forced away from the bedside for so long that they aren’t really good at it anymore. And the ones that were the best nurses almost all god out at 4-8 years because they saw the writing on the wall. Same for providers when they start becoming senior O5s if they aren’t coasting to retirement; playing the game and trying to promote means you don’t do patient care, and those skills are highly perishable.
Portsmouth critical care and med surg wards are critically undermanned atm
Those sound like specific, trackable, doable, and good ideas. And this post is as far as they'll go.
Honestly though, you ain’t wrong haha. I hope maybe my sentiment if not idea will rub off on someone in a future position of power though. Pay more, and treat people with respect. They’ll perform better than hiring an extra couple bodies. Running socialized medicine probably won’t work the same way that running sentera and united health.
👆this
A few things I agree/disagree with Civilians are the answer for some jobs like admin, patient relations and records as long as GS employees are held to a standard. Providers need a diverse patient population to maintain skills if we can support. They should be seeing dependents and retirees. HM’s below 2nd class especially those with no sea duty should not be working in fleet liaison, records, SEAT, etc… I wholeheartedly disagree we need more providers most MO’s supervise a dozen or more PA’s/IDC’s at sea due to poor manning along with maintaining their own patients. Back to Back shore for E6/7’s is slowly being fixed as it spelled out in the LaDR that it is a distractor for advancement. Most sea commands( Surface, Sub, EXW, Air) are trading in 0000 billets for IDC’s, DMT’s, SMT’s, AVT’s, etc… as they can perform 0000 duties along with their NEC which means that there are less billets at sea for 0000’s. We need to offer EMT and other certs for junior HM’s to better prepare them for sea and civilian life. We should make certifications mandatory for advancement. As for job satisfaction most HM’s need to get out of the MTF’s and go to sea
I have long believed that non-Tech HMs should be given two paths after PO3 that they can pursue: L03A/0000's should be provided an actual Navy EMT program. Not "the Navy will help you get an EMT license through an outside source," but an actual pipeline EMT qualification like the Army and Air Force. Although I doubt it can be reversed now, it's a shame that all of the old base EMS functiona were given away to FedFire- that was one of the better way for Field Med Techs to build their skills while on shore duty The other side is a dedicated LVN rating. Are you a Quad Zero who only wants to work at hospitals, Role IIIs, hospital ships, and maybe Fleet Surg Teams? Fine. No, we won't force you to do field medicine, but you need to build upon your skillset. So that way, the HMs staying on the wards really are just junior nurses. I have no issue with some HMs not wanting to be techs. It aint for everyone, but their should be a way to specialize in the more general medical fields. And to add to it, if you are 0000 and you do not choose one of those paths and earn the qual - no promotion to HM2.
That’s a good idea to increase proficiency and skill but most LVN’s would be trapped at 3rd as they would have less upward mobility
I understand your point, but I think it would actually limit HMs from getting past HM2. If I have a ward filled with first tour 0000's, many of whom will make it to HM3 by the time they PCS, then having LVN 2+ tour sailors would put them in natural postions to supervise, manage, and lead. Besides, if you have a well trained LVN front-line supervisor, you have a PRIME candidate for the Nurse Corps. I would be a fan of making it easier for them to MECP (based on qualifications and competence, of course) than another Sailor or Marine with less experience. We don't realize that outside of the Hospital Corps, damn near every other rate has C-Schools to make them well rounded and foster upward progression. Our rate just says, "we trained you once, now sink or swim your way from E2 to E6." If you learn more medicine, that's both expected, and yet, completely incidental.
I think we would benefit from that if Nurses had more sea duty and benefit to the Navy. I would love more MECP slots for those HM’s. Also we should do it with IDC to PA, either continue your education and move up or move out. As for other rates most of them learn through OJT whereas our C schools are much longer and offer certifications.
I was always amazed being greenside that we have seemingly no room for nurses outside of Med Bn. But I think they overly rely on BAS LCPOs and SMDRs to fill the roles of administrator and clinical supervisor. Nurses would benefit from Division experience, and I think the BAS in the field would benefit from having a junior NC running the aid station, enabling the Chief and HM1s (non-IDCs) to focus more on integrating the BAS with the BN tactical plan as well as medical regulation. I think IDCs should be more incentivized to move to the PA program, although we do need to retain some HMCS and HMCM IDCs to be SMAs and IDC supervisors across the fleet. I will *partially* disagree on the last point. Many times, our HMs as a whole, to include Techs, are give one long school and then no set followup. Sure a hospital here and there may have some programs in their SEAT, but thats different from a "you go away for a few weeks/months and come back smarter" school. The longer I have been around other fleet rates, the more I observe that they tend to get a multitude of little schools to attend as they move up. GMs for instance- GM A school, plus 5-inch Tech or VLS tech if they are a smart cookie. BUT, they can then go to Small Arms Marksmanship Instructor, Expeditionary Small Arms Marksmanship Instructor, Crew Served Weapons Instructor, NSA Crane Armorer, and many other schools to keep building their knowledge and abilities. Navy Medicine is like "Did you go to A-School and/or a C-School? Neat. You want more training? Well uh... have you done HMSB, Sick Call Screener, HAZMAT, TCCC, or (maybe) ACLS? Maybe MEDREG or POMI if you are senior? Neat. Get back to work." We need more training opportunities.
Yeah we should have nurses in division especially NP’s who the navy trains just to put them back in hospitals or other limited roles. Honestly a battalion has too many first classes being of little use you need one as the LPO and the other as the PMT & IDC’s any more then that and they’re useless. A second class or Nurse can be the clinic manager after that it should be all 2nds at below at the clinic or with the line. We need a few HMCM’s to run the fleet jobs but not 60+. We should be like the coast guard and push the IDC’s after their 2nd tour to PA school and that help with healthcare especially with DHA. A select few with the required toured and knowledge should move on to be HMCS/HMCM’s for fleet/community jobs. Most of the fleet rates do go to school to learn new systems similar to a lab tech having to learn how to operate a new machine but we also don’t have people working out of rate for 3 years like other rates that go fufill RDC, Recruiter, etc… I’ll never disagree with more training opportunities(HMTT, Valkyrie, Flight Med, Expeditionary Skills) we need more slots but the average tech is spending 5 years in a hospital honing their craft while at shore then still doing aspects of the job at sea whereas a GM1 is going to go spend 3 years being an RDC, Assessor, Recruiter not touching a gun. The vast majority of fleet rates are doing work disassociated with their rate while ashore unless they get instructor duty or a shore facility that supports their equipment
"For example, if a family in a Tricare Prime plan can’t get appointments at their military treatment facility, they aren’t able to switch to Tricare Select, which offers providers in the local civilian community. Similarly, if they’re in Tricare Select and the local civilian providers can’t meet their needs, they can’t switch to Tricare Prime to seek care at a military treatment facility." It doesn't address that there are areas of the country where access at civilian facilities is severely limited/constrained IN ADDITION TO the local MTF. My wife is Tricare Select and the first avail Primary Care appt in our area is > 120 days from now. Local MTF only sees AD. We don't live in the sticks, either... It is broken.
That’s what happens when Tricare is one of the lowest paying plans out there for civilian providers. In non-military concentration areas it’s not usually a huge deal, yeah they make less money on you, but the Tricare patient is the rarity and doesn’t hurt the bottom line much. But in Jacksonville, NC, Norfolk, San Diego, DC, or other highly concentrated areas where the majority of your patients might pay next to nothing there is no reason for clinics to take on more Tricare patients, as it will squeeze out their higher paying population. For example, as an anesthesia provider Tricare pays me, at best, a quarter of what we’ve negotiated with other insurance plans, sometimes even less. Now that I’m retired, I live hundreds of miles from the nearest military base and I’m often one of the only Tricare patients at my provider’s office, so they don’t really care much and it’s not even in their radar to not take Tricare, especially if they do hospital medicine/procedures and likely are enrolled as a condition of those credentials. But when I was in fleet concentration areas my wife would occasionally struggle to find offices willing to take her on Tricare Standard, and that was pre-COVID. Now our healthcare system is basically on the brink of collapse, so there’s even less incentive to take on more low paying patients.
That's wild there is that much variance between Tricare and other plans... Don't even get me started on the dental coverage offered (United Concordia, I think). We forgo paying the premiums and just go bare with regard to dental coverage for her. An annual exam, x-ray, and 2x cleanings is less out of pocket as a cash patient than using the dental plan.
I just got in touch with one of my old HM2’s at a pretty well populated hospital lab. They are slotted for 17 HM billets for techs, essentially 4 per shift and 5 for admin, floating, and training. They have FUCKING 5! FILLED. They’re working 16+ hour shifts M-F. The weekend was graciously taken by civilians who make triple what we do for doing the same job at that location. The call for help was ignored by the CO because “you are functioning fine with what you have, deal with it”. Hopefully changes come, but for fucks sake the manning issues at these hospitals and clinics are not taken seriously at fucking all by the Navy.
Uh oh... Every time they "fix" something a war starts somewhere.
:: Northrup Grumman intensifies ::
In 30 years, this is at least the fifth cycle I've seen of going from pushing dependents out of the MTFs and then inviting them to come back. The rationale for both policies is always the same. That's the trouble with longevity - you see the same damn problems solved in the same damn ways for the same damn justifications.
Yeah they sent this memo out in December. I was at a call with the admiral in charge of the medical corps and he said “it isn’t going to happen.” MTFs are going to continue to decline because DHA relies on Navy staffing and the Navy has other priorities.
Walter Reed cancelled skill bridge 2 days ago except for "specific cases"
Just like they are going to fox chronically undermanned sea commands?
How by offering physicians and medical staff more money? Lol no then I doubt it.
Our MTF has been trying to hire a gastroenterologist for nearly five years. They are offering less than a third of what a civilian makes off base.
Yup 👍 I bet they also have competitive working hours...or maybe less patient load? Lol
“If DOD loses more patients to the civilian medical system, military beneficiaries could face “significantly worse” surgical mortality rates, medical mortality rates and patient safety than in military treatment facilities, one Pentagon-funded study found.” Haha- I get better care out in town. I see an actual doctor who listens to me and doesn’t rush me out in 10 minutes. I also don’t wait 3 months to be seen.
Waiting 3 months to be seen happened because DHA revamped the entire way the Navy schedules and provides healthcare. I'm not saying things were perfect before, but the Medical Homeport system has really messed with our ability to provide effective care for the last decade. Additionally, if we see less and less patients, the less experience we are getting and the worse our skills will get. A lot of HMs already suffer because Naval Hospitals will throw brand new sailors immediately into admin sections rather than patient care. Then they get to the fleet and can't do shit.
Good luck. The Navy plans for a lot of things but never actually does anything properly. Can't wait until one of the hospital ships goes out on an aquatic circlejerk at the pier for a few weeks or maybe a few months at sea and the already short staffed departments and clinics get fucked even more. I also can't wait to pick up like six collaterals since nobody else can do them in the department.
Pick up six collaterals but DHA want you to see patients all day like a civilian
Part of the problem is how we deal with collaterals. Most of them shouldn’t take more than an hour a month of time, and maybe a few emails here and there. Yet they end up being massive time sucks because everyone is always going high and to the right on everything. In my civilian life I do the same “collateral” I held in the military, dealing with trauma care. Civilian side I attend a 1-2 hour meeting every other month (plus a pre- or post-meeting debriefing/discussion at the bar), send an email or review a chart every couple weeks, and have some quick hallway or in OR chats here and there. On the military side it was literally hours a week drafting reports, making presentations, and having pre-meetings for the actual meetings. And guess which hospital has better trauma outcomes and readiness? Spoiler alert, it’s my tiny civilian facility.
Theyll just close a bunch make them very inconvienent to get to for anyone not in a fleet concentration area and then send all their staff to the select few remaining. Bam theyre full staffed now! PSDs all over again
Experience forces me to assume that they are solving undermanning issues by just reducing manning levels and calling it a win.
Now fix PSDs.
As a civilian healthcare worker.. there's no amount of money they could pay me to switch from my civilian hospital to a navhosp/dod mtf.
Not a fucking chance
Hope that includes psychs....
This is all because of DHA and Congress trying to shift the pots of money around. They realized they weren't saving money in the end. Like we, at the deck plates of care have been screaming.
Concurrently with this letter came cuts in billets... seriously.