Military looking for a few good medics

Paging Dr. Dogface
Some of these specialties are perennially difficult to keep. For the most highly skilled — cardio-thoracic surgeons, neurological specialist, orthopedic surgeons -– bonuses can in some cases be up to $70,000 a year. As Wheat attests, for those who prefer to work as private consultants on the front lines in Iraq, the amount can be much higher.

For the most part, the military’s medical system trains its own doctors, either through ROTC-like scholarship programs, which trade medical school tuition and some expenses for a seven year commitment to the military, or more directly by educating them at the Uniformed Services Universities of the Health Sciences just north of Washington.

“We’ve been in a sustained deployment now and it has its impact on recruiting and retention,” says Virginia Stephanakis, an Army Medical Command spokesperson. “It’s something we’re keeping an eye on. But the long commitment after training helps ensure we always have enough people to fight a war and to take care of military family medical needs.”

Kiley and other military medical commanders recently appeared before Congress to urge them to increase the flexibility of the current bonus system. Kiley says if he had the flexibility to offer special packages when they were needed to certain specialties, “I’d fill every slot, I believe. As it is under the current system, I have 4,347 physicians authorized, but only 4,220 on duty.”

Bonuses under the current system are set year-by-year by Congress, with little discretion exercised by military medical commanders.

“For instance, this year all obstetricians may get $34,000, but that could drop next year to $29,000,” Kiley says. “A radiologist could get as high as $50,000. And others further down the list could be offered a “multiple specialty bonus” — meaning if you sign on for two years you get $20,000 over that period.”

Steve Kosiak, an analyst with the Center for Strategic and Budgetary Assessments in Washington, notes that bonuses currently make up five percent of the total amount the Pentagon spends on military pay. “Most of that is in across the board bonuses, like the $20,000 being offered for reenlistment,” he says. “If it were structured to target specialists better, it could be a more effective program.”

Where are the nurses?
Other specialties in the medical and other fields also are experiencing serious shortfalls. These include information and internet specialists, as well as many mid-level officers who appear to be concluding that plotting a military career during wartime is not as attractive as it may have been during the 1990s.

Others, like registered nurses, who rank as officers in the military, and non-commissioned physicians assistants and certain engineering positions, reflect shortages that extend into the civilian economy, as well.

“We are having some problems retaining nurses,” Gen. Kiley says. “They are in great demand in the civilian sector. And we’re also having some trouble with physicians assistants, too. It’s not just a question of Iraq, it’s a question that there aren’t enough slots open in universities — military or civilian — to fill current demand.”

FREE VIDEO Black recruiting down June 8: With soldiers dying on a regular basis in Iraq, recruiting is down, especially in the black community. NBC’s Don Teague reports. Nightly News

“Unfortunately, the way the military’s pay and retirement and promotions system is structured creates a distortion,” says Cindy Williams, an MIT military analyst who for years specialized in personnel issues for the Congressional Budget Office. “They wind up keeping too many of the wrong people — cooks and clerks and unskilled laborers where the salaries and benefits in the civilian economy would not be so different — and not enough of the right people who can make far more by leaving.”

The problem with that, Williams says, “is that serving 14 to 20 years as a medical specialist probably means that at the end of your career you are a stellar medical specialist. Where as, say, someone who has been cooking in a mess hall for 20 years is likely to be only marginally better, if at all.”

Kiley recognizes the problem, but says he has to live in the “real world” if he is to mitigate the consequences.

“You ask the doctors who are leaving where they’re going, and it is stunning, mind-boggling what the cardiologists, radiologists and orthopedic surgeons are getting,” Kiley says. “In a sustained way, we can’t keep up. We have to rely, at least in part, on patriotism and a sense of duty, and the obligation that some of these doctors and nurses and other people owe the military because we trained them.”

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