Attrition: The Dark Side of MASH


May 9, 2006: Not all the casualties of the war on terror are physical. Medical personnel (mainly doctors and nurses) have always been in short supply, and the prospect of wartime service has not brought in enough volunteers.

The military has to pile on lots of bonuses to even come close to competing with pay available in civilian medical jobs. For three decades, the main tool for obtaining doctors has been the Health Professions Scholarship Program, which pays all tuition for medical students, in return for a long term commitment to serving in the military. However, fewer high school students are applying for these scholarships. The word has gotten around that, in wartime, you spend lots of time overseas in unpleasant areas. Since each of the services recruit doctors, using these scholarships, the recent response shows how prospects are reacting to combat duty. The army filled only 77 percent of scholarship spots in the Department of Defense Medical School. The navy, which supplies doctors for the marines (and puts a lot of them on ships, for long periods afloat), got only 56 percent. The air force was oversubscribed, with 115 percent.

More money is unlikely to work, because we are literally talking about work, "you can't pay people to do." The military has already discovered, over the last few decades, the declining results as bonuses, to medical personnel, rose higher and higher. Another solution, to combine medical care for all the services, might work. But, with everyone at risk for overseas assignments, all potential applicants for medical scholarships would face the same downside. But by combining the medical personnel of the three services into a "Department of Defense Medical Corps," there would be some savings as duplications of effort were eliminated.

Ultimately, the military is going to have to pay the market rate for the medical specialists it needs. This is nothing new for the military. Seven centuries ago, the first crews for heavy artillery were civilian contractors, and the military has long used civilian physicians for treating the troops on the battlefield. Going into the 20th century, there were still plenty of civilian contractors, even in combat zones. These were almost always technical specialists, and that's what the increasingly scarce medical personnel are.

This process would begin with large scale replacement of medical specialists serving troops in the United States, and then expand to those overseas. The wartime situation has made state-side duty harder as well, because with more medical personnel overseas, there are fewer to take care of the families back home. If more civilian medical personnel were used. the uniformed medical professionals would be, as much as possible, the ones used in combat zones. But even there, if the pay and benefits were right, you could recruit civilian "temps." Another example of outsourcing, and why.




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