For more than a century, the United States military has relied on enlisted health care providers — primarily medics and corpsmen — to provide lifesaving care to sick and wounded service members aboard ships, on distant airfields, and on battlefields. When these skilled and dedicated individuals leave the military, there are no comparable jobs for them in the civilian world. That’s a shame — they could play vital roles in filling the shortage of primary care providers that now exists and will only get worse.
The branches of our armed services have different names for these health care providers: Army medics, Navy corpsmen, and Air Force medical technicians. Within each group, the level of training ranges from delivery of lifesaving trauma care on the battlefield to the independent care of service members when they are deployed to war zones.
But when these skilled providers come home between deployments, they are often relegated to simple clinical or clerical tasks. The situation is even worse once they wrap up their military careers and seek to reenter civilian life. Because there are no corresponding roles in civilian health care, a retiring medic or corpsman must either go back to school to obtain a medical, nursing, or physician assistant degree, or pursue a nonmedical career. Both options are a tragic waste of time, money, and talent.
Instead of casting these providers aside, we should incorporate them into America’s health care workforce to bolster access to primary and urgent care. Our nation’s shortfall of primary care physicians, currently around 10,000, is expected to rise to as high as 35,000 by 2025. The impact of this shortfall is already apparent. The free clinics conducted around the country by the nonprofit Remote Area Medical Volunteer Corps attract thousands of patients. Some camp out for days in advance to make sure they get treatment. For many, it’s the only care they receive all year.
Nations with strong primary care systems enjoy better health, and spend less money, than those that do not. Although American spends more on health care than any other nation, our access to primary care is worse than in most high-income countries. As a result, treatable problems go unmanaged, and frequently grow worse. For example, if we improved treatment of the 34 million Americans who have poorly controlled high blood pressure, we would sharply reduce the rate of heart attacks and strokes, conditions that are costly, disabling, and deadly. Better access to care could also decrease costly ER visits and hospitalizations.
Current efforts to close the primary care gap aren’t working very well. It takes up to 12 years of post-secondary education, and large sums of money, to train a new doctor for independent practice. At that point, fewer than 1 in 4 chooses primary care. Creation of physician assistants and nurse practitioners has helped, but these providers also require years of expensive education. Many of them also opt for specialty practice.
In some parts of the country, clinics are employing community health workers to take on nonclinical tasks such as teaching patients how to care for themselves, visiting them in their homes, and helping them make sense of our complicated health care system. Unfortunately, a lack of clinical skills limits what they can do.
What our nation needs is a new type of primary care extender who has the local knowledge of a community health worker, the procedural skills of a physician assistant or nurse practitioner, and ready access to the knowledge of their supervising primary care providers through a mobile telehealth link. They should be easy to train and able to work apart from their supervising provider or primary care clinic.
Retiring medics and corpsmen are ideally suited for this role.
Would patients accept treatment from a former medic or corpsman? I believe so. For four decades, Americans have gladly received lifesaving care from emergency medical technicians and paramedics working under the license and remote supervision of emergency physicians. The legislation that created this approach, the Emergency Medical Services Systems Act, was enacted in 1973 and quickly rolled out nationwide.
A comparable opportunity exists today for states or the federal government to transform primary care. Virginia has taken the first step by enacting a pilot Military Medics and Corpsmen program. It allows former military medics and corpsmen to “perform certain delegated acts that constitute the practice of medicine under the supervision of a physician.” Louisiana recently followed suit.
A corps of primary care technicians that includes, but isn’t limited to, former armed services health workers would be a boon to communities that currently lack access to primary care. The payoff for former medics and corpsmen would be equally big. Rather than having to go back to school or start over when they complete their military careers, they could readily translate their clinical skills and experience to serve communities in a new and valuable way.
Military medics and corpsmen have saved lives on distant battle zones for decades. They can do the same at home. Having defended our nation, they deserve a chance to heal it as well.
Arthur L. Kellermann, M.D., is dean of the Hébert School of Medicine at the Uniformed Services University of Health Sciences in Bethesda, Md. The views expressed here are his own and do not necessarily represent those of his university, the Department of Defense, or the U.S. Government.