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.
America has attempted to address shortages via training too many times to count – and all have failed. New sources include nurse practitioners now expanded up to 35,000 graduates a year and still increasing at 2500 more each new class year or 14 times the annual population growth rate of 0.6% – but still shortages. PA and DO and Caribbean grads are up 8 – 10 times population growth rate. US MD is up 30% since 2000 and increasing at 6 times population growth rate. International at about 3000 per class year. New sources include assistant physicians (did not pass boards but MD) but studies demonstrate that they did not go where needed either. Pharmacists as clinicians proposed – but the places where needed lack pharmacies because the financial design that shapes shortages of physicians, clinicians, hospitals, nursing homes – also has killed off pharmacies.
We don’t need more promises to fix shortages. We need people to support a better financial design. 90% of local services where half of Americans are short of workforce are lowest paid generalist and general specialty services paid 15 per cent lower and penalized more in the past decade.
Workforce can only be supported by health care dollars. When the dollars are shaped by the most lines of revenue and the most reimbursement in each line in 1% of the land area in 1100 zip codes with 45% of the health workforce and over half of health spending – little is left for basic health access where most Americans most need care.
Any time you have someone propose a new type of workforce for shortage fixing, ask them how this new plan will support more team members in more places where patients and their situations are most complex. Ask them how this will return billions more a year to the practices and hospitals forced to send more billions away to consultants and corporations.
Fix the financial design to fix shortages.
Or have training entirely local during preparation, admission, training, and an 8 year obligation. This is of course the opposite from the most exclusive origins, preparations, schools, training exams, specialties, and financial designs that dominate – and discriminate.
My sister is an lpn working on her rn degree and my son is a dental lab tech with 5 yrs of experience.
I know that this article deals with medical ( non dental) info.
But people in those rural areas need both medical & dental help also.
My sister is in the medical field & my son in the dental field.
Is it possible that their experiences coyld be used in this program? If so please let me know.
Wow. I understand those who got out of the medical service because of patient tx protocols that requird licensing. I couldn’t do what I used to do as a Medical Service Specialist (ICU), for 3.5 years in the USAF. When I got out in 1975, I got a job in an Emergency Department, working the grave shift. The ER docs were really cool about letting me do all kinds of care that an “orderly” (what my DD214 said I was in civy life) normally could not do. Worked there over a year with no hassles from anyone, then we got a new charge nurse, and she wouldn’t let me do zip. “Liability” she said. She took it to HigherHigher and I was relegated to just doing CPR and cleaning up the unit.
So, left there and went to a back-office job with an ortho surgeon, (day shift!) who was also a veteran. He let me do all kinds of stuff. Guess what happened next? He hired a new Nurse Prac who had a big frown on her face, 90% of the time, when she saw what I was doing (doing well, correctly, and better than she could!). Said to heck with it all. Yeah, coulda/shoulda/woulda gone to PA school, but I had to work to pay the rent and couldn’t afford to stop.
This article’s spot on. I’m now 68, and keep my hand in the medical field, helping out at the VA, in a non-clinical job. When other vets hear I was a medic, they smile and shake my hand. That’s good enough for me.
Doc MacRea, I’m a reporter working on a story for Health Affairs. If you see this, could you either telephone me at 202 462 2080 or email me. I would like to hear your story. Thanks. T R Goldman
The story about Medics (All branches) working above and beyond their civilian counterparts is a never ending story. This is to include civilian contract companies that want military medics to have current American Certificates to work overseas where these certs mean nothing!!! There are no standards in many of these countries!!! Those are also lost opportunities for former medics that could deliver years of skilled experience around the world. U.S.Army (Retired) Flight Medic.
I am a Vietnam Era Veteran, served as a Medical Service Specialist in the USAF. I am now 64. I have worked for years as a Surgical Tech and 5 years with a Internal Med Doctor. I am now unemployed and need a job. I can work until 70. No health issues. I have said this for years. Why can’t I work without answering phones and use my diagnostic experience to help people? My knowledge base is better than some Doctors and definitely more than some of the PA’s schools are turning out.
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