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Health Official Answers Concerns Raised by Articles

By Douglas J. Gillert
American Forces Press Service

WASHINGTON, Nov. 13, 1997 – Retired Air Force Technical Sgt. Bill Romedy has gone to the Malcolm Grow Medical Center, Andrews Air Force Base, Md., for health care since he transferred to the region 37 years ago.

"My wife passed away from cancer in 1982, but during her illness, she was treated at Malcolm Grow and also had her gall bladder removed, there. They always treated her well," Romedy said.

Today, Romedy is enrolled in the hospital's family practice, where he's guaranteed to be seen and treated by the same team of doctors, nurses and technicians. He recently spent four days there as an inpatient, for blood-thinning treatment.

"The professionalism and care is well above what I've seen in non-military hospitals," Romedy said. "The care the nurses, providers and technicians gave me was great."

Halfway across the continent, another retiree offered similar praise for the quality of care at the Wright-Patterson Air Force Base, Ohio, medical center. Despite living more than 90 miles away, across the border in Indiana, retired Coast Guard Chief Warrant Officer Bill Redwine said he and his family "have never used another doctor or medical facility" closer to home.

"I've had better treatment since I retired than when I was active duty," Redwine said of the care he receives at Wright-Patterson.

Romedy and Redwine are reaping the benefits of a health care system that is, itself, the healthiest its ever been, according to a DoD official. In the last 10 years, DoD health care has risen to where it's as good or better than any health care system, the official said after articles published by the Cox News Service criticized military medicine.

"Much of what the Cox articles talk about occurred was true in the 1970s and 1980s but isn't true today," said John Mazzuchi, deputy assistant secretary of defense for clinical services.

When the military draft ended in the mid-1970s, the military could no longer expect to automatically receive top-notch physicians, Mazzuchi said. First of all, the services couldn't pay them enough.

"We knew, therefore, that a lot of the physicians coming into the military might not be the best of the best," he said. "We also knew we needed a huge amount of [obstetricians, gynecologists and surgeons], and those are the very people who have the highest incidents of malpractice."

All this happened during a time when malpractice insurance costs were soaring, and for many physicians, the military offered a financial haven. "We had a lot of people with expensive malpractice suits against them saying, 'The heck with civilian life, I'll go into the military,'" Mazzuchi said. "So there's no doubt that during this time of direct accession of physicians, we did not access the best people."

To get higher-quality physicians in uniform, DoD launched two "grow your own" physician education initiatives, the Health Professions Scholarship Program and the Uniformed Services University of the Health Sciences. The scholarship program sent students to top civilian medical schools and residencies in exchange for an equal number of years' military service. To match the high caliber of the best civilian medical schools, DoD made entry into the in-house university in Bethesda, Md., highly competitive. Today, only about one in 20 applicants is admitted, Mazzuchi said.

The first graduates of these programs finally began arriving at their first military practices in the mid-1980s. At the time, nearly half of new physician accessions still came from the street. Today, however, only about 1 percent come from sources other than the DoD scholarship program or in-house medical school.

By the time the "home grown" medics finish their initial service obligations, most have already reached or passed the 10-year point. "Our hope is, as they get invested in the military system, they'll decide to stay to earn military retirement benefits," Mazzuchi said.

Military physicians also wouldn't find medicine today much different in the civilian world, he said. "As we have moved into TRICARE, so has the rest of the country moved into managed care," he said. "The idea of the rich doctor in private practice in the community is dying. Consequently, the satisfiers for staying in the military have increased."

DoD also pays its doctors more if they obtain and regularly renew board certifications in their specialties or sub-specialties.

"Congress was tremendously helpful to us in authorizing special pay, but you get significantly more money if you're board certified," Mazzuchi said. "Giving our people the incentive to make the best buck they can is very helpful. As a result, 88 percent of our fully trained people are board certified. That's considerably higher than the standard of the [civilian] managed care community, which is 72 percent of primary care physicians and 82 percent of specialty care physicians."

Besides drawing only the top medical school graduates, DoD has required military physicians to pass state licensing exams since 1988. Nobody without a state license can practice medicine unsupervised in a military hospital, Mazzuchi said.

"These efforts to increase the quality of our medical corps have been highly successful," Mazzuchi said. "We are getting awfully good people in today, and that gives us a very good portent for the future."

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