Army Doc Recognized as Leader, Primary Care Champion

Based on a ranking system incorporating multiple facets of health care management, the clinic was rated second-to-last among the U.S. military’s 18 stand-alone facilities in Europe. When a superior officer asked what he was going to do about the clinic’s dismal numbers, Switaj requested nine months to change things.

And change it he did.

Before the military officially adopted the patient-centered medical home, Switaj’s clinic implemented the model, including team-based care. The facility was physically restructured to group all the clinical functions together on one floor, while all the administrative offices moved to another.

“We changed everything from booking patients to all of our workflows,” he said. “We rebuilt everything essentially from the ground up.”

When his nine months were up, the clinic’s rank had improved from 17th to fourth. The dramatic overhaul helped accelerate Switaj’s promotion from major to lieutenant colonel and put him on a path to ultimately play vital roles in one of the Defense Health Agency’s key markets.

Switaj, who was recently honored with the AAFP’s Robert Graham Physician Executive Award, is assistant director for medical affairs and chief medical officer for the agency’s San Antonio market, which comprises roughly 12,000 staff caring for 250,000 beneficiaries at 15 multispecialty clinics, an academic medical center and ambulatory surgical center. He also serves as the primary care optimization lead for the Defense Health Agency, leading primary care reform efforts that impact more than 4.5 million beneficiaries across the globe.

The colonel plans to retire from the Army next year and is pondering where his next step in family medicine leadership will take him.

It came as no surprise that Switaj found a career in the Army. Three of his grandparents served in the military, including an Army nurse who served overseas during World War II.

“There is a pretty strong military presence in the family,” he said.

The surprise for Switaj was finding himself in family medicine.

After graduating from Uniformed Services University in 2002, he spent a year as a pediatric neurology intern at Walter Reed Army Medical Center in Washington, D.C. But before beginning residency, he served two years as a flight surgeon and squadron surgeon for a helicopter unit in South Korea and Texas.

“A nice thing about the military is that once you have your medical license, you’re able to go out and practice,” he said. “I got my license after my internship. I took care of pilots, but then they would bring their wives and kids in to see me, too. I grew to like the family concept of it. I also knew that I wanted to be involved in leadership in my career, and family medicine was a good fit for that. I ended up going back and doing my residency in family medicine. It’s worked out very well.”

Switaj was the primary author of COVID-19 protocols for the San Antonio market, which were adopted by several other markets in the Defense Health Agency.

“We published them, and then we’d update them whenever there was a significant change,” he said. “In the first couple of months, we were probably sending out updated protocols almost daily because the guidance was changing so quickly.”

Switaj also served as the lead physician on twice-weekly international webinars for military treatment facilities to educate staff on COVID-related processes, alleviate concerns and answer questions. He said such webinars existed before the pandemic, but the process ramped up with more frequent events because of COVID-19.

“It was a forum for putting out changes and information,” he said. “It just turned out that the most active area where we were making changes at the time was primary care. During pretty much every webinar there was something for me to talk about because we were doing a lot of work on primary care.”

Although Switaj’s time in the Army is winding down, he’s still looking for better ways to do things. For example, he’s leading a pilot program that is empaneling patients to physicians based on acuity.

“We’re taking into account the complexity of their medical needs when we empanel them,” he said. “We’re matching the resources and the environment of care to the needs of the patient. For those patients who do not come in often, only episodically for minor illness or wellness checks, there does not need to be a big elaborate system in place, just someone to see them and tend to their needs. Whereas your patients with complex diabetes or COPD, for example, who come in more frequently, need a whole team built around them to manage their care. We’re looking at taking patients, based off their needs, and providing them with the care they need, in the setting they need and with the resources that it requires.”

Switaj also is leading efforts to standardize primary care processes across different branches of the military, such as staffing models and onboarding and orientation for new clinicians.

“In San Antonio, I have 15 primary care clinics; about half of them are Army, and half of them are Air Force,” he said. “Right now the Army clinics follow Army guidance and the Air Force clinics follow Air Force guidance. Their staffing models are different. Some of their basic processes are different. By publishing a policy that puts us all on the same page, we can talk the same language. It makes it easier for staff to go between the facilities because now they’re all doing things the same way. Their basic processes are the same. The staffing models are the same. It eliminates some of the unwarranted variance in what we do.”