Without crucial legislative protection, the proposed fiscal year 2020 Department of Defense budget jeopardizes military medical readiness and the health care of millions of Americans, the Academy and 16 other medical organizations recently warned congressional leaders.
The proposed budget(comptroller.defense.gov) includes a request to "eliminate approximately 15,000 military health care personnel billets and replace them with civilian positions."
That move, which also threatens graduate medical education programs throughout the Military Health System -- would reduce access to primary and subspecialty health care services for service members and their families, said the organizations' July 19 letter(3 page PDF) to the chairs and ranking members of the Senate and House armed services committees. The result would be "detrimental to the more than 9 million TRICARE beneficiaries, including 2 million children, who receive care through the MHS."
The letter called on legislators to retain language from the House version of the 2020 National Defense Authorization Act(www.congress.gov) that prohibits the realignment or reduction of military medical end strength "until analyses are conducted on potential manpower realignments and the availability of health care services in the local area."
The letter acknowledged that the Defense Health Agency intends the planned reduction of uniformed medical positions to be part of an overall modernization strategy, but the organizations pointed out harms that such a move would cause.
"While perhaps well-intentioned, these proposals would severely reduce the number of uniformed pediatricians, obstetrician-gynecologists, family medicine physicians" and other health care professionals, the organizations, wrote. This would mean "devastating consequences" for the members of the armed forces and their families who rely on these medical professionals for essential health care services.
Further, the letter reminded legislators that women make up 16 percent of enlisted military personnel and 18 percent of the officer corps, and that women and families make up the majority of dependents. The proposed reduction or elimination of certain medical specialties, specifically OB/Gyn and pediatrics, "would deprive armed forces families and their children of accessible, effective and affordable medical treatment," the letter said.
The medical groups quoted federal data to support their case.
"As indicated in a 2018 Government Accountability Office report,(www.gao.gov) there is already an insufficient workforce capacity to handle the basic health needs of our country's armed forces and their families," the letter said.
That report highlighted the troubling shortage of military family physicians in particular: "Air Force officials noted that fully qualified family medicine physicians have become increasingly difficult to recruit. They noted that family medicine is the foundational platform for training in aerospace medicine, an essential Air Force specialty."
Still another recent GAO report(www.gao.gov) "concluded that the DoD has not assessed the suitability of federal civilians and contractors to meet operational medical personnel requirements," the letter said. That report found that military department officials expressed a preference for using military personnel and cited possible difficulties in securing civilian and contractor interest in such positions.
"In fact, senior officials at each of the six military treatment facilities that GAO spoke with for the report cited challenges with the federal civilian hiring process, and five of the six MTF officials noted challenges with the contracting process."
The Academy and its fellow medical groups closed with a call for members of the House and Senate armed services committees to insert protections from the 2020 National Defense Authorization Act in their final conference report.
"We urge you to oppose these proposals and work to pass a bill that ensures the continued progress of the military medical workforce in their efforts to serve the members and families of the armed forces serving our country," the letter said.
Related AAFP News Coverage
Command Performance: Caring for Families in the Line of Duty